Over the next 40 years, it is estimated that the proportion of people aged 60 years and over will double from 11% to 22% of the total world population. The most significant increase is expected among those aged >80 years of whom there were 102 million in 2009; by 2050 this number will increase to 395 million.1 A ‘dramatic and steady rise’ in the number of deaths is also predicted.2 Fifty-six million people died in 2009; 91 million are likely to die in 2050. For developed countries, the ageing and dying of the ‘baby boomers’ will be one of the key public health challenges of this century.

Many older people will have protracted deaths linked to a combination of long-term conditions. Further, there is mounting evidence that older people often receive what is euphemistically termed ‘suboptimal’ care at the end of life. In other words, they are the ‘disadvantaged dying’.3 As a group, they often experience high physical and psychological symptom burden at the end of life, are likely to have few opportunities to express preferences for care and are still less likely to access specialist services. Those with dementia are arguably the most vulnerable to dying in circumstances far removed from contemporary Western ideals of the ‘good death’.

While improving palliative care provision for older people has been recognised as an international public health priority by the WHO,4 there is little evidence that the sheer scale of this challenge has been taken on board, either by policy makers or by the wider practitioner and academic communities. The recently published UK report Dying for Change5 argues that society is ill-prepared for how caring for the dying will change in the next two decades as people live longer. So what is the …