Dying comfortably in very old age with or without dementia in different care settings - a representative "older old" population study

Fleming, Jane, Calloway, Rowan, Perrels, Anouk, Farquhar, Morag, Barclay, Stephen, Brayne, Carol and , CC75C Cambridge City over-75s Cohort study collaboration (2017) Dying comfortably in very old age with or without dementia in different care settings - a representative "older old" population study. BMC Geriatrics, 17. ISSN 1471-2318

[img] PDF (Accepted manuscript) - Submitted Version
Restricted to Repository staff only until 31 December 2099.

Download (1065kB) | Request a copy
    [img]
    Preview
    PDF (BMCGeriatrics) - Published Version
    Available under License Creative Commons Attribution.

    Download (1299kB) | Preview

      Abstract

      Background: Comfort is frequently ranked important for a good death. Although rising numbers of people are dying in very old age, many with dementia, little is known about symptom control for “older old” people or whether care in different settings enables them to die comfortably. This study aims to examine, in a population-representative sample, associations between factors potentially related to reported comfort during very old people’s final illness: physical and cognitive disability, place of care and transitions in their final illness, and place of death. Methods: Retrospective analyses linked three data sources for n=180 deceased study participants (68% women) aged 79-107 in a representative population-based UK study, the Cambridge City over-75s Cohort (CC75C): i) prospective in-vivo dementia diagnoses and cognitive assessments, ii) certified place of death records, iii) data from interviews with relatives/close carers including symptoms and “How comfortable was he/she in his/her final illness?” Results: In the last year of life 83% were disabled in basic activities, 37% had moderate/severe dementia and 45% minimal/mild dementia or cognitive impairment. Regardless of dementia/cognitive status, three-quarters died following a final illness lasting a week or longer. 37%, 44%, 13% and 7% of the deceased were described as having been “very comfortable”, “comfortable”, “fairly comfortable” or “uncomfortable” respectively during their final illness, but reported symptoms were common: distress, pain, depression and delirium or confusion each affected 40-50%. For only 10% were no symptoms reported. There were ≥4-fold increased odds of dying comfortably associated with being in a care home during the final illness, dying in a care home, and with staying in place (dying at what death certificates record as “usual address”), whether home or care home, compared with hospital, but no significant association with disability or dementia/cognitive status, regardless of adjustment. Conclusions: These findings are consistent with reports that care homes can provide care akin to hospice for the very old and support an approach of supporting residents to stay in their care home or own home if possible. Findings on reported high prevalence of multiple symptoms can inform policy and training to improve older old people’s end-of-life care in all settings.

      Item Type: Article
      Faculty \ School: Faculty of Medicine and Health Sciences > School of Health Sciences
      Depositing User: Pure Connector
      Date Deposited: 22 Sep 2017 06:06
      Last Modified: 16 Feb 2019 00:58
      URI: https://ueaeprints.uea.ac.uk/id/eprint/64944
      DOI: 10.1186/s12877-017-0605-2

      Actions (login required)

      View Item