Why it really is better for elderly to die at home

THE ‘very old’ are much more likely to die comfortably if they are at home rather than in hospital, research shows.

Just one in ten of the ‘oldest old’, those aged over 79, in the study died in their own homes. But those who did, or who were in a care home, were four times more likely to be comfortable than those in hospital.

The Cambridge University researchers said it shows more needs to be done to improve end of life care.

The team spoke to the families of 180 people who had died aged 79 to 107. With life expectancy soaring, this age group now makes up almost half of people who die and many do so with multiple illnesses including dementia, heart disease and cancer.

The relatives’ interviews revealed 69 per cent of those who died in hospital were comfortable. That rose to 89 per cent for those in their home and 91 per cent for those in long-term care such as a nursing home.

The researchers said when the figures were adjusted to reflect the fact that fewer people died in hospital, the odds of being comfortable in their own home or a care home were four times higher than in hospital.

The study also found that just one in ten died without suffering any symptoms at all. Nearly half of the deceased experienced at least three symptoms in their final days.

The most common were pain and distress, with other symptoms including pressure sores, depression, confusion, loss of consciousness or neglect. The majority felt pain, but only half were successfully treated for it. The study, published in the journal BMC Geriatrics, states: ‘All too commonly a patient is admitted to hospital without those concerned having considered where they can be best cared for, or would wish to die.’

Lead author Dr Jane Fleming, from the Department of Public Health and Primary Care at Cambridge, added: ‘The UK is not the only country where an urgent review of the funding for older people’s long-term care is needed, along with commitments to staff training and development in this often undervalued sector.

‘It’s heartening the majority of very old people in our study appear to have been comfortable at the end of life, but we need to do more to ensure that everyone is able to die comfortably, wherever they are.’

Co-author Dr Rowan Calloway said: ‘We need to address the shortage of palliative care doctors in the NHS.

‘In the future, community care will be increasingly reliant on non-specialists, so it will be crucial that all members of the multidisciplinary teams needed to support frail older people near the end of their lives have good training.’

‘Need to address the shortage of doctors’