Stakeholder Response: Help the Aged 

Help the Aged is appealing to the NHS to tackle age discrimination prevalent in end of life care. Today the charity publishes stark new research highlighting the shortfalls in end of life care provision.

Its new report, written by experts at the University of Sheffield, reveals how inherent discrimination against older people by health services is preventing many from having a dignified death. It says there is an enormous difference in the level and quality of special care or support available to older dying patients and their families, compared to younger people facing death.

Inequalities in palliative care means that the opportunity to go into a hospice declines with age, as does the chance to die at home, as 50 per cent of older people would prefer. Notably only 8.5 per cent of older people who die from cancer do so in a hospice, compared with 20 per cent of all cancer sufferers.

Help the Aged found that many older adults’ experiences in the last year of their lives consist of movement between settings as their health deteriorates, known as the ‘revolving door’ problem.

“Too often, the idea that people ‘die from old age’ means that they are not receiving the care and support, or the opportunities to make choices they would like in their final years”, says Paul Cann, director of policy and research at Help the Aged.

He adds: “Good quality end of life care must be available for all who need it, regardless of their age or medical status. The concept of rationing care at the end of life on the basis of age is appalling. Older people are the single largest group of health service users, they have made a huge investment in the NHS and it is a perverse system which denies those who have been paying for it the longest.”

The research also concludes that: 

• Older people who die in hospital often endure their final days in dirty and noisy wards, where busy medical and nursing staff can devote little attention to them;
• Evidence suggests that older people who die of non-malignant diseases have as many complex care needs as those with advanced cancer and yet very few receive specialist care;
• Older people who are dying are more likely to experience multiple health conditions, have less informal support networks and experience greater financial hardship, compared to younger people who are dying; 
• Taboos surrounding death and dying often leads to older people feeling unable to articulate their concerns and wishes about how they would like to die.

Help the Aged has combined the new research with comprehensive recommendations for health and social care providers, which include: 

• Training and support to deliver high-quality care at the end of life should be imperative for all staff working with older people;
• Co-morbidity and frailty in older age should be recognised as key issues in older adults’ experiences of end of life;
• The impact of bereavement should be an integral part of the assessment of older people’s needs;
• Accessible information must be available to help inform older people of the support that they should expect at the end of life. 

Paul Cann concludes: "Choices must be available for older people known to be dying so they can have the kind of death they would prefer. Current taboos around death and dying means that older people are too often not consulted on their preferences.

"Health and care services must concentrate not only maximising quality of life for the living but also on providing a good quality of death."

Opposition Response: The Liberal Democrats

A Lib Dem spokesperson told ePolitix.com: "Liberal Democrats believe all people should be able to access the care they need both in the management of long-term medical conditions and at the end of life. Access to this care should not be limited by a person's age, diagnosis, social or ethnic background.

"Liberal Democrats recognise and value the wealth of experience and expertise in the voluntary hospice movement as well as in the NHS.  We believe palliative care is best developed through a strong partnership between the NHS, local authorities and the voluntary sector supported by a National Service Framework. However, tens of thousands of patients annually die in the NHS without access to specialised care and pain management. We will prioritise extending choice and access to these services, including more support for hospices."