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Living and dying in late old age: fresh opportunities for palliative care

04 April 2018

Dr Caroline Nicholson, Senior Clinical Lecturer in Supportive and End of Life Care at King’s College London and St Christopher’s Hospice, explains how palliative care must support people in late old age.

Most people will die in late old age. However, older people are currently referred to as the “disadvantaged dying.”  They are, without doubt, a section of society with poorer experiences as they approach the end of their life with less access to palliative care than other groups. As such they are a concern for us practitioners working in hospice and palliative care.

My professional life began in palliative care some 30 years ago. More recently I have developed an interest in care for older people. Throughout my career I have been struck by the polarised nature of discussions about this group of people and my experience will be little different to many others working in either speciality. I have often sat in palliative care conferences where age is barely mentioned or in older people’s conferences that concentrate mainly on keeping people on their feet. 

It was therefore a joy to attend a recent British Geriatric Society (BGS) Conference where clinicians from geriatric and palliative care got together to discuss how to support older people to both live and die well with frailty.  We soon moved from discussion about which service should be doing the work (geriatrics OR palliative care) to what the concerns and needs of an older person might be as they approached the end of life – as a basis for discerning how professionals respond.  The discussions were about the importance of both geriatric and palliative medicine and the vital role of community services - statutory and voluntary.

The community is where most people will live and die in old age, and there were honest conversations about the need for greater integration and the importance of looking beyond what “we“ do currently to something quite different . The challenge of moving to a wider focus than our current conventional palliative or older people’s services was evident, as was the energy to think and behave quite differently.

Our context is demanding but so was the courage and interest to redress current gaps in provision displayed at that conference. I was struck by a courageous conversation between hospital doctors about how to attend to an individual older person and what matters to them, within the pace and scale of need on an acute elderly care ward. We need more of those discussions; more of those provocations to individuals and to the system as a whole. We need to include older people and their communities in related conversations. We need to continue to explore how palliative care and older people’s services could work better together – a journey well begun by the BGS.  

With that in mind we at St Christopher’s Hospice along with King’s College London are holding a conference on Thursday 14 June in London. If you are curious, committed to providing the best care for the very old, and interested in seeing their world and ours differently, this is an important event to attend.  It is a chance for individuals and organisations delivering palliative care to gain new insights into ways and means to deliver enhanced palliative care to older people living and dying in late old age.  The event will help move the experience of dying from disadvantage to opportunity.

For more information visit  St Christopher’s website, contact the St Christopher’s Education Team or call 020 8768 4656.

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