Symptom burden at the end of life in older people

1. Symptom burden at the end of life in older people Lynne Partington Senior Lecturer/Researcher Cheshire Hospices Education & St Luke’s Hospice

2. Why is it important to understand and meet the needs of older people Putting a case forward…

3. What are the issues? • An increasing population

4. A worldwide issue 1500 AD 400,000,000

5. A worldwide issue 19th Century 1,000,000,000

6. A worldwide issue 20th Century 1,600,000,000

7. A worldwide issue 21st Century 6,000,000,000

8. A worldwide issue 22nd Century 11,500,000,000* *Projected by the United Nations, 2005

9. What are the issues? • An increasing population • Increased life expectancy

10. An increase in life expectancy by more than 30 years over the last century

11. What are the issues? • An increasing population • Increased life expectancy • An increasingly aged population

12. An ageing population

13. 65 plus Increase from 15% (1983) to 16% (2008) = + 1.5 million 16 and under Decrease from 21% (1983) to 19% (2008) In 2008 there were more older people than younger people Office of National Statistics, 2006 An ageing population

14. 65 plus Increase from 15% (1983) to 16% (2008) = + 1.5 million 16 and under Decrease from 21% (1983) to 19% (2008) In 2008 there were more older people than younger people The ‘oldest old’ In 1983, there were just over 600,000 people in the UK aged 85 and over. In 2003, there are 1.3 million By 2033, the figure is projected to reach 3.2 million Office of National Statistics, 2006 An ageing population

15. At the current time… …it appears that the last 8 – 11 years of our life are accompanied by some sort of disability (or ‘loss of healthy years’) International database, 2005

16. What are the issues? • An increasing population • Increased life expectancy • An increasingly aged population • Ageism/poorer care for older people

17. Help the Aged, 2008

18. “She had a tumour the size of a football in her back which could have killed her” Esther’s story Help the Aged, 2008

19. What are the issues? • An increasing population • Increased life expectancy • An increasingly aged population • Ageism/poorer care for older people • Need for specialised end of life care for older people

20. Just a brief look at some of the evidence has identified that… • Older people are less likely to die in their place of choice than younger people (Seymour, 2005) • Older people are less likely to receive appropriate pain control than their younger counterparts. This is especially so for patients with dementia. They are less likely to take opioids for pain due to cultural beliefs (British Geriatrics Society, 2009) • Co-morbidity and drug reactions make symptom control more difficult (Sutton et al, 2003) – Drug reactions are 2 to 3 times higher than in younger age groups (Schofield & Reid, 2006) • Symptoms were often not treated in dying elderly patients (Seah et al, 2005)

21. What are the issues? • An increasing population • Increased life expectancy and decreasing birth rate • An increasingly aged population • Ageism/poorer care for older people • Need for specialised care for older people

22. What are the issues? And yet, there is so little evidence and guidance on how we should and can provide care for older people at the end of their life… • An increasing population • Increased life expectancy and decreasing birth rate • An increasingly aged population • Ageism/poorer care for older people • Need for specialised care for older people

23. What are the issues? • An increasing population • Increased life expectancy and decreasing birth rate • An increasingly aged population • Ageism/poorer care for older people • Need for specialised care for older people

24. Thank-you…