Search

Table of contents

Who's at risk and why?

Adults :: End of life :: Who's at risk and why?

The National Audit Office's report on end-of-life care suggests that approximately 40% of patients dying in acute hospitals do not have medical needs requiring a hospital stay.[1] In Medway, this equates to about 408 people annually. The report suggests that people approaching end-of-life and their families may be at risk of a poor end-of-life experience if their needs are not being met because they are in an inappropriate setting at the time and therefore not receiving the right and appropriate level of care and support. Early recognition of end-of-life is particularly problematic for patients with non-cancer diagnosis as, traditionally, end-of-life services have been provided to only cancer patients.

Inequalities

The national End-of-Life Care Strategy highlights that, although much has been done already, inequalities still exist in the care that different groups of people receive at the end of their life.[2] The groups experiencing less favourable outcomes include: older people, those with dementia and learning disabilities, those with non-cancer diagnosis and black and minority ethnic (BME) groups.[3] Deprivation is a known risk factor for health inequalities and has been identified as a risk indicator for poor end-of-life care outcomes.[4]

Death rates increase steeply with age, with 81.9% (1,755) of deaths occurring in people aged over 65 years and 62.3% (1,335) in people over 75 in Medway. Older patients have complex needs due to their frailty, comorbidities and increased reliance on support from older carers. It is estimated that, for those over 85, the prevalence of dementia is 21%.[5] This represents a significant group with unmet needs, people whose preferences for end-of-life care may not have been identified earlier and then provided appropriate support.

According to the 2011 census, the BME group is around 10.4% of the Medway population.[6] During 2013, Public Health England published a report called 'Palliative and end-of-life care for Black, Asian and Minority Ethnic (BAME) groups in the UK',[7] which provides an evidence-base to understand the profile of BAME populations living in the UK and identifies their unmet needs regarding palliative and end-of-life care. The report highlighted that BAME groups had lower access to palliative and end-of-life care services when compared with white British people. This was associated with lack of awareness of relevant services, lack of information in relevant language and previous bad experiences when accessing care also contributed to the gap. Poor communication between the healthcare professional providing end-of-life care and the patient or patient's family also contributed to the inequalities observed by the BAME groups. Lack of referrals to the end-of-life care services also contributed to the gap.

In 2016, only 38.6% of non-sudden deaths were attributed to cancers in Medway, suggesting a large proportion of patients with non-cancer diagnosis. The majority of deaths not attributable to cancer are in patients who are older and frailer than those with cancer and thus requiring more support for longer periods.[8]

Social factors such as deprivation (lower income), increased age, and coming from a minority ethnic descent, were also associated with fewer home deaths. This may be explained by the lower income and resources available to afford adequate care at home.[9]


References

[1]   National Audit Office. End of Life Care 2008; National Audit Office. http://www.nao.org.uk/publications/0708/end_of_life_care.aspx .
[2]   Department of Health. National End of Life Strategy - promoting high quality care for all adults at the end of life 2008;
[3]   National Institute for Health and Clinical Excellence. Guidance on Cancer Services: Improving Supportive and Palliative Care for Adults with Cancer: The Manual 2004; National Institute for Health and Clinical Excellence. https://www.nice.org.uk/guidance/csg4/resources/improving-supportive-and-palliative-care-for-adults-with-cancer-pdf-773375005 .
[4]   Gomes, B., Higginson, I.J.. Factors influencing death at home in terminally ill patients with cancer: systematic review British Medical Journal 2006; 332 (7540): 515-521.
[5]   Hofman A, Rocca W, Brayne C, et al. The Prevalence of Dementia in Europe: A Collaborative Study of 1980--1990 Findings International Journal of Epidemiology 1991; 20: 736-748.
[6]   Office for National Statistics. Census 2011;
[7]   Calanzani, N., Koffman, J., Higginson, IJ.. Palliative and end of life care for Black, Asian and Ethnic Minority groups in the UK: demographic profile and the current state of palliative and end of life care provision. 2013; https://www.mariecurie.org.uk/globalassets/media/documents/policy/policy-publications/june-2013/palliative-and-end-of-life-care-for-black-asian-and-minority-ethnic-groups-in-the-uk.pdf .
[8]   Murray S, Sheikh A. Palliative Care Beyond Cancer British Medical Journal 2008; 336: 958-959.
[9]   Higginson I, Jarman B, Astin P, et al. Do social factors affect where patients die: an analysis of 10 years of cancer deaths in England Journal of Public Health Medicine 1999; 21(1): 22-28.