This study confirmed the inexorable decline in activities of daily life and social isolation for patients with severe COPD. Adaptive strategies were common and some positive aspects were identified. Support from the primary health care team was appreciated. The strain on carers was very apparent. The concept of a more structured sharing of information and a surveillance role mediated by health care professionals known to the patient and carer would be a pragmatic approach to improving care.

these findings underscore the complexity of the oldest carers' experiences and challenges in times of illness and end of life. Healthcare professionals should be alerted to the myriad ways caregiving is enacted in serious illness and seek opportunities for developing supportive interventions specifically for older carers.

Background: It is recognised that patients with chronic obstructive pulmonary disease (COPD) should have the chance to discuss endof-life care and advance care planning (ACP). Admission to hospital with an exacerbation may be a possible opportunity.

Objective To explore how bereaved family members recall managing end of life medications when delivering care to a patient dying at home in England.Design Qualitative study. Setting Domestic homes in two contrasting areas in England.Participants 59 bereaved family carers who have delivered care to a patient who spent a minimum of two weeks at home prior to their death from cancer or other non-malignant condition. Cases were excluded if place of death was: hospice, nursing home or NHS hospital.Results Participants identified a number of important concerns about managing end of life medication for the dying person at home. Although some support with medications is provided by general practitioners and nurses in the community, family carers take primary responsibility for drug administration and storage. They reported anxiety about giving correct and timely dosages, and concerns about keeping the patient comfortable without overdosing them or risking shortening their lives. In particular they reported that certain analgesic medications, especially opioids, were considered to have a symbolic significance and increasing analgesia and the use of a syringe driver were associated with deterioration and 3 approaching death. Key barriers to managing end of life medications at home included: complex regimes; unwanted responsibility in deciding when to use 'as needed' medication; disagreements with professional staff and anxiety about medication errors, especially if perceived to have implications for survival. ConclusionsFamily carers require more information about end of life drugs and their effects, support and training in managing medication for a dying person. Significant concerns were identified, and these need to be addressed if current UK policy to increase the number of patients dying at home is to be safely realised.Words: 276

BackgroundDying at home is the preference of many patients with life-limiting illness. This is often not achieved and a key factor is the availability of willing and able family carers.AimTo elicit family carers’ views about the community support that made death at home possible.Design and settingQualitative study in East Devon, North Lancashire, and Cumbria.MethodParticipants were bereaved family carers who had provided care at the end of life for patients dying at home. Semi-structured interviews were conducted 6–24 months after the death.ResultsFifty-nine bereaved family carers were interviewed (54% response rate; 69% female). Two-thirds of the patients died from cancer with median time of home care being 5 months and for non-cancer patients the median time for home care was 30 months. An overarching theme was of continuity of care that divided into personal, organisational, and informational continuity. Large numbers and changes in care staff diluted personal continuity and failure of the GPs to visit was viewed negatively. Family carers had low expectations of informational continuity, finding information often did not transfer between secondary and primary care and other care agencies. Organisational continuity when present provided comfort and reassurance, and a sense of control.ConclusionThe requirement for continuity in delivering complex end-of-life care has long been acknowledged. Family carers in this study suggested that minimising the number of carers involved in care, increasing or ensuring personal continuity, and maximising the informational and organisational aspects of care could lead to a more positive experience.