The Oldest Old in the Last Year of Life: Population‐Based Findings from Cambridge City over‐75s Cohort Study Participants Aged 85 and Older at Death

Zhao, Jun; Barclay, Stephen; Farquhar, Morag; Kinmonth, Ann Louise; Brayne, Carol; Fleming, Jane

doi:10.1111/j.1532-5415.2009.02622.x

Cited by 50 publications

(41 citation statements)

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“…Community palliative care programmes can enable more people to die in their 'preferred place of death', [70][71][72] but demographic projections and trends in place of death point to an urgent need for service expansion. 25,51,73 Previous CC75C study findings showed markedly higher disability levels among people dying at age 90 years or older compared even with people dying at age 85-89 years, 74 indicating enormous implications for end-of-life care as life expectancy rises. However, alongside increased community provision for end-of-life care for the frail elderly, equally crucial is the need to develop training and service provision to improve end-of-life care in hospitals and care homes -the settings where the majority of very old people die.…”

Section: Discussionmentioning

confidence: 99%

“…283 (100) 15 (22) 18 (20) All 76 (66), [57][58][59][60][61][62][63][64][65][66][67][68][69][70][71][72][73][74][75] 35 (55), 44 (42), [33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52] 155 (55) …”

Section: (100)mentioning

confidence: 99%

“…1 (7) 20 (32) 24 (28) All 79 (69), [60][61][62][63][64][65][66][67][68][69][70][71][72][73][74][75][76][77] 35 (55), 53 (51), 167 (59) residents moved. Everybody with cognitive impairment in sheltered housing moved to a hospital (Table 3).…”

Section: (100)mentioning

confidence: 99%

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Place of death and end-of-life transitions experienced by very old people with differing cognitive status: Retrospective analysis of a prospective population-based cohort aged 85 and over

et al. 2013

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Background: Despite fast-growing 'older old' populations, 'place of care' trajectories for very old people approaching death with or without dementia are poorly described and understood. Aim: To explore end-of-life transitions of 'older old' people across the cognitive spectrum. Design: Population-based prospective cohort (United Kingdom) followed to death. Setting/participants: Mortality records linked to 283 Cambridge City over-75s Cohort participants' cognitive assessments <1 year before dying aged ≥85 years. Results: Overall, 69% were community dwelling in the year before death; of those with severe cognitive impairment 39% were community dwelling. Only 6% subsequently changed their usual address. However, for 55% their usual address on death registration was not their place of death. Dying away from the 'usual address' was associated with cognition, overall fewer moving with increasing cognitive impairment -cognition intact 66%, mildly/moderately impaired 55% and severely impaired 42%, trend p = 0.003. This finding reflects transitions being far more common from the community than from institutions: 73% from the community and 28% from institutions did not die where last interviewed (p < 0.001). However, severely cognitively impaired people living in the community were the most likely group of all to move: 80% (68%−93%). Hospitals were the most common place of death except for the most cognitively impaired, who mostly died in care homes. Conclusion: Most very old community-dwelling individuals, especially the severely cognitively impaired, died away from home. Findings also suggest that long-term care may play a role in avoidance of end-of-life hospital admissions. These results provide important information for planning end-of-life services for older people across the cognitive spectrum, with implications for policies aimed at supporting home deaths. KeywordsCognitive impairment, dementia, aged, 80 and over, aged, frail elderly, patient transfer, residential characteristics, homes for the aged, nursing homes, delivery of health care, terminal care 221What is already known about the topic?• More people will be dying in very old age and dying with dementia or cognitive impairment.• Half the very old move in the last year of life and die away from their usual residence, but it is poorly understood how cognitive impairment affects these transitions. What this article adds?• Prospective population-based research with very old people, including cognitive assessments, reveals patterns in individual trajectories through care settings that routine data cannot explore.• Although 39% of ≥85-year-olds with severe cognitive impairment live in the community in their last year of life, only 8% die there, compared with 20% home deaths among cognitively unimpaired ≥85-year-olds.• The proportions of very old people dying in hospitals or in care homes decrease and increase, respectively, with worsening cognitive impairment. Implications for practice, theory or policy• Community end-of-life care provision needs to in...

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Section: Discussionmentioning

confidence: 99%

Section: (100)mentioning

confidence: 99%

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Place of death and end-of-life transitions experienced by very old people with differing cognitive status: Retrospective analysis of a prospective population-based cohort aged 85 and over

et al. 2013

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“…Similarly, satisfaction with the health care provision and trust in the family physician were among the few parameters to actually improve with older age. The dissonance between the increasing objective burden of negative parameters and the positive subjective assessment of health has been observed elsewhere, in the Cambridge City over-75s Cohort study [28] as well as the Leiden 85+ study [29], and led to speculation that in response to the loss accompanying objective physical and functional decline, successful aging among older people necessitates a process of subjective adaptation [30]. …”

Section: Discussionmentioning

confidence: 99%

Changing Profile of Health and Function from Age 70 to 85 Years

et al. 2012

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Background: Old age has traditionally been considered to begin at age 65. The improving health and functional status observed among older people may necessitate reevaluation of this cut-off point. Objective: To present the changing prevalence of common geriatric syndromes, functional parameters, common disease status and health care utilization, at ages 70, 78 and 85, in order to help address the question of when does contemporary aging actually begin. Methods: Medical, psychosocial, cognitive, and functional status, and health service utilization at age 70, 78 and 85 were assessed through the Jerusalem Longitudinal Cohort Study (1990–2010), which prospectively followed a representative sample (born 1920–1921), of 1,861 people, all of whom underwent home-based comprehensive assessment. Results: At age 70, the cohort had good health, low comorbidity, preserved cognition, mobility and independence in basic and instrumental activities of daily activities (ADL). Rising comorbidity, declining cognitive status, increasing depression, and difficulty in ADLs were seen at 78. By age 85, compared to age 70, comorbidity had tripled, depression, hearing and visual impairment, falls, dizziness and mobility problems had doubled; 23% of subjects had cognitive impairment, 42.5% suffered urinary incontinence, and dependence in basic and instrumental ADLs was common (37.8 and 51.7%, respectively). Home care was 4.5, 10.1, and 24.6%, and hospitalization in the previous year occurred among 12.3, 18.8 and 27.8% at ages 70, 78 and 85, respectively. Conclusions: At age 70, the overall health profile was favorable, prevalence of geriatric syndromes was low, cognitive and functional status was preserved, and health service utilization was low. The progressive deterioration seen at ages 78 and more profoundly so at age 85, suggest that a cut-off point beyond age 70 years may serve to better define entry into old age.

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“…Data thus gathered over more than two decades offer a rare opportunity to examine residence transitions in extreme old age shortly before death. 17 Figure 1 depicts the sampling frame, and Figure 2 depicts the construction of a subsample of 'oldest old' people in their last year of life for this analysis: n = 320 males and females who died aged ≥85 years within a year of participating in any of CC75C's seven surveys .…”

Section: Methodsmentioning

confidence: 99%

Place of death for the ‘oldest old’: ≥85-year-olds in the CC75C population-based cohort

Fleming

Zhao²,

Farquhar³

et al. 2010

Br J Gen Pract

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Deaths are rising fastest among the oldest old but data on their transitions in place of care at the end of life are scarce. AimTo examine the place of residence or care of ≥85 yearolds less than a year before death, and their place of death, and to map individual changes between the two. Design of studyPopulation-based cohort study. SettingCambridge City over-75s Cohort (CC75C) study, UK. MethodRetrospective analysis of prospective data from males and females aged ≥85 years at death who died within a year of taking part in any CC75C survey (n = 320); death certificate linkage. ResultsOnly 7% changed their address in their last year of life, yet 52% died somewhere other than their usual address at the time of death. Over two-thirds were living in the community when interviewed <1 year before death, but less than one-third who had lived at home died there (less than one-fifth in sheltered housing). Care homes were the usual address of most people dying there (77% in residential homes, 87% in nursing homes) but 15% of deaths in acute hospital came from care homes. ConclusionMore than half the study sample of individuals of advanced old age had a change in their place of residence or care in their last year of life. These findings add weight to calls for improved end-of-life care in all settings, regardless of age, to avoid unnecessary transfers. The study data provide a baseline that can help plan and monitor initiatives to promote choice in location of care at the end of life for the very old. Keywords aged; aged 80 or over; aging in place; frail elderly; terminal care. INTRODUCTIONEnd-of-life care for older people is now an acknowledged priority.1 Recent UK policy initiatives and reports recognise the increasing number of people who will be dying in very old age.2-5 Emphasis on a care pathway approach highlights the importance of the place of care, place of death, and transitions between them.6-8 The NHS End of Life Care Programme's aims include reducing emergency admissions and transfers from care homes to hospital in the last week of life, alongside providing the support needed to enable people to die where they choose. 9 The policy drive to facilitate 'good deaths' at home envisages savings on costly acute care, enhancing value for money at the same time as choice, quality, and equality. 2,10,11 In many developed countries, deaths, including inhospital deaths, are rising fastest among ≥85-year olds. 1,12,13 Data are scarce on older people's place of care trajectories before death,

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The Oldest Old in the Last Year of Life: Population‐Based Findings from Cambridge City over‐75s Cohort Study Participants Aged 85 and Older at Death

Cited by 50 publications

References 33 publications

Place of death and end-of-life transitions experienced by very old people with differing cognitive status: Retrospective analysis of a prospective population-based cohort aged 85 and over

Place of death and end-of-life transitions experienced by very old people with differing cognitive status: Retrospective analysis of a prospective population-based cohort aged 85 and over

Changing Profile of Health and Function from Age 70 to 85 Years

Place of death for the ‘oldest old’: ≥85-year-olds in the CC75C population-based cohort

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