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Many older patients see death as 'too far off' to plan end of life care, suggests survey


People are increasingly leaving it “too late” to face their own mortality, experts said, after figures suggest that many older people think death is “too far off”.

Almost one in four (23%) of people over the age of 75 have not discussed their wishes around dying or planned for their end of life care because death is seen as too far away, the British Social Attitudes Survey found.

And just over a third (35%) of people of all ages have a will, down from almost two-fifths (39%) in 2009, the survey of more than 2,000 British adults found.

The poll, released to coincide with Dying Matters Awareness Week, also found that only 11% of people have written down their wishes for funeral plans.

The Dying Matters Coalition, a group made up of charities, health and social care workers and other organisations, said that while many people feel more confident to talk to loved ones about death, people should not “shun” difficult conversations about dying.

“It’s encouraging that older people are becoming more comfortable discussing dying and their end of life wishes, but as a nation too many of us are still shunning the conversations that can help avoid heartbreak and regret at the end of life,” said Eve Richardson, chief executive of the Dying Matters Coalition and the National Council for Palliative Care.

“You don’t have to be ill or dying to make plans for your future, which is why we are calling on people across the country to take practical steps by writing a will, recording their funeral wishes, planning their future care and support, considering registering as an organ donor and telling loved ones their wishes.”

Professor Mayur Lakhani, chair of the coalition and a practising GP, added: “There are powerful benefits of having early conversations with people who are approaching the end of their life, as it puts them in control and gives a chance to resolve any life issues. It also means that plans can be made for people to get the care and support that is right for them.

“Whilst more of us than ever are living to a ripe old age, people are also living for longer with dementia and other life limiting conditions, which makes it especially important to talk more openly about the care and support we would want. It’s only by having the conversations that matter and planning ahead that care of the dying will be improved and people will get their end of life wishes met.”

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Readers' comments (3)

  • michael stone

    Yes, most of know there are advantages to having 'early' conversations about 'dying' - we also know they tend to be avoided.

    We also know that ACP is in principle a good idea: pity that it turns out to very complicated and unsatisfactory in reality (for example, it is for all practical purposes impossible to forbid attempted cardiopulmonary resuscitation by 999 for a CPA, if the death could not be certified: so people have got a legal right which is impossible to utilise: if you cannot even get HCPs to respect your legal rights, what is the point of claiming that ACP is a meaningful concept ?!).

    Similarly, 'most people will be determined to avoid moving to a care home, until there really seems to be no other choice'.

    Throw in 'We won't tell him he is dying, because it would distress him to know', etc, and it is all very 'messy' indeed.

    One consultant, who had been publishing EoL guidance, tried to tell me that 'you can't refuse cardiopulmonary resuscitation, if you do not believe an arrest is likely', which is absurd nonsense (as he came to realise): I've never been savaged by a shark, and I don't expect to be savaged by a shark, but I can still validly decide I wouldn't like it !

    There was a debate about EoL issues in a recent BMJ edition, and even some simple things (such as 'he is expected to die' NOT being the same as 'his death is expected {re post-mortem behaviour for death at home during known EoL (final year)}) did not seem to be properly 'grasped', even on the BMJ 'site.

    A few weeks ago, I was talking to a GP who did not seem to know the difference between an Advance Decision refusing CPR, and a DNACPR Form signed only by a doctor - more talking, more understanding and much better training, are all needed 're dying'.

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  • making a will early also has its problems as things change over time and adding a codicil each time costs a considerable sum of money!

    attitudes about how one may wish to be cared for also change with altered family circumstances, advances in medicine and the fact one does not know how one may feel when faced with particular sets of circumstances. I have had many patients, some elderly, who have been given a poor prognosis who seem to gain a second wind and fight to the very last. it is easy to decide when you are well what you wish for when you reach this stage but when the time comes it may be very different.

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  • michael stone

    Anonymous | 13-May-2013 1:39 pm

    'it is easy to decide when you are well what you wish for when you reach this stage but when the time comes it may be very different.'

    Exactly - you only die once, so you are only guessing at how you view any particular 'stage of dying' if you express 'preferences' in advance. This is why ACP should only be seen as a process where a set of options is being planned for.

    Probably the only exception, is when someone decides 'On balance, if I have arrested, leave me alone' - you are not going to learn anything more about being dead, without being dead (and I suspect not even then), but if your life is already pretty 'nasty' and you know you are dying, being 'successfully' resuscitated if you arrest isn't going to improve 'the bleak outlook for the rest of my life'.

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