Managing transitions to palliative care for older people in acute hospitals

This is the fourth in a series of six articles that aim to encourage nurse leaders to explore how to use research findings to improve practice and services where they work. The series focuses on research that has been funded by the National Institute for Health Research (NIHR) and included in NIHR Dissemination Centre publications. The authors seek to relate the content directly to the Nursing and Midwifery Council’s code of professional standards of practice and behaviour, specifically the themes of practising safely and promoting professionalism and trust.

Introduction by Elaine Maxwell, clinical adviser at the National Institute for Health Research Dissemination Centre

The NIHR Dissemination Centre helps clinical staff, commissioners and patients to make informed decisions about best practice and treatment in health and social care. In 2015, we looked at the evidence on best practice in caring for people who are dying in our themed review Better Endings.

Every year in England and Wales over 500,000 people die (Office for National Statistics (ONS) 2017). For many of it is a process that may take days, weeks or even years, involving a progressive decline in functioning and frequent interactions with health professionals (Hughes-Hallett et al 2011).

Improvements in health care have contributed to increased life expectancy and a shift in the age at which most people die. However, as the number of older people in the population is increasing the number of annual deaths is expected to rise by almost 10% by 2030 to 574,000 (ONS 2016).

While much work has been done on end of life care for people with premature deaths, such as from cancer, we still have much to do in ensuring good deaths for older people. Most still die in hospital and the National Survey of Bereaved People in England (ONS 2015) found family members of people cared for in hospitals are consistently less likely to express satisfaction with the quality of end of life care their loved one received.

Our review included the findings of one study, Transitions to palliative care for older people in acute hospitals: a mixed-methods study (Gott et al 2013), that concentrated on older people approaching the end of their lives and the attitudes and actions of staff in acute hospitals. This article looks at how the research was conducted and how healthcare providers might respond.

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