End-of-Life Care and Preferences for Place of Death among the Oldest Old: Results of a Population-Based Survey Using VOICES-Short Form

Background: End-of-life care (EOLC) is a key component in care of older people. However, evidence suggests that the oldest old (>85 years) are less likely to access specialist EOLC.

Objective: The study's objective was to explore experiences of EOLC among the oldest old and determine their reported preference for place of death.

Design: The study involved a self-completion postbereavement survey.

Methods: A census was taken of deaths registered between October 2009 and April 2010 in two health districts, identified from death certificates. Views of Informal Carers-Evaluation of Service (VOICES)–Short Form was sent to each informant (n=1422, usually bereaved relative) 6 to 12 months after the death.

Results: Of 473 (33%) who responded, 48% of decedents were age 85 or over. There were no age differences in reported care quality in the last three months, but in the last two days the oldest old were reported to receive poorer relief of nonpain symptoms and less emotional and spiritual support. Compared to people under age 85, the over 85s were less likely to be reported to know they were dying, to have a record of their preferences for place of death, to die in their preferred place, to have enough choice about place of death—and more likely to be reported to have had unwanted treatment decisions. Being over 85 years was associated with a reduction in the odds of home death (OR=0.36); failure to ascertain and record preference for place of death contributed to this.

Conclusions: Age-associated disparity exists in care provided in the last two days and the realization of preferences.