Older people are more likely to die comfortably if they spend their last hours at home rather than in hospital.
A study has found the chances of a good death are four times higher for people in their own house or a care home than those in a hospital ward.
Researchers from Cambridge University looked at the ‘oldest old’, aged over 85, at the end of their lives.
With life expectancy soaring, this age group now makes up almost half of people who die and many do so with multiple illnesses including dementia, heart disease and cancer.
The study of 180 people found just one in 10 died without suffering symptoms including distress, pain, depression, delirium or confusion.
Older people are more likely to die comfortably if they spend their last hours at home rather than in hospital (Stock image)
However, interviews with their relatives and carers found their chances of a comfortable death were greatly increased if they were not taken to hospital.
Most people express their desire to die at home if at all possible, and the findings have prompted criticism of the NHS.
Lead author Dr Jane Fleming, from the Department of Public Health and Primary Care at the University of Cambridge, said: ‘The UK is not the only country where an urgent review of the funding for older people’s long-term care is needed, along with commitments to staff training and development in this often undervalued sector.
‘It’s heartening that the majority of very old people in our study, including those with dementia, appear to have been comfortable at the end-of-life, but we need to do more to ensure that everyone is able to die comfortably, wherever they are.’
Only a minority of very old people in Britain die in their own home, with just 11 per cent of those in the study doing so.
Those with memory problems, such as people with dementia, are most likely to live and die in care homes.
People with no cognitive problems or mild memory loss are most likely to live at home but be admitted to hospital when they are dying.
The Cambridge researchers examined the cases of 180 pensioners aged 79 to 107.
Interviewing relatives and friend after each person’s death, it emerged that 69 per cent of those who died in hospital had died comfortably.
That rose to 89 per cent for those who died in their own home and 91 per cent for those in long-term care such as a nursing home.
The results were based on respondents, normally the pensioners’ children, describing their death in a questionnaire as ‘very comfortable’, ‘comfortable’, ‘fairly comfortable’ or ‘uncomfortable’.
The study, published in the journal BMC Geriatrics, states: ‘Transfer to a preferred place of care should be facilitated whenever possible, but all too commonly a patient is admitted to hospital without those concerned having considered where they can be best cared for, or would wish to die.’
Nearly half of the older people, who died at an average age of 91, experienced at least three symptoms listed in the study during their final illness.
The most common were pain and distress, with the other symptoms including pressure sores, depression, delirium or confusion, loss of consciousness or neglect.
Pain was treated in the majority affected, but successfully for only half, with a fraction of those older people thought to have depression to have received treatment.
Co-author Dr Rowan Calloway, from the University of Cambridge, said: ‘In the UK, we particularly need to address the current shortage of palliative care doctors in the NHS, where training numbers are not going up to match demand.
‘In the future, community care will be increasingly reliant on non-specialists, so it will be crucial that all members of the multi-disciplinary teams needed to support very frail older people near the end of their lives have good training in palliative and supportive care skills.’