Improving quality of life at the end of life – New research to meet the global challenge of healthcare for an ageing population

In an unprecedented era of global ageing, it is becoming ever more important that health and social services for older populations support both living well and adapting to the decline of old age.

In today’s world, there are about 901 million people aged over 60. By 2050, the United Nations predicts this will have increased to 2.1 billion. The number of people over 80 is projected to more than triple from 125 million today to 434 million by 2050. This means people over 60 will have risen from 12% to 22% of the world’s population.

In England, projections on population ageing and death indicate a rise in the total number of deaths from 501,424 in 2014 to 635,814 in 2040. People aged 85 years or over will account for 54% of deaths in 2040, rising from 39% in 2014.

To meet this challenge, researchers at King’s have been investigating the best ways healthcare can respond to the needs of our ageing populations towards the end of life to improve quality of life. They conducted a rapid review of health service delivery models for older people nearing the end of life and have identified two overarching classifications of integrated geriatric and palliative care. This research highlighted the urgent need for changes in health systems to meet the universal healthcare demands of palliative care integrated in all health services.

The publication Service Delivery Models to Maximize Quality of life for Older People at the End of Life: a rapid review, incorporates 72 systematic reviews encompassing over 784, 000 individuals from across the world.

The research team identified two overarching classifications of service models, both orientated to improving health related quality of life but with differing emphasis on target outcomes:

• Integrated Geriatric Care, emphasizing physical function.
• Integrated Palliative Care, focusing mainly on symptoms and concerns.

The authors assert that the use of health services should be informed by the intended benefits and outcomes rather than on prognosis. Both service models demonstrate improved health-related quality of life and emphasise person-centred care, education, and a multi-professional workforce.

The review recommended policymakers act to improve access to palliative care before the last months of life and increase geriatric care provision to maintain and optimise function. This would ensure that continuity and coordination of care and services is maintained across the continuum of late life, where the demarcation of boundaries between healthy aging and healthy dying become increasingly blurred. The findings iterate the urgent need for health system change to improve end-of-life care across health services globally as part of universal health coverage.

“This systematic review demonstrates priorities for health and social care to align services to the needs of our ageing population by attending to both functions to enable independence, however small, and symptoms and concerns for people to live as well as possible and to die peacefully.” – Dr Catherine Evans, HEE/NIHR Senior Clinical Lecturer

“Our findings highlight the urgent need for health system change to improve palliative and end of life care as part of Universal Health Coverage. Access to palliative care is often needed before the last weeks and months of life and should be driven by goals of care and each individual’s priorities.” – Dr Matthew Maddocks, Senior Lecturer

The review was funded by the World Health Organisation and published in The Milbank Quarterly.

The full publication is available online