The influence of patient and carer age in access to palliative care services
1 School of Nursing, Midwifery and Social Work, The University of Manchester, Coupland III, Oxford Road, Manchester M13 9PL, UK
2 Department of Palliative Care and Policy, King’s College London, Weston Education Centre, Cutcombe Road, Denmark Hill, London SE5 9RJ, UK
3 General Practice & Primary Care Research Unit, University of Cambridge, Institute of Public Health, Forvie Site, Robinson Way, Cambridge CB2 2SR, UK
Address correspondence to: G. E. Grande. Tel: (+44) 161 2758701. Fax: (+44) 161 2757566. Email: Gunn.Grande{at}manchester.ac.uk
Background: older patients are less likely to receive palliative care than younger patients. As patient and primary carer age correlate positively, patterns may be due to carer rather than patient age, and reflect better ability to obtain support among younger carers.
Objective: to investigate how both patient and carer age relate to palliative care use, controlling for relevant variables.
Design: comparison of patients who received community Macmillan nurse specialist advice, Marie Curie nursing or inpatient hospice care with patients who did not, using univariate analysis and multivariate logistic regression. Patient and carer data were collected through electronic service record linkage and carer post-bereavement interviews.
Sample: patients referred to a hospice at home service whose primary carer could be interviewed (n = 123).
Results: whilst a cancer diagnosis was an important determinant of access for all services considered, logistic regression shows that carer age, but not patient age, and hospice at home access predicted Marie Curie nursing use. Both patient and carer age predicted use of Macmillan nurse advice. Age of the patient, but not carer age, predicted admission to inpatient hospice, alongside requiring care for over a month (all P<0.05).
Conclusions: carer age may be as important a predictor of palliative home care use as patient age. We need to investigate whether younger carers have greater support needs or show greater effectiveness in obtaining help and to assess whether older carers need more assistance in recruitment of support.
Keywords: palliative, access, services, age factors, elderly
Received June 16, 2005; accepted in revised form February 2, 2006.
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