Age and Ageing Advance Access published online on November 23, 2009
Age and Ageing, doi:10.1093/ageing/afp212
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The experiences of older adults in the community dying from cancer and non-cancer causes: a national survey of bereaved relatives
1 Department of Epidemiology and Public Health, UCL, 1-19 Torrington Place, London, WC1E 6BT, UK
2 Department of Palliative Care, Policy and Rehabilitation, School of Medicine at Guy's, King's College and St Thomas' Hospitals, King's College London, Weston Education Centre, 3rd Floor, Cutcombe Road, London, SE5 9RJ, UK
3 Division of Health and Social Care Research, King's College London, Florence Nightingale School of Nursing and Midwifery, 5th Floor Waterloo Bridge Wing, Franklin Wilkins Building, London, SE1 9NN, UK
4 School of Health Sciences, University of Southampton, Highfield, Southampton, SO17 1BJ, UK
Address correspondence to: J. Burt. Tel: (+44) 20 7679 1680; Fax: (+44) 20 7813 0280. Email: jenni.burt{at}ucl.ac.uk
Background: there is limited understanding of symptoms and care in the last few months of life for adults dying from causes other than cancer.
Objective: the aim of the study is to compare the experiences in the community in the last 3 months of life of older adults dying from cancer and non-cancer causes.
Design: the study employed a retrospective cross-sectional survey of bereaved relatives.
Setting: the survey took place across eight cancer networks in England.
Subjects: a random sample of 1,266 adults who registered a death occurring in someone aged 65 and over between August 2002 and February 2004 was drawn.
Methods: VOICES (Views of Informal Carers—Evaluation of Services) questionnaires were sent to sampled informants by the Office for National Statistics 3–9 months after the registration of the death. Differences in the reported experiences of cancer and non-cancer decedents in symptoms, treatment and care were assessed using Pearson’s chi square test.
Results: cancer decedents were significantly more likely than non-cancer decedents to have had pain (93 vs 79%, P < 0.001), nausea and vomiting (62 vs 40%, P < 0.001) and constipation (74 vs 66%, P = 0.03), whilst a greater proportion of non-cancer decedents experienced breathlessness (74 vs 65%, P = 0.006). Across both groups, less than half of the decedents were reported to have received treatment which completely relieved their symptoms some or all of the time. There were significant variations in the receipt of district nursing, general practitioner care and other health and social care and the reported quality of this care, for decedents dying of cancer and non-cancer causes. Further, informants for cancer deaths reported greater satisfaction with support received.
Conclusions: there are important differences in the reported experiences of older adults dying from cancer and non-cancer causes in the last months of life, independent of age.
Keywords: end-of-life, palliative care, cross-sectional survey
Received 28 May 2009; accepted in revised form 10 July 2009.