+AA
Fr
McMasterLogo_New-2017-300x165
Back
Evidence Summary

What is an Evidence Summary?

Key messages from scientific research that's ready to be acted on

Got It, Hide this
  • Rating:

More supports are needed for frail and older adults, their families and health professionals to enable appropriate end-of-life care planning discussions.

Sharp T, Moran E, Kuhn I, et al.  Do the elderly have a voice? Advance care planning discussions with frail and older individuals: A systematic literature review and narrative synthesis British Journal of General Practice. 2013;63(615):e657-668.  

Review question

What are the attitudes of the public and healthcare professionals to advance care planning discussions with frail older people?

Background

Despite improvements in end-of-life care, there are concerns that services focus too heavily on patients with cancer.

End-of-life care for frail older adults with no overriding diagnosis is important, given they account for around 40% of deaths, and are often associated with multiple chronic conditions as well as some degree of decreased mental functioning.

How the review was done

The review searched the health and social science literature for relevant studies published from January 1991 to September 2012.

12 694 studies were found, of which 26 were included after the authors screened titles and abstracts.

The authors were funded by the UK National Institute of Health Research (NIHR) and MacMillan Cancer Support.

What the researchers found

A minority of frail and older individuals have end-of-life care conversations with a healthcare professional.

While most frail and older adults would welcome the opportunity to have end-of-life care conversations, there are some who would prefer not to discuss end-of-life care, and preferences for timing these discussions among those who are interested are highly variable.

Healthcare professionals see end-of-life conversations as their responsibility, but may not be able to initiate them given workload pressure and uncertainty over the prognosis of the patient.

Barriers to discussions included family members who may be reluctant to discuss end-of-life care, and the expectations among frail older adults that others (e.g. family, god, health professionals) would decide for them.

Conclusion

Frail and older adults and their family members need opportunities and supports that enable them to discuss (or to refuse to discuss) end-of-life care with health professionals.

Health professionals require supports and encouragement to find appropriate opportunities to initiate end-of-life discussions with frail older adults and their families.

This summary is based on a review that was determined to be of medium methodological quality based on an assessment using the AMSTAR tool.




Related Evidence Summaries

Related Web Resources

  • Breast cancer: Risks and benefits, age 50-69

    Canadian Task Force on Preventive Health Care
    Your risk of dying from breast cancer is slightly reduced if you have regular screening. However, regular screening increases your chance of a false positive result, a biopsy and having part or all of a breast removed unnecessarily.
  • Breast cancer: Patient algorithm

    Canadian Task Force on Preventive Health Care
    The Canadian Task Force on Preventive Health Care recommends women between 50 and 74 years old who are not at high risk get screened for breast cancer every 2 to 3 years. Talk to your doctor about screening options if you are at high risk or over 74 years old.
  • Breast cancer: Patient FAQ

    Canadian Task Force on Preventive Health Care
    This resource includes frequently asked questions about breast cancer, including: Who is considered high risk? What are the harms associated with mammography? and Why is routine screening NOT recommended for women 40-49 years?
DISCLAIMER These summaries are provided for informational purposes only. They are not a substitute for advice from your own health care professional. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the McMaster Optimal Aging Portal (info@mcmasteroptimalaging.org).

Register for free access to all Professional content

Register
Want the latest in aging research? Sign up for our email alerts.
Subscribe

Support for the Portal is largely provided by the Labarge Optimal Aging Initiative. AGE-WELL is a contributing partner. Help us to continue to provide direct and easy access to evidence-based information on health and social conditions to help you stay healthy, active and engaged as you grow older. Donate Today.

© 2012 - 2020 McMaster University | 1280 Main Street West | Hamilton, Ontario L8S4L8 | +1 905-525-9140 | Terms Of Use