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.