ALMOST HALF OF older people who died in Ireland were depressed in the months before their death.
That’s according to a study by the Irish Longitudinal Study on Ageing (TILDA) at Trinity College Dublin which gives an insight into the end-of-life experience of older adults in the country.
The report examines where people died, which services and care they received and their quality of life before their death.
Participants of the study died in four main places - nearly half (46%) died in a hospital, over a quarter (27%) died at home, just over one in ten died in a hospice (11%) and one in ten in a nursing home (10%).
The death in hospital rate in seven other high-income countries is between 22-52% which places Ireland at the higher end of this group.
Other research suggests a high hospital death rate is considered an indicator of a poor health system performance as it’s not what patients want and is associated with both high resource use and poor patient experience.
Extra care
Many people accessed community care such as a public health nurse (45%), allied health care such as physiotherapy (33%) and home care services such as home help (20%) in the last year of life.
However, the research also found that a high proportion of people who needed home, community and allied health services were unable to access them – between 15-30% depending on the service.
There is no evidence connecting this is due to socioeconomic or geographical factors. Rather, the data suggest that inability to access community care stems from lack of awareness of availability and a reluctance to apply for services.
On average, people received two hours of care per day but 10% received 24-hour unpaid assistance.
The study noted that the high proportion of unpaid care provided by family members was striking – accounting for 42% of all care received.
People who lived alone received less informal help with everyday activities, but this shortfall was not matched by increased use of formal healthcare services. People living alone received less care on average.
Pain and depression
There was a wide difference in levels of disability among older adults in the last three months of life.
Around a third were active and disability-free while another third needed help with everyday tasks such as eating, bathing and taking medications.
The report also found that a significant proportions of older people experienced health problems towards the end of life that could be modified to improve their quality of life – including falls (41%), regular pain (50%) and regular depression (45%).
The authors said that while the use of healthcare services by older adults increases in the last year of life, there is no evidence of the highly intensive end-of-life care that is seen in other countries and which is often associated with inappropriate care and undesirable outcomes.
The research used 375 interviews completed by family members and friends of TILDA participants who died since the study began in 2009.
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