Review: End-of-life care in UK care homes: a systematic review of the literature

The importance of end-of-life (EoL) care in care homes is becoming increasingly significant. For instance, current demographics show that the population in the UK is getting older, with 18% aged 65 years and older and 2.4% aged 85 years and older (Office of National Statistics, 2017). In 2013, the number of residential care home beds (declared at the point of registration) in England was 244,232, with the number of nursing home beds 218,678 (National Institute for Health and Care Excellence, 2015).

In Scotland the overall number of care home places available in 2016 was 41,461, with the number of long-stay residents aged 85 years or over 17,579 (Information Services Division, 2016).

With predicted demographics, the number of older people – particularly in the over 85 years, ‘oldest old’ category – is rising, with the number of people in care homes requiring EoL care also increasing. This is compounded by the increasingly complex needs of residents, with fewer staff who are often poorly paid (Bulman, 2017). Age UK (2017) recently stated that the current crisis in care is highlighted by four main areas: underfunding; postcode lottery – in which local variation is still leaving many older people without any support; unmet needs; and declining access – with cuts in local authority care services having placed increasing pressure on unpaid carers.

The reviewed study explored how EoL care is being delivered in UK care homes. The mixed method review included 14 studies. Four themes were identified from the included studies: the phases of dying during EoL care; EoL pre-planning processes; understandings of EoL care; and interprofessional EoL care provision.

The majority of the included studies explored EoL care from the health professionals’ viewpoint. This is arguably a flaw of the included studies. To improve care home research and care it is important to include the views of residents themselves and their family members. We know that older people even coming towards the end of life want to participate in research (Hall et al., 2009). Moreover, methods have been developed to explore the views of older people in care homes with cognitive impairment (Dewing, 2007).

The key strength of the reviewed study is providing an overview of important features of EoL care in care homes and highlighting the importance of discussion and communication with residents and families as well as the need to have future planning discussions.

From a policy perspective, the reviewed study gives insight into the role of both communication and education for staff. An understanding of EoL care influences the care that care home staff provide. The reviewed study identified the need for more interprofessional collaboration and the need for more liaison between care homes and specialist palliative care services. Although this is increasingly happening in some areas (Hospice UK, 2017), there is clearly a need for further integration and support from specialist palliative care services for care homes.

Biography

Bridget Johnston holds the post of Florence Nightingale Foundation Chair in Clinical Nursing Practice Research in the School of Medicine, Dentistry and Nursing, University of Glasgow. This is a joint clinical academic post between the University of Glasgow and NHS Greater Glasgow and Clyde. She has a clinical, educational and research background in palliative care. Her clinical remit in NHS Greater Glasgow and Clyde relates to palliative and end-of-life care, with some strategic responsibility for developing capacity in nursing research, evidence-based practice and nurse clinical academics.