Background: Cancer patients who receive care from specialist palliative care services in the UK are younger than those who do not receive this care. This may be explained by agerelated differences in attitudes to end-of-life care. Objective: To determine the relationship between age and i) attitudes to death and preparation for death; and ii) knowledge about, and attitudes to, cancer and palliative care. Design: Interviews with older people, using a novel questionnaire developed using nominal groups. Main comparisons were made between people aged 55-74 with those aged 75 years and over. Setting: General practices in London. Subjects: 129 people aged 55-74 and 127 people aged 75 years or over on the lists of general practitioners. Methods: A cross-sectional survey to determine knowledge and experience of hospice care; preparation for end-of-life; and attitudes to end-of-life issues. Results: Participants were knowledgeable about specialist palliative care and almost half had some indirect contact with a hospice. People aged <74 were less likely than younger participants to want their doctor to end their life in a terminal illness. Although they believed death was easier to face for older people, they did not believe that younger people deserved more consideration than older people when dying, or that they should have priority for hospice care. Education, social class, hospice knowledge and anxiety about death had little influence on overall attitudes. Conclusions: The relative under-utilization of hospice and specialist palliative care services by older people with cancer in the UK cannot be explained by their attitudes to end-of-life issues and palliative care.
Addington-Hall JM , Altmann D , McCarthy M . Who gets hospice in-patient care?Soc Sci Med1998; 46: 1011-1016 .
2.
Addington-Hall J , Altmann D . Which terminally ill cancer patients in the United Kingdom receive care from community specialist palliative care nurses?J Adv Nurs2000; 32: 799-806 .
3.
Gray J , Foster D . Factors associated with utilization of specialist palliative care services: a population based study . J Pub Health Med1997; 19: 464-469 .
4.
Burge F , Johnstone G , Lawson B , et al. Populationbased trends in referral of the elderly to a comprehensive palliative care programme . Palliat Med2002; 16: 255-256 .
5.
Hunt R , McCaul K . A population-based study of the coverage of cancer patients by hospice services . Palliat Med1996; 10: 5-12 .
6.
Hunt R , Fazekas B , Luke C , et al. The coverage of cancer patients by desginated palliative care services: a population-based study . Palliat Med2002; 16: 403-409 .
7.
Grande G , McKerral A , Todd C . Which cancer patients are referred to hospice at home for palliative care?Palliat Med2002; 16: 115-123 .
8.
Ahmed N , Bestall JC , Ahmedzai SH , et al. Systematic review of the problems and issues of accessing specialist palliative care by patients, carers and health and social care professionals . Palliat Med2004; 18: 525-542 .
9.
Grande G , Todd C , Addington-Hall JM . Variables related to place of death and access to home care services: are certain patient groups at a disadvantage?Soc Sci Med1998; 47: 565-579 .
10.
Hospice Information. Services and Patients 2002. Retrieved 17 February 2001, from http://www.hospice%20information.info/factsandfigures/services.asp.
11.
Office of National Statistics. 1999 Death registrations: deaths by age, sex and underlying cause. Retrieved 6 June 2000, from http://www.statistics.gov.uk/statbase.
12.
Degner LF , Sloan JA . Symptom distress in newly diagnosed ambulatory cancer patients and as a predictor of survival in lung cancer . J Pain Symptom Manage1995; 10: 423-431 .
13.
Addington-Hall JM , Altmann D , McCarthy M . Variations in age in symptoms and dependency levels experienced by people in the last year of life, as reported by surviving family, friends and officials . Age Aging1998; 27: 129-136 .
14.
Feifel H , Branscomb A . Who's afraid of death?J Abnorm Psychol1973; 81: 282-288 .
15.
Galt CP , Hayslip B . Age differences in level of overt and covert death anxiety . Omega1998; 37: 187-202 .
16.
Bruce-Jones P , Roberts H , Bowker L and Cooney V . Resuscitating the elderly: what do patients want?J Med Ethics199622: 154-159 .
17.
Catt S , Blanchard M , Addington-Hall J , Zis M , Blizard R , King M . The development of a questionnaire to assess the attitudes of older people to end-of-life issues (AEOLI) . Palliat Med2005; 19: 397-401 .
18.
Jarman B . Identification of underprivileged areas . BMJ1983; 286: 1705-1709 .
19.
Thorson JA , Powell F . A revised death anxiety scale. In Neimeyer RA ed. Death anxiety handbook: research, instrumentation and application. Washington DC: Taylor and Francis , 1994.
20.
EuroqoL Group . EuroqoL: a new facility for the measurement of health related quality of life . Health Pol1990; 16: 199-208 .
21.
Sheikh JA , Yesavage JA . Geriatric Depression Scale (GDS): recent findings and development of a shorter version. In Brink TL ed. Clinical gerontology: a guide to assessment and intervention. New York: Howarth Press , 1986.
22.
SPSS for PC version 9.0, SPSS Inc., Chicago, Illinois, USA.
23.
Williams R . A protestant legacy: attitudes to death and illness among older Aberdonians. Oxford: Clarendon Press , 1990.
24.
Taylor-Davis S , Smiciklas-Wright H , Davis AC , Jensen GL , Mitchell DC . Time and cost for recruiting older adults . J Am Geriatr Soc1998; 46: 753-757 .
25.
Petty DR , Zermansky AG , Raynor DK , et al. ‘No thank you’: why elderly patients declined to participate in a research study . Pharm World Sci2001; 23: 22-27 .
26.
Zapka JG , Chasantaber L , Bigelow C , Hurley T . Methodological issues for health-related surveys of multicultural older women . Evaluat Health Profess1994; 17: 485-500 .
27.
Office of Population Censuses and Surveys (OPCS) . National population projections: 1991-based. Series PP2, No. 18, Appendix 1. London: HMSO , 1993.
28.
Fortner BV , Neimeyer RA . Death anxiety in older adults: a quantitative review . Death Stud1999; 23: 387-411 .
29.
Edmonds P.Rogers A . ‘If only someone had told me...’ A review of the care of patients dying in hospital . Clin Med2003; 3: 149-152 .
30.
Thorpe G . Enabling more dying people to remain at home . BMJ1993; 307: 915-918 .
31.
Eve A , Higginson IJ . Minimum dataset activity for hospice and hospital palliative care services in the UK 1997/98 . Palliat Med2000; 14: 395-404 .
32.
National Council of Hospices and Specialist Palliative Care Services . Voluntary euthanasia: the Council's view. London: NCHSPCS , July 1997.
