How Irish people die: many suffer unnecessarily in final year

Tilda survey of relatives shows high prevalence of pain and depression before death

The biggest killers of elderly Irish people are cancer and cardiovascular illness. They account for more than two-thirds of those who died.  Photograph: Bryan O’Brien

The biggest killers of elderly Irish people are cancer and cardiovascular illness. They account for more than two-thirds of those who died. Photograph: Bryan O’Brien

 

Many elderly Irish people experience unnecessary suffering in their final year of life, new research suggests.

The problems of falls, pain and depression affect almost half of all Irish people in their final year, according to the most comprehensive survey to date of the circumstances in which Irish people die.

The Irish Longitudinal Study on Ageing (Tilda) survey interviewed the relatives of 375 people who died between 2009 and 2014. The average age of the deceased was 78.

It found half of those who died experienced regular pain in their last year of life, 45 per cent bouts of depression and 41 per cent had a serious fall.

The Tilda survey involves a nationally representative sample of at least 8,000 adults aged 50 and over. It monitors on an ongoing basis Ireland’s increasingly ageing population.

The biggest killers of elderly Irish people are cancer and cardiovascular illness. They account for more than two-thirds of those who died.

Some 15 per cent died suddenly and a further 14 per cent within a month of being diagnosed with a serious illness.

Some 21 per cent were ill for between one and six months, 17 per cent were ill for between six and 12 months and a third were ill for more than a year.

Multiple problems

Senior author Prof Charles Normand of Trinity College Dublin said the findings that many people experienced pain and depression in their final year of life were surprising given the treatments available for both.

“People with multiple health problems also often have depression, but it is not well managed in the last year of life,” he said.

“You normally think pain is something that we are good at managing at the end of life, but it wasn’t the case here.”

He also suggested falls among elderly people can be prevented by modifying the homes of people at risk, such as those with osteoporosis.

The survey showed a large spectrum of health and wellbeing in the year before death. A majority of people, 61 per cent, were either disability-free or mostly disability-free in their final year of life.

It also found that almost half, 46 per cent, died in a hospital setting which is higher than the European average.

Healthcare needs

More than a quarter, 27 per cent, died at home, 11 per cent died in a hospice and one in 10 died in a nursing home.

Prof Normand said the number of people who die in hospital is too high and demonstrates that people at the end of their lives are not getting the healthcare they need.

“While it is sometimes necessary for someone to be in hospital to access support for complex needs and hard-to-manage symptoms, it is clear that in many cases we could improve experiences for families and possibly reduce costs if care were provided in more appropriate settings,” he said.

The study also revealed that 42 per cent of all care provided in the last year of life in Ireland is provided informally by either friends or family.