Worsening disability in older people: a trigger for palliative care

In a linked paper reporting a 15 year observational study, Gill and colleagues (doi:10.1136/bmj.h2361) highlight a strong association between admission to hospital and worsening disability in older adults.1 The authors suggest that hospital admission itself may be an important risk factor for increasing dependency in four activities of daily living (bathing, dressing, walking, and transferring) and adverse outcomes. About half of their study cohort had persistent or progressive disability and substantial care needs. These people also had a higher risk of dying than others in the cohort, especially when their functional ability declined rapidly. The authors’ main recommendation is important: that older people admitted to hospital with substantial disability should be considered for palliative care for control of symptoms, care planning, and increased support with personal care needs. How can this be done consistently?

It is known that older people are increasingly likely to have unplanned hospital admissions as their health deteriorates in the last year of life and that this happens for complex reasons, including age, socioeconomic deprivation, and …