Abstract
Global ageing means that death is now most commonly an event of older age. For most
older people, the nature of living and dying in later life will be frailty and multimorbidity
(MM – the co-existence of two or more long-term conditions).
Frailty is age-related and describes the gradual loss of inbuilt physiological reserves that
leads to sudden, potentially fatal health deteriorations following seemingly small events,
such as a minor infection. Frailty and MM increase the risk of dying in older age; those
with severe frailty are five times more likely to die within a year than non-frail elders.
However, the fluctuating progression of frailty, often over years, can make it hard to
proactively identify when an older person is in their last year of life which is often a
marker used as a referral to palliative and end of life services. Access to palliative care for
all people with life-limiting conditions is recognised as important at the highest policy
level. However, the experience of older people nearing the end of their lives is often poor.
Many older people risk over-treatment to prolong life, and under-treatment from
palliative care; actively addressing quality of life and person-centred needs and care goals,
when a cure is not possible, is too often poorly handled.