End of Life Issues and Older People’s Mental Health

Dying in old age is seen as a natural part of the human condition. However, the individual meanings that we give to both dying and death are influenced by many factors, such as the age of the person who is dying or has died, the way in which he or she died, and our own cultural and spiritual beliefs about death and dying. In the UK, as in many other countries, you have the same rights as everyone else even when you are dying. However, some groups of patients may experience inequalities in accessing appropriate end of life care, and research suggests that many older people receive poor standards of care towards the end of their lives. As professionals, we have both a professional and legal duty to protect and fulfil people’s human rights up until their death (Human Rights Act 1998) and to work to eliminate discrimination (Equality Act 2010). This chapter looks at a range of issues related to dying and how we might maintain anti-discriminatory practice when older people are in the process of dying. It also reflects on some of the issues practitioners face when the person who is dying has diminished capacity. The chapter starts by examining how dying has been portrayed and constructed historically within the UK. It reviews the age at which different groups of people die and questions if there can be such a thing as a ‘good death’. The following section looks at end of life care (palliative care) and identifies some of the issues that different groups of older people face in trying to access end of life services. Towards the end of the chapter, we address some of the more practical issues concerning advance care plans and power of attorney for older people living with mental health issues. Finally, the chapter addresses ways in which practitioners can promote anti-discriminatory practice in the care of older people living with mental health conditions.