This ethical hub topic shows ways in which our ethical guidance can be applied in this area of care and signposts to relevant resources. It does not set new professional standards and is not intended to replace the formal guidance.
A patient’s age shouldn’t determine the standard of treatment and care they receive. Sadly we continue to see evidence that older adults experience significant health inequalities and a poorer quality of care compared to the wider population.
Practical steps to include older adults in their care
Find out what is important to your patients
Like all of us, older adults want to be heard, respected and included in decisions about their care. We all have different goals and priorities in life, knowing what matters at the start can help guide treatment and care options and can have a big impact on your patients’ quality of life.
Make information accessible and check for understanding
Older adults may have a range of ‘hidden’ physical or other conditions, such as difficulties hearing and poor eyesight, that may mean they don’t take on board information given to them during a consultation. Providing information in an accessible format for your patient is therefore essential. This may include the use of large print leaflets, an electronic amplifier or audio recordings. Involving speech and language therapists can be helpful for those with dysphasia. It is always important to ensure they understand the information you have given, techniques such as teach-back can useful.
Involve family members or carers
Involving families and carers can be key to providing good care for older patients, as they are often a valuable source of support and advocacy for the patient. Read our mental capacity page for information about involving the family, carers or friends of an older adult who has fluctuating capacity to make decisions. If you’re concerned that patient confidentiality may be a barrier to involving others, then read our confidentiality guidance for advice on when it is OK to share information.
Allow more time for consultations
Assessing older adults under time constraints such as a 10 minute GP appointment can be challenging as there can be numerous presenting problems, co-existing health conditions and complex social care needs. Where possible, plan for extra consultation time to explore issues thoroughly and aim for a holistic assessment of their needs.
Communicate with other services and the multidisciplinary team
A number of health and care professionals may be involved with your patient’s care. So, timely and effective communication between health care teams and across different services will be vital for joined up care planning. Discuss with your patient if they would like to use a Healthcare ‘passport’ to help them when accessing other services. These passports contain information about your patient such as current medical conditions and medication, what’s important to your patient and how they like to be treated.
Consider working with them to develop an anticipatory care plan
Older adults with complex health and care needs can often benefit from having an advanced care plan (ACP). This is a process of discussion between an individual, their healthcare provider and often those close to them about their future care. By encouraging people to have conversations about what matters to them, ACPs can help prevent crisis, reduce future stress and promote quality of life.
Good doctors work in partnership with patients and respect their rights to privacy and dignity. They treat each patient as an individual. They do their best to make sure all patients receive good care and treatment that will support them to live as well as possible, whatever their illness or disability.
Treat older people as individuals
Older patients don’t want to be treated differently because of their age. They want to be treated as individuals, feel they are being listened to, have the opportunity to ask questions and have access to the information and support they need to make their own decisions.
In some circumstances, there may be objective evidence to provide treatment which prioritises older people. This is often the case with vaccinations, such as the flu vaccine. Department of Health and NICE guidelines recommend vaccinating people aged over 65 who are at an increased risk of flu-related complications.
"Too often the healthcare system makes snap judgements on an older person on the basis of their age, as opposed to what matters most to them."
Jagter Dhanda - Head of Inclusion, Macmillan Cancer Support
What does the law say?
Some groups of patients, including older adults, can experience inequality of treatment when it comes to getting access to healthcare services and in the standard of care provided. This can happen because of physical, communication and other barriers, or a lack of knowledge and understanding about the particular needs and concerns of older people by those providing services.
It is important to note that the Equality Act 2010, duties in mental capacity, and human rights laws reinforce the ethical obligations on doctors not to discriminate against older patients and ensure they receive a good standard of care.
Good medical practice
Decision making and consent
Treatment and care towards the end of life
- Advance care planning supports adults at any age or stage of healthcare in understanding and sharing their values, life goals, and medical care preference
- An advance care plan helps make sure people receive care that is consistent with their values, goals and preferences during serious and chronic illness
- Advance care planning can help empower patients
Advance care planning
Advance care planning can be key to ensuring your patient receives timely access to safe and effective care that meets their needs and wishes, enabling them to live and die well.
It often involves many conversations and can apply to all patients. It can be particularly useful in maternity care, for those with long term conditions or patients approaching the end of their lives. It should be offered when the patient is well enough, before any loss of mental capacity.
A good conversation is where the patient feels they have expressed their wishes and been heard. This might include a refusal to consider the issue, if that is what the patient is most comfortable with, and that decision should be respected.
Doctors often worry about having these discussions as they fear it will cause undue distress to their patients. But patients who accept the offer of a discussion have been shown to find such conversations empowering.
'Advance care planning is a process that supports adults at any age or stage of health in understanding and sharing their personal values, life goals, and preferences regarding future medical care. The goal of advance care planning is to help ensure that people receive medical care that is consistent with their values, goals and preferences during serious and chronic illness.'
The approach to advance care planning varies from patient to patient. Some key areas to consider when having advance care planning conversations are:
Step 1 – Think about having a discussion if:
- the patient asks
- the patient has a life limiting illness
- the patient has an illness which is likely to result in loss of capacity
- a patient with a chronic condition experiences a change or deterioration of symptoms
- the patient's personal circumstances change e.g. move to a care home or a bereavement
Step 2 – Explain what advance care planning is
- Take time to explain what's involved and encourage the patient to ask questions
- Consider giving the patient written information
- Encourage the patient to discuss their decisions with those close to them
- If the patient is reluctant to engage in the discussion you should respect their decision
Step 3 – Explore their wishes
- Have a conversation which explores the patient's needs, symptoms, preferences or fears in relation to future treatment and care
- This may include:
- What they want to happen
- What they don’t want to happen
- Who will speak on their behalf if they lose capacity
- This discussion may lead to an advance statement, advance requests or refusal of treatment, appointment of power of attorney or a DNACPR form.
Step 4 – Record and share information
- You must make a record of the discussion and decisions made.
- This should be made available to the patient and if they consent, shared with others involved in their care.
- If they make an advanced refusal of treatment the patient should be encouraged to share this with those close to them and key health and social care staff involved in their care.
Step 5 – Review and revisit their decision
- Plans need to be reviewed and updated regularly as the patient's situation or views change.
Good medical practice
Decision making and consent
Treatment and care towards the end of life
Resources to help with advance care planning
The Royal College of Physicians have a resource to support doctors in improving the care and choices available to people at the end of life care in the acute care setting.
Dying Matters have a range of resources that you can share with your patients when discussing advance care planning. Planning for your future care