This ethical hub topic shows how our professional standards 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. Page last reviewed: 30 January 2024.
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.
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.
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.
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.
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.
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.
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.
The approach and attitude of a medical practitioner can have a lasting impact on a patient. Treating patients with kindness, compassion and respect can profoundly shape their experience of care.
Good medical professionals recognise that patients are individuals with diverse needs, and don’t make assumptions about the options or outcomes a patient will prefer. They listen to patients and work in partnership with them. 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.
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.
A report by the Care Quality Commission (CQC) which looks at how people are being involved in their own care: Better care in my hands report
"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
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: Paragraphs 52 - 56 - Contributing to positive working and training environments
Decision making and consent : Paragraphs 8 - 49 - The Dialogue leading to a decision
Treatment and care towards the end of life: Paragraphs 7–9 – Equalities and human rights
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:
Decision making and consent: Paragraphs 8 - 49 - The Dialogue leading to a decision
Treatment and care towards the end of life: Paragraphs 50 - 62 - Advance care planning
We work with doctors, patients, and other stakeholders to support good, safe patient care across the UK.
