Which population groups are at risk and why?
This section will focus on core epidemiological issues that take account of fixed risk factors (such as age, gender, ethnicity, family history) and modifiable risk factors (such as behaviour). The wider determinants of health (such as housing, transport and environment) are also considered.
Age
Older adults aged 85 and over often experience multiple long-term conditions, frailty and cognitive impairments which can complicate care needs and communication. They are the most likely to face barriers in accessing timely and appropriate services1.
Younger adults and children with life-limiting conditions may not always receive age-appropriate or specialist palliative care1.
Gender
Women are often at greater risk of receiving poorer quality end of life care compared to men. OHID research suggests women are more likely to die in care homes or at home, where access to specialist palliative care may be more limited compared to hospital settings2.
Socioeconomic status
Lower socioeconomic groups are at significantly higher risk of receiving poor end of life care. People living in more deprived areas are less likely to access specialist palliative care services and are more likely to die in hospital rather than their preferred place of care1.
Qualifications
Individuals with lower levels of educational attainment are at greater risk of receiving poor end of life care. Qualification level is a key sociodemographic factor influencing access to and quality of palliative and EoL care1. Challenges include lower health literacy, reduced ability to navigate healthcare systems and limited awareness of available services and rights to care.
Mental health
People with severe or long-term mental health conditions often face reduced access to palliative care services due to stigma and misconceptions about their ability to participate in care planning3. People with mental health conditions are among groups most likely to experience inequities in access and quality of care4.
Ethnicity
Black, Asian and minority ethnic (BAME) groups are at increased risk of receiving poor end of life care. These communities face barriers including language difficulties, cultural misunderstanding, lack of culturally appropriate services and limited awareness of available options5.
Prisoners
Prisoners are at risk of receiving poor end of life care due to the challenges of delivering healthcare within the prison system, particularly within the ageing prison population with complex chronic and life-limiting conditions6.
Sexual Orientation
Individuals from the LGBTQ+ community are at increased risk of receiving poor end of life care as they may feel uncomfortable accessing care and may require additional support to ensure their needs are met4. NHS England acknowledges LGBTQ+ individuals often experiences disproportionately worse health outcomes and healthcare experiences7.
Vulnerable Children
Palliative and End of Life care services that are available for children have significant inequalities in access, quality and coordination of care. Vulnerable children may face additional barriers such as fragmented services, limited specialist paediatric palliative care availability and lack of personalised care planning8.