The ‘oldest old’ towards the end of life

Focusing on 'older old' people approaching the end of their lives, this project combines qualitative and quantitative methods to examine end-of-life care issues from the perspective of very old people and their carers.

Collaborating with one of the world’s longest-running studies of older old age, the Cambridge City over-75s Cohort (CC75C) study, we are working with a rare dataset gathered over three decades from following-up a representative population of older people into their last years. In-depth interviews with the surviving study participants, by then all in their late 90s or past 100, and with their relatives and other carers, including post-bereavement interviews, enriched this large epidemiological study in its later years.

Research topics include the characterisation of cognitive impairment, physical disability, emotional well-being and self-rated health for the very old in their last year of life; their formal and informal support, service use and transitions in place of care; experiences and perceptions of care from both older old people’s and their carers’ perspectives; attitudes towards quality of life at the end of life and towards dying and death; and the symptoms and comfort levels experienced by very old people dying in different care settings.

Publications

Longitudinal analysis of the impact of loneliness on cognitive function over a 20-year follow-up Hanyuying Wang, Caroline Lee, Sally Hunter, Jane Fleming, Carol Brayne and The CC75C study collaboration Aging and Mental Health e-pub 20 Aug 2019, DOI: 10.1080/13607863.2019.1655704

When frail older people relocate in very old age who makes the decision? Fiona Scheibl, Morag Farquhar, Jackie Buck, Stephen Barclay, Carol Brayne and Jane Fleming on behalf of the Cambridge City over-75s Cohort (CC75C) study collaboration Innovation in Aging Volume 3, Issue 4, August 2019, igz030, DOI: 10.1093/geroni/igz030

The experience of transitions in care in very old age: implications for general practice Fiona Scheibl, Jane Fleming, Jackie Buck, Stephen Barclay, Carol Brayne and Morag Farquhar on behalf of the Cambridge City over-75s Cohort (CC75C) study collaboration. Family Practice e-pub June 2019, DOI: 10.1093/fampra/cmz014

Is loneliness associated with increased health and social care utilisation in the oldest old? Findings from a population-based longitudinal study Hanyuying Wang, Emily Zhao, Jane Fleming, Tom Dening, Kay-Tee Khaw, Carol Brayne & The CC75C Study Collaboration. BMJ Open 2019;9:e024645

Mortality risk of loneliness in the oldest old over a 10-year follow-up Hanyuying Wang, Yue Leng, Emily Zhao, Jane Fleming, Carol Brayne & The CC75C Study Collaboration. Aging & Mental Health, e-pub 17 Nov 2018. DOI:

Lack of associations between modifiable risk factors and dementia in the very old: Findings from the Cambridge City over-75s Cohort Study. Kay Deckers, Sebastian Köhler, Martin van Boxtel, Frans Verhey, the CC75C study collaboration, Carol Brayne, Jane Fleming. Aging and Mental Health e-pub: 2 February 2017, DOI: 10.1080/13607863.2017.1280767

Dying comfortably in very old age with or without dementia in different care settings – a representative “older old” population study. Jane Fleming, Rowan Calloway, Anouk Perrels, Morag Farquhar, Stephen Barclay, Carol Brayne on behalf of the CC75C Cambridge City over-75s Cohort study collaboration. BMC Geriatrics 2017 17/222 DOI 10.1186/s12877-017-0605-2

Death and the oldest old: Attitudes and preferences for end-of-life care – Qualitative research within a population-based cohort study Fleming J & Farquhar M [joint first authors], CC75C study collaboration, Brayne C, Barclay S.  PLoS ONE 2016;11(4):e0150686.

Very old people dying – what would relatives like to have seen managed differently? Fleming J, Evans R, Scheibl F, Buck J, Barclay S, Farquhar M, Brayne C, and Cambridge City over-75s Cohort (CC75C) study collaboration. RSM/Marie Curie, London, Oct 2016. BMJ Supportive & Palliative Care 2016; 6(3):392.

Dying comfortably in very old age with or without dementia- a representative “older old” population study Fleming J, Calloway R, Perrels A, Farquhar M, Barclay S, Brayne C and CC75C Cambridge City over-75s Cohort study collaboration. Palliative Care Congress, Glasgow, March 2016 Palliative Medicine April 2016 vol. 30 no. 4 S36 (P45). Published online before print March 6, 2016, doi: 10.1177/0269216316631462

Place of death and end-of-life transitions experienced by very old people with differing cognitive status: retrospective analysis of a prospective population-based cohort aged 85 and over Anouk J. Perrels, Jane Fleming, Jun Zhao, Stephen Barclay, Morag Farquhar, Hilde M. Buiting, Carol Brayne and the Cambridge City over-75s Cohort (CC75C) study collaboration. Palliative Medicine, 2014 Mar 3;28(3):220-233 (e-pub ahead of print Dec 2013)

Support, loneliness and well-being amongst very old people in their last year of life Farquhar M, Zhao J, Pepper H, Barclay S, Brayne C, Kinmonth AL, Fleming J and the Cambridge City over-75s Cohort (CC75C) study collaboration. European Association for Palliative Care Research Congress, Glasgow, Jun 2010. Palliative Medicine June 2010 vol. 24 no. 4 Suppl S168; doi: 10.1177/0269216310366390

Place of death for the “oldest old”: ≥85-year-olds in the CC75C population-based cohort Fleming J, Zhao J, Farquhar M, Brayne C, Barclay S and the Cambridge City over-75s Cohort (CC75C) study collaboration British Journal of General Practice 2010 (April); 60(573): e171-179, DOI: 10.3399/bjgp10X483959.

The “oldest old” in the last year of life: population-based findings from CC75C study participants aged at least 85 at death Zhao J, Barclay S, Farquhar M, Kinmonth AL, Brayne C, Fleming J and the Cambridge City over-75s Cohort (CC75C) study collaboration Journal of the American Geriatrics Association 2010 Jan;58(1) 1-11

Inability to get up after falling, subsequent time on floor, and summoning help: prospective cohort study in people over 90. Jane Fleming, Carol Brayne and the Cambridge City over-75s Cohort (CC75C) study collaboration BMJ 2008;337:a2227.

Falls in advanced old age: recalled falls and prospective follow-up of over-90-year-olds in the Cambridge City over-75s Cohort study. Jane Fleming, Fiona E Matthews, Carol Brayne and the Cambridge City over-75s Cohort (CC75C) study collaboration BMC Geriatrics 2008, 8:6.

Cohort profile: the Cambridge City over-75s Cohort (CC75C). Fleming J, Zhao E, O’Connor DW, Pollitt PA, Brayne C and the CC75C study. International Journal of Epidemiology2007 Feb;36(1):40-6.