Key Messages  

• Place of death preferences: A significant proportion of older adults express a preference to die at home or in familiar surroundings, yet many continue to die in hospital settings. 

• Resource allocation disparities: Variations in local funding and resource distribution contribute to unequal access to quality end-of-life care services across different regions. 

• Policy-practice gap: Despite national policies advocating for patient-centred end-of-life care, implementation at the local level often falls short, leading to inconsistencies in care experiences. 

Policy Implications 

• Alignment of policy and practice: There is a critical need to bridge the gap between national end-of-life care policies and their practical implementation to ensure consistent and equitable care for older adults. 

• Holistic care approach: Effective end-of-life care should integrate medical treatment with social and emotional support, honouring the preferences of older adults to receive care in familiar environments. 

• Addressing systemic disparities: Policymakers must recognise and address the systemic factors contributing to regional inequalities in end-of-life care provision, ensuring that all individuals have access to high-quality care regardless of location. 

Commentary 

This study highlights significant geographical disparities in the provision of end-of-life care for older adults in England. Variations in local resources and funding result in unequal access to quality care, with some regions unable to fully implement national policies due to systemic constraints. These inequities underscore the necessity for targeted policy interventions that consider regional differences, aiming to provide equitable end-of-life care services across all areas. Addressing these disparities is essential to honour the preferences of older adults and to ensure that high-quality care is accessible to all, irrespective of geographical location.