For people 90 years old and above, the prospect of dying is one they encounter every day, much in the same way they face mornings and evenings.

In the United Kingdom, more and more people are living into old age because of improvements in lifestyle and environment. In Britain alone, about 500,000 centenarians are expected to live by 2066.

Another report by the Office of the National Statistics also revealed that in the UK, the number of people who died at the age of 90 and above had increased threefold in the past 30 years.

Despite the growing number of elderly in the country, however, researchers from the University of Cambridge said little is known about what the "oldest old" feel about the end of their lives. Additionally, little is known about the difficult decisions regarding their end-of-life care.

Living Beyond 90

Led by Jane Fleming of the university's primary care and public health department, the Cambridge researchers interviewed 33 elderlies who were aged 95 and older, or their proxy - a relative or a member of the care home staff - about attitudes toward dying, death and end-of-life care.

Researchers found that the participants were willing to discuss dying and their end-of-life care, but they are rarely asked about it.

Most of the study participants had outlived their peers. Many of them felt they were living on "borrowed time," but felt grateful for the each day that passed by, not worrying about tomorrow.

One of the elderlies described only being "three-quarters of the way" through her life, but majority of the interviewees knew and accepted that they were going to die soon.

Some of the participants said they felt they were being a burden to the people around them, while others said they had lived too long.

Many of the participants were concerned about how they would die and when, hoping they would slip away quietly in painless sleep.

"I'd be quite happy if I went suddenly like that," said one of the participants.

When asked if they wanted lifesaving medical care or treatment to help them remain comfortable, most preferred comfort. Few said they wanted to be admitted to the hospital if they got sick.

Majority of the participants said they were not afraid of dying, while for some, seeing the peaceful death of others was encouraging.

The topic of funeral planning and preparation was more common among elderlies than open discussions about death, researchers found. Some of the interviewees had made preparations for themselves in advance.

Knowing Preferences

Fleming and her colleagues found that most of the interviewees had had discussions about end-of-life preferences with health care professionals and seldom with family members.

Nevertheless, proxies tended to feel that they know the elder's preferences, although the study found in several instances that the proxies' guesses were wrong.

A care home manager said that professionals do not necessarily broach the topic with the individual and go straight to relatives.

Fleming said it is very important to know the views and concerns of elderlies when it comes to dying and end-of-life care.

She said these are very difficult conversations, and no one wants to face their own death or the death of a loved one, but talking about it before it is too late can ensure that the person's wishes can be heard.

The team's findings are featured in the journal PLOS-ONE.

Photo: Vinoth Chandar | Flickr