Palliative care for older people in nursing homes.

Healthcare does not follow a linear track of prevention, health gain, health maintenance and palliative care. Instead, aspects of each occur to differing degrees at various stages of life 1 . While the palliative care component increases as we near the end of our life span, we also engage in a range of preventive measures in later life (and in nursing homes) such as influenza vaccination, falls prevention programmes, and cardiovascular prevention. Finding the right equipoise between the various components is a complex task, and the emergent interest in end of life care for older people provides an opportunity for reflection on the global care needs of this population. This is a significant issue, as although at any one time less than 5% of older people are resident in nursing homes, 46% of older people will spend time in a nursing home before they die 2 . Those in nursing homes are the most frail group of older people 3 , and nursing homes are an increasingly common place for older people to die. Are there synergies for improving during-life and end of life care in nursing homes, and what skill sets do we need to develop to ensure person-centred care throughout the stay in nursing home?