Good care for older people at the end of life: Shared responsibilities, flexible boundaries

The majority of deaths occur among older adults, many living with frailty, multimorbidity, disability and/or cognitive impairment. When care is organised around single diseases and episodic crises, people can experience fragmented, reactive care and burdensome interventions. We argue that good end-of-life care is a shared responsibility across settings, requiring flexible boundaries between geriatric medicine, palliative care, primary care, social care and the voluntary sector. Clinical vignettes illustrate challenges including prognostic uncertainty, treatment burden, transitions between services, and achieving preferred place of care and death. We propose neighbourhood-based, person-centred care that anticipates deterioration: shared decision-making and parallel planning; minimising treatment burden (including deprescribing); coordinated anticipatory care plans with accessible records; and timely care in the last months focused on comfort, dignity and family support. Delivery depends on appropriate funding and workforce capacity.