title: The influence of patient and carer age in access to palliative care services.
abstract: BACKGROUND
  Older patients are less likely to receive palliative care than younger patients. As patient and primary carer age correlate positively, patterns may be due to carer rather than patient age, and reflect better ability to obtain support among younger carers.
  
  
  OBJECTIVE
  To investigate how both patient and carer age relate to palliative care use, controlling for relevant variables.
  
  
  METHODS
  Comparison of patients who received community Macmillan nurse specialist advice, Marie Curie nursing or inpatient hospice care with patients who did not, using univariate analysis and multivariate logistic regression. Patient and carer data were collected through electronic service record linkage and carer post-bereavement interviews.
  
  
  METHODS
  patients referred to a hospice at home service whose primary carer could be interviewed (n = 123).
  
  
  RESULTS
  Whilst a cancer diagnosis was an important determinant of access for all services considered, logistic regression shows that carer age, but not patient age, and hospice at home access predicted Marie Curie nursing use. Both patient and carer age predicted use of Macmillan nurse advice. Age of the patient, but not carer age, predicted admission to inpatient hospice, alongside requiring care for over a month (all P < 0.05).
  
  
  CONCLUSIONS
  Carer age may be as important a predictor of palliative home care use as patient age. We need to investigate whether younger carers have greater support needs or show greater effectiveness in obtaining help and to assess whether older carers need more assistance in recruitment of support.
authors.affiliation: School of Nursing, Midwifery and Social Work, The University of Manchester, Coupland III, Oxford Road, Manchester M13 9PL, UK. Gunn.Grande@manchester.ac.uk
authors.forename: Gunn E
authors.initials: GE
authors.lastname: Grande
authors.forename: Morag C
authors.initials: MC
authors.lastname: Farquhar
authors.forename: Stephen I G
authors.initials: SI
authors.lastname: Barclay
authors.forename: Chris J
authors.initials: CJ
authors.lastname: Todd
mesh_terms: D000368:Aged; D000375:Aging; D017028:Caregivers; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care