Decrepit death as a discourse of death in older age: implications for policy

Background.  In Australia, care of the older person dying in residential aged care is contentious. This paper reports on selected results of a study of aged and palliative care policies, undertaken to elicit discourses of dying in aged care environments. Aims.  To gain understanding of the relationship of policy to practice and to highlight commonalities and differences between aged and palliative care policies. Design and method.  Utilizing discourse analysis, a range of palliative care and aged care documents were analysed, to explicate layers of complexity. Two divergent discourses emerged in the data organization. Results.  The dominant palliative care discourse about dying decries an 'undeserved death'; the discourse about an older dying person is described as 'decrepit death'. These competing discourses provide a framework for examining emerging national policy work to improve care of the dying. Conclusions.  Dying in residential aged care has been hidden and unacknowledged by the community. The challenge of providing more equitable care has recently received significant government policy attention. Relevance to clinical practice.  Policy influences practice; both aged care and palliative care nurses, could benefit from understanding the place of policy in implementing changes on behalf of those in their care.