Measuring and monitoring the quality of dying in the UN Decade of Healthy Ageing

Rowan H Harwood¹, Jotheeswaran Amuthavalli Thiyagarajan², Afsan Bhadelia³, Andrea Foebel⁴, Catriona R Mayland⁵, Chetna Malhotra⁶, Deborah Blacker⁷, Elizabeth L Sampson⁸, Eric Andrew Finkelstein⁶, Harmehr Sekhon⁹, Jean Woo¹⁰, Jenny T van der Steen¹¹, Julia Verne¹², Leon Geffen¹³, Lieve Van den Block¹⁴, Mayaline Youssef¹⁵, Megan Doherty¹⁶, Moise Muzigaba¹⁷, Muthoni Gichu¹⁸, Sarah Hopkins¹⁹, Shampa Sinha²⁰, Julie Ling²¹, Stefania Ilinca²¹, Ritu Sadana²², Matteo Cesari²², Yuka Sumi²², Alana Officer²³, Theresa Diaz¹⁷, Anshu Banerjee²⁴

Affiliations

¹ School of Health Sciences, University of Nottingham, Nottingham, UK.
² Ageing and Health Unit, Department of Maternal, Newborn, Child and Adolescent Health and Ageing, WHO, Geneva, Switzerland. Electronic address: amuthavallithiya@who.int.
³ Department of Public Health, College of Health and Human Sciences, Purdue University, Lafayette, IN, USA.
⁴ Indicator Research and Development, Canadian Institute for Health Information, Ottawa, ON, Canada.
⁵ School of Medicine and Population Health, University of Sheffield, Sheffield, UK.
⁶ Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore.
⁷ Harvard T H Chan School of Public Health, Harvard Medical School, Boston, MA, USA.
⁸ Academic Centre for Healthy Ageing, Barts Health NHS Trust & Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, London, UK; Department of Psychological Medicine, Royal London Hospital, East London NHS Foundation Trust, London, UK.
⁹ Department of Medicine, Division of Geriatric Medicine, McGill University, Montreal, QC, Canada.
¹⁰ Jockey Club Institute of Ageing, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.
¹¹ Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands.
¹² Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK.
¹³ The Albertina and Walter Sisulu Institute of Ageing in Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
¹⁴ VUB-UGhent End-of-Life Care Research Group, Vrije Universiteit Brussel, Department of Family Medicine and Chronic Care, Brussels, Belgium.
¹⁵ School of Public Health, University of Montreal, Montreal, QC, Canada.
¹⁶ Clinical Services and Systems, Department of Integrated Health Services, WHO, Geneva, Switzerland.
¹⁷ Epidemiology, Monitoring and Evaluation Unit, Department of Maternal, Newborn, Child and Adolescent Health and Ageing, WHO, Geneva, Switzerland.
¹⁸ Division of Healthy Ageing, Palliative Care and Older Persons, Ministry of Health, Nairobi, Kenya.
¹⁹ Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
²⁰ Department of Palliative Medicine, St Vincent's Hospital, Sydney, NSW, Australia.
²¹ Health Workforce and Service Delivery, European Regional Office of WHO, Copenhagen, Denmark.
²² Ageing and Health Unit, Department of Maternal, Newborn, Child and Adolescent Health and Ageing, WHO, Geneva, Switzerland.
²³ Demographic Change and Healthy Ageing Unit, Department of Social Determinants of Health, WHO, Geneva, Switzerland.
²⁴ Ageing and Health Unit, Department of Maternal, Newborn, Child and Adolescent Health and Ageing, WHO, Geneva, Switzerland; Epidemiology, Monitoring and Evaluation Unit, Department of Maternal, Newborn, Child and Adolescent Health and Ageing, WHO, Geneva, Switzerland.

PMID: 40716442
DOI: 10.1016/j.lanhl.2025.100739

Free article

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Measuring and monitoring the quality of dying in the UN Decade of Healthy Ageing

Rowan H Harwood et al. Lancet Healthy Longev. 2025 Jul.

Free article

. 2025 Jul;6(7):100739.

doi: 10.1016/j.lanhl.2025.100739. Epub 2025 Jul 24.

Authors

Affiliations

¹ School of Health Sciences, University of Nottingham, Nottingham, UK.
² Ageing and Health Unit, Department of Maternal, Newborn, Child and Adolescent Health and Ageing, WHO, Geneva, Switzerland. Electronic address: amuthavallithiya@who.int.
³ Department of Public Health, College of Health and Human Sciences, Purdue University, Lafayette, IN, USA.
⁴ Indicator Research and Development, Canadian Institute for Health Information, Ottawa, ON, Canada.
⁵ School of Medicine and Population Health, University of Sheffield, Sheffield, UK.
⁶ Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore.
⁷ Harvard T H Chan School of Public Health, Harvard Medical School, Boston, MA, USA.
⁸ Academic Centre for Healthy Ageing, Barts Health NHS Trust & Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, London, UK; Department of Psychological Medicine, Royal London Hospital, East London NHS Foundation Trust, London, UK.
⁹ Department of Medicine, Division of Geriatric Medicine, McGill University, Montreal, QC, Canada.
¹⁰ Jockey Club Institute of Ageing, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.
¹¹ Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands.
¹² Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK.
¹³ The Albertina and Walter Sisulu Institute of Ageing in Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
¹⁴ VUB-UGhent End-of-Life Care Research Group, Vrije Universiteit Brussel, Department of Family Medicine and Chronic Care, Brussels, Belgium.
¹⁵ School of Public Health, University of Montreal, Montreal, QC, Canada.
¹⁶ Clinical Services and Systems, Department of Integrated Health Services, WHO, Geneva, Switzerland.
¹⁷ Epidemiology, Monitoring and Evaluation Unit, Department of Maternal, Newborn, Child and Adolescent Health and Ageing, WHO, Geneva, Switzerland.
¹⁸ Division of Healthy Ageing, Palliative Care and Older Persons, Ministry of Health, Nairobi, Kenya.
¹⁹ Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
²⁰ Department of Palliative Medicine, St Vincent's Hospital, Sydney, NSW, Australia.
²¹ Health Workforce and Service Delivery, European Regional Office of WHO, Copenhagen, Denmark.
²² Ageing and Health Unit, Department of Maternal, Newborn, Child and Adolescent Health and Ageing, WHO, Geneva, Switzerland.
²³ Demographic Change and Healthy Ageing Unit, Department of Social Determinants of Health, WHO, Geneva, Switzerland.
²⁴ Ageing and Health Unit, Department of Maternal, Newborn, Child and Adolescent Health and Ageing, WHO, Geneva, Switzerland; Epidemiology, Monitoring and Evaluation Unit, Department of Maternal, Newborn, Child and Adolescent Health and Ageing, WHO, Geneva, Switzerland.

PMID: 40716442
DOI: 10.1016/j.lanhl.2025.100739

Abstract

WHO aims to identify metrics to monitor the quality of dying, complementing those indicators proposed under the UN Decade of Healthy Ageing. However, the proposed criteria for a good death are contentious. Needs and priorities vary between individuals and their carers, across conditions, over time, and across communities and cultures. Monitoring should also consider sudden or rapid deaths and assisted dying. Fundamental challenges in data collection include who reports, over what timeframe, and when. This Personal View explores these challenges, identifying potentially measurable indicators and ambiguities in their use, and offers recommendations towards a practical measurement framework. We aimed to define a concise, meaningful, and pragmatic set of indicators that could be collected and applied universally across countries and over time. We define a logic model of candidate variables at different conceptual levels and describe an empirical exercise for prioritising and operationalising these variables for measurement.

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Conflict of interest statement

Declaration of interests ELS reports her role as Vice-chair of the UK Faculty of Liaison Psychiatry. ABh reports receiving a Fulbright US Scholar Teaching and Research Award from the Bureau of Educational and Cultural Affairs, US Department of State, for work related to palliative care and outside the submitted work. ABh also received consulting fees through a research grant from the Medical Research Council to the University of Edinburgh and from the University of Miami Institute for the Advanced Study of the Americas for work related to palliative care and outside the submitted work. LVdB reports receiving institutional funding for EU-funded projects (EU NAVIGATE, PACE, INDUCT, and DISTINCT) under European Commission grant agreements. LVdB also reports institutional funding from national and charitable sources, including the Research Foundation–Flanders (FWO), Flanders Innovation & Entrepreneurship (VLAIO), Francqui Foundation, Research Council of the Vrije Universiteit Brussel, Kom Op Tegen Kanker (Flemish Stand Up To Cancer), Alzheimer Foundation, and King Baudouin Foundation. Additionally, she received personal honoraria or expense reimbursements (including travel, accommodation, and preparation time) for lectures delivered to caregivers, citizens, and professionals, organised by the Flemish Federation of Palliative Care, universities, postgraduate programmes, and umbrella organisations. For lectures at international conferences (eg, European Association for Palliative Care, Alzheimer Europe), registration fees, travel, and accommodation were covered by the event organisers. HS reports grants from the Alzheimer’s Society of Canada and St. Mary’s Research Centre and Foundation and travel support from the AGE-WELL Rising Star Award. JTvdS reports funding from the European Research Council Consolidator Grant, Leiden University Medical Center, Leiden, Netherlands, and Radboud University Medical Center, Nijmegen, Netherlands. RS reports funding from the Velux Stiftung Foundation, travel support from the Global Female Leaders and Canadian RTOERO. Moreover, RS is a member of The Lancet Healthy Longevity International Advisory Board, and has an unpaid Faculty Associate position at the Center for Health Policy Research, UCLA, CA, USA. JW is a member of The Lancet Healthy Longevity International Advisory Board. All other authors declare no competing interests.

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Measuring and monitoring the quality of dying in the UN Decade of Healthy Ageing

Affiliations

Measuring and monitoring the quality of dying in the UN Decade of Healthy Ageing

Authors

Affiliations

Abstract

Conflict of interest statement

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical