Practical palliative care after stroke

Dr Ruth England is a Consultant in Palliative Medicine at Royal Derby Hospital. She tweets @DrRuthEngland. She will be speaking at the upcoming BGS event Living and Dying Well with Frailty on 6 March in London. Please note this event has now SOLD OUT.

Palliative care is an active, holistic approach to those facing life-threatening illness. Good palliative care allows us ‘to live as well as possible for as long as possible’; and includes support for those approaching the end of their life.

In the UK, someone suffers a stroke every 5 minutes. Although there has been a decline in stroke mortality, it remains a leading cause of death in those aged over 65.  There a high risk of dying immediately after an event, and 40% of those affected by stroke die within a year. Long term survivors are likely to be burdened with ongoing physical, psychological and social issues.

The chasm of dementia; a carer’s perspective

Sue Newsome supported her Father during the last year of his life after he was diagnosed with Vascular Dementia. In this blog she shares her thoughts and feelings from a carer’s perspective.  

Supporting someone with Dementia is a contradiction of what it is ok to feel and the guilt about those feelings. A whole raft of thoughts, feelings and behaviours that I continually checked and reviewed. My relationship with Dad changed, he had never said he was scared before and I was to hear this from him throughout his Dementia journey.

Initially in his phone call to me telling me ‘Sue I am scared I am having a Stroke’ which although slurred was articulate, to the same feeling the night before he died when despite his end stage Dementia and aspiration pneumonia, when he struggled to breathe, he managed to say ‘I’m scared’. His fear and mine punctuated our relationship for the last year of his life. Our fear of the future what it held and how we could adapt. It felt like I held my breath for a year. Living on adrenaline, the skipped heartbeat when the phone rang, what had happened to Dad this time!

Esther Clift’s African Blog Series; Part 3 ‘Palliative care’

Esther Clift is a Consultant Practitioner Trainee in Frailty with Health Education Wessex. This is the third part of a four part BGS blog series about her time in Africa. She tweets @EstherClift

The scourge of AIDS in the 1990s led to the introduction of palliative care as both a medical speciality in symptom management and a community initiative to support people at the end of their lives to live at home with their loved ones. Communities identified and trained community carers to offer practical support for activities of daily needs. Some palliative care facilities were developed, particularly in Uganda where AIDS was rife, and the government and NGOs were particularly proactive in both prevention measures and care, as both centres of training and excellence, as well as hospice care.

Palliative care for frail older people: what, when and how?

Anna Bone is a Cicely Saunders International PhD Training Fellow in the Department of Palliative Care, Policy, and Rehabilitation at King’s College London. In this blog Anna discusses her recent Age and Ageing paper on developing a model of palliative care for frail older people. This is part of the OPTCare Elderly Study, a joint project between King’s College London and Sussex Community NHS Foundation Trust, led by Dr Catherine Evans. @AnnaEBone

In the minds of many, palliative care is synonymous with cancer and end of life. This is unsurprising, as it is within this context that palliative care has developed. The goal of palliative care is to relieve suffering and improve the quality of life of people with life threatening illness. It is increasingly believed that palliative care has much to offer to other patient groups whose health is deteriorating, and not just at the end of their life.
People are now living longer, with multiple chronic illnesses and frailty, and dying at older ages. We need to consider the needs of this growing group. Specialist palliative care services for frail older people with deteriorating health may provide an extra layer of support to help them and their families live as well as possible.

The Liverpool Care Pathway has been made a scapegoat

“It is as illogical to discredit the LCP because of errant clinicians as it is to ban the Highway Code because of bad drivers.”

Claud Regnard, FRCP, a palliative care consultant, has called the demise of the Liverpool Care Pathway a “tragedy” in his paper published in Age and Ageing today.

After a series of media stories about the palliative care system causing malnutrition, dehydration, and premature death in patients across a wide age-range, the Liverpool Care Pathway (LCP) was subject to review by a panel under Baroness Neuberger. The panel delivered their findings on 15 July 2013. They said that the LCP needed to abandon its name, as well as the use of the word “pathway”, and that the LCP should be replaced within 12 months by an “end of life care plan”.

Assessment of pain in older adults with dementia – there’s an app for that

Professor Pat Schofield leads research around pain, ageing and dementia at the University of Greenwich. She is the Chair of the Pain in Older People SIG at the British Pain Society. She describes the development and initial trial of a new Pain App that is targeted at frail, older patients.  

Pain in the older population is a common problem, and can be under-recognised and under-treated. Recent prevalence studies suggest that chronic pain exists in over 50% of community dwelling older adults and this increases to over 80% when we look at those living in long term care. We also know that the incidence of dementia in the UK and the rest of the world is high and set to increase significantly over the next 20 years.

What is the future of care for the dying?

Kate Granger is an Elderly Medicine Registrar at Pinderfields Hospital in Yorkshire. She tweets at @GrangerKate and blogs at drkategranger.wordpress.com 

 

As a vocal advocate of the Liverpool Care Pathway I have experienced a wide range of emotions since the publication of the Independent Review regarding its use, ‘More Care, Less Pathway’.

Initially I was shocked something which had become a routine part of my post registration working life was going to be scrapped. I cannot recall such a prominent change in practice since I qualified. Personally I always found the LCP a very useful framework to employ when caring for dying patients.  As the shock subsided I will admit to some negative emotions; I was upset and angry but mostly disappointed; disappointed that our efforts to dispel the media misrepresentation and scaremongering had been in vain. A feeling of indifference followed. This is a rare feeling for me to experience when it comes to anything Palliative Care related; I am usually so passionate.

Chronic disease begins in childhood

A conference report from the BGS Spring Meeting in Belfast, by Liz Gill.

Research is increasingly suggesting that old age is influenced by conditions and events in early life, a concept supported by data from The Irish Longitudinal Study on Ageing, TILDA, which has studied 8,500 people aged 50 and over for the past ten years. Opening a special session on the last morning of the conference, its principal investigator Prof Rose-Anne Kenny of Trinity College Dublin, described the process. Participants were given an initial comprehensive assessment which included physical health, cognition, psychology, behaviour, family background and use of health care. They were then revisited every two years providing a rich set of data involving almost one in every 140 people in Ireland.

The war against dementia: are we battle weary yet?

Dr Heather Lane is a PhD Candidate at the Centre for Palliative Care, St Vincent’s Hospital and Consultant Geriatrician, Eastern Health, Melbourne, Australia.

I have noticed expressions such as ‘fighting’ or ’battling’ dementia increasingly being used, not only in the popular media, but also in the medical literature.  These sort of military metaphors have long been used in medicine, particularly when referring to cancer. I work in a palliative care unit as well as in geriatric medicine and doing so has given me some opportunity to reflect on the importance of such terminology. In a recent Age and Ageing article I considered what we have learned about the use of such metaphors from palliative care and oncology and what effect they have on how we manage and support patients with dementia.