No Les, No Moore

5801631762_dd88709954_oPaula Shepherd is a University Practice Learning Adviser for Bournemouth University; supporting pre-registration health education in practice. @pshepherdBU

‘Here lies Lester Moore, 4 slugs, from A44, No Les, No Moore’

At the age of 14, I received the ‘A Small Book of Grave Humour’ in my Christmas stocking. It contains tombstone inscriptions which reflect characteristics of the person memorialised or, should I say, the person selecting the stone. An odd selection for a child, but even at that formative age I realised that we all live on in some form, what we do influences the way the world works; has an impact. So why, I wonder, do we seem so reluctant to incorporate life and death as unified progression? Continue reading

Death rates in care homes – a measure of quality?

Dr Eileen Burns is the recently elected BGS President Elect and is a Consultant Geriatrician at St James’s Hospital, Leeds.shutterstock_106616363

 “My Mum no longer recognises me or my sisters. She needs help with everything- washing and dressing, eating and drinking. She is incontinent. If she could see herself like this she would be distraught. We were very relieved when her GP met with us to discuss what we felt she would have wanted for herself in this situation. We don’t feel that there is anything to be gained for her by another hospital admission- unless she has a problem which is causing her distress which they can’t alleviate here in the home. We’d like her to die here with the dignity she has left in the place and with the carers she’s familiar with”

The recent spotlight on increasing death rates in care homes accompanied by commentaries implying that this is an unwanted and regrettable development put a naive and simplistic gloss on a complex issue. Continue reading

Dyson’s Law and the Medical Registrar: A frontline view

This is a follow-up to Dr Aroras’ earlier blog about the recent legislations surrounding Do Not Resuscitate [DNR] orders. Dr Suthahar, who is a final year geriatric registrar, reflects on the immediate impact of the legislation on the wards and the acute general take.shutterstock_139322513

They say change comes slowly to the NHS… Think of the time it takes for the latest NICE guidance, CQUINs, newest drug or quality measures to filter down to the frontlines of clinical work. However in one stroke Lord Dyson in his landmark ruling on DNR orders and the legal necessity to communicate the DNR order to the patient or family members, has effectively changed clinical practice overnight. Continue reading

Ethics and care for older people approaching the end of life – Symptoms, Choices and Dilemmas

An RCPE Symposium with live links and international web streaming

Thursday, 3 April 2014.
Royal College of Physicians of Edinburgh.
The Queen Mother Conference Centre, Edinburgh.

The care of patients approaching the end of life is once again a controversial and high profile topic. The provision of high quality care to older patients with complex health and social care needs brings a unique set of clinical and ethical challenges. Lectures and interactive case discussions will cover symptom control in chronic pain, vertebral fracture and advanced heart failure; ways of delivering advance care planning for older people in the community; ethical decision making in advanced dementia, around nutrition at the end of life, and around escalation of care. Our endowed lecture will consider how we can deliver high-quality end of life care across the health service in the post-Liverpool Care Pathway era. A series of interactive cases will allow exploration of practical approaches to ethical dilemmas at the end of life.

This symposium will be of practical value to all healthcare professionals in the multidisciplinary team caring for frail, older patients including geriatricians, primary care physicians, general physicians and specialists in palliative medicine. Attendees will improve their knowledge of symptom control in difficult conditions, improve their decision-making in challenging ethical situations including advanced dementia, and will gain perspective on the recent debate regarding the optimal organisation and delivery of end of life care in the hospital and community.

Dr Miles Witham
Chair, Organising Sub-Committee

Click here for more information