Palliative care provisions are not meeting the needs of an ageing population

A commentary published today in Age and Ageing, the scientific journal of the British Geriatrics Society, warns despite the fact that frail older people with multiple illnesses and end stage dementia are the most rapidly growing group in need of palliative care current provisions are not aligned to meet their needs.

The authors of the commentary noted that current projections indicate that between 25% and 47% more people may need palliative care by 2040 in England and Wales. A high proportion of these people will die following a prolonged period of increasing frailty and co-morbidity including cancer, but also other long-term conditions such as heart failure, chronic obstructive pulmonary disease, diabetes or renal failure. Continue reading

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

aaIn 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. Continue reading

Forgotten wisdom: what happens when we die?

8376547873_822be9a7e4_oDr Kathryn Mannix is a Palliative Care consultant based at the Royal Victoria Hospital in Newcastle, who began the UK’s first dedicated palliative care CBT clinic.

‘We’re all going to die!’

No, not a scary action movie, but life. We have been dying for millennia and notwithstanding medical advances, the death rate remains 100%. And yet, despite so many opportunities to study the phenomena around dying, most doctors are unable to describe the process that takes people out of the world.

What a contrast with the processes of pregnancy and birth, to which magazines, shops and websites are dedicated; lessons are delivered in schools; couples are invited for ‘birth practice’ sessions as the due date approaches… Perhaps not all of these analogies are directly transferable to the process of dying, especially as 50% of candidates will expire suddenly, but dying is a recognisable process and modern medicine has largely forgotten it in the rush to postpone it.

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You know you’re a Geriatrician when… you ignore ‘date of birth’

5374200948_aae6df98f9_oClare Bostock is a consultant geriatrician in Aberdeen. In this blog, she looks at issues around ‘date of birth’ and ageism.

It sounds very clichéd to say that I ignore date of birth, and it is not strictly true. I routinely check the date of birth of patients for two key reasons: identification, and as a test of cognition (4AT). The truth is, however, that I don’t think age is important and so I often don’t know how old my patients actually are!

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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

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”. Continue reading

Dying isn’t Working

Following Kate Granger’s blog entry on her personal response to the withdrawal of the Liverpool Care Pathway, we present a blog from Jason Suckley, director of Policy and Campaigns at Sue Ryder, explains what healthcare professionals could do to improve end of life careTrees-nurse-man-wheelchair

In a civilised society and 65 years since the establishment of the NHS, it’s totally unacceptable that individuals and their families remain unsupported at the one of the most life-changing and emotionally challenging times.  Your diagnosis, where you live, or who your doctor is shouldn’t pre-determine whether or not you have a good death – we want to change that.

To work towards addressing the problem, in June, we launched our campaign, “Dying isn’t Working”.  The campaign is based on our own experience as a service provider of end of life care and evidence from two reports we’ve produced with think-tank Demos – Ways and Means (published on 19 June), looking at barriers to accessing end of life care, and A time and a place (published on 9 July), exploring what people want at end of life.  Insights from the reports highlight a number of ways in which healthcare professionals can improve end of life care for all. Continue reading

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 shutterstock_137790233

 

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. Continue reading

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. Continue reading