Care of Dying Elderly

• Improved Education
  Palliative care teams are eager to provide education to those who care for patients nearing the end of their lives. Training in holistic assessment, symptom management (both physical and psychological), and communication skills may be included.

  • Improved communication with the palliative care team
  • Integrated Care Pathways

A dying patient integrated care pathway has been developed5 ("the Liverpool care pathway"). This is increasingly being utilized to improve care for patients dying in hospitals and at home. The approach is intended for patients with a known diagnosis who have worsened to the point where death appears to be unavoidable. Symptoms are evaluated and managed predictably, with a focus on comfort, communication, and death preparation with spiritual support.

• Others

  • Advance directives are becoming more prevalent and can assist clinicians make tough decisions in the best interests of patients who are unable to give consent. Such directions may be of limited utility because they frequently do not explain the exact clinical scenario in advance. A living will cannot compel a doctor to do therapy that he believes is wrong. The BGS, RCP, and x collaborated to create Advance Care Planning advice.

  • The mental capacity legislation, which went into effect in 2007, permits patients to appoint a "health advocate" to help them make treatment decisions.

  • Legal boundaries between allowing death and facilitating death are difficult to draw, and while patients have the right to choose their own treatment while they retain capacity, there is no legal right to die.

  • The BGS guidance on "Nutritional advice in frequent clinical circumstances" addresses eating and hydration issues (part of the BGS Good Practice Guide of Guidelines, Policy Statements, and Statements of Good Practice)