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Gold Standards Framework - End of life care and geriatricians

At the BGS Autumn meeting in Liverpool, Martin Vernon, BGS EoLC Lead (and now NCD for older people and integrated care), threw down the gauntlet to geriatricians with the question, “is end of life care core business for geriatricians?”

His challenge calls into question whether caring for people approaching the end of their lives (using the GMC definition of those in the final year or so of life), is not part of mainstream geriatrics, which of course is wrong as it will be a significant part of everyday life and work for all geriatricians in every setting. But the question infers that sometimes, there may be a reluctance on the part of some geriatricians to embrace the concept of end of life care as a key part of the role, and some might struggle occasionally to be clear about the practical implications of this. 

 

Martin asked me, as a former GP and now National Clinical Director for the Gold Standards Framework Centre (GSF) in End of Life Care to respond, encouraged by the great partnership working we enjoy with the BGS, as we collaborate together to co-badge Quality Hallmark Awards in End of Life Care in hospitals. I affirmed the view that this is a key time for geriatricians who should be rightly proud of the contribution they are making. The growing ageing population living with multi-morbidities, multiple social issues and polypharmacy, presents an exciting opportunity to geriatricians, the experts in dealing with the complexity of care and increasing challenges of the elderly population. 

End of life care has been seen by some as the domain of specialist palliative care providers and hospices, with ‘overlapping territories’ that might occasionally appear to de-skill the vital and important role of geriatricians. However the Clarke study of 2014 (Pall Med) confirmed that at any one time about a third of people in hospital are in their last year of life, and we know that 85 per cent of people who die are over 65 years. Vital as palliative care teams are, in fact geriatricians and GPs provide the majority of medical cover for the one per cent of the population that die each year in our country.  

It is our experience at The GSF Centre, working with geriatricians in the community, acute and community hospitals that they play a key role, but that sometimes this active supportive care needs mobilising and enhancing. The Gold Standards Framework is a systematic process to support the identification, assessment and planning of care for patients in the last year of life. At the core of GSF is the belief in empowerment of teams and change in professional culture in order to support patients in planning ahead. 

Our GSF programmes focus on enabling generalists to reach their full potential in supporting all people with any condition, in any setting, as they near the last years, months, weeks and days of life. The GSF Centre is the UK’s largest training provider for end of life care training for generalists. 

GSF is widely used by GPs in the community at foundation or bronze level. More than 3000 care homes and teams in almost 100 hospital wards and other settings have completed the training. We focus on early recognition of decline, identifying the one per cent of the population, 30 per cent of hospital patients and 80 per cent of care home residents who may be in the last year of life, then assessing their needs though better listening with advance care planning discussions leading to better planned ways of living and when the time comes, dying. 

Prof Keri Thomas
National Clinical Director for the Gold Standards Framework Centre in End of Life Care

 

Tags: end of life care

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