End of Life Care and the BGS
Premila Fade (Consultant Geriatrician) and Caroline Nicholson (Professor of Nursing) are the BGS joint leads for End of Life Care. This blog explains their passion to improve end of life care for people living and dying in late old age and their ambition to create a new SIG focussing on this vital area of our practice.
Historically, geriatricians had to battle for older people to have the same access to emergency medical care as younger patients. However, increasingly the focus of our practice is to explain to older people and their families, the limitations and possible adverse consequences of medical interventions. Our strengths are our generalist knowledge and skills, and our ability to factor frailty into complex medical decisions. The development of highly technical medical specialities has, to the detriment to our patients, fragmented medical care. Consequently, the need for integrated multispecialty multi-professional person-centred care for older people is rightly now the focus of the BGS.
Despite the statistics about the ageing population and the increase in people living with multiple chronic diseases, the NHS still provides most primary and secondary care based on a model of healthcare for single diseases and discrete episodes of healthcare need. At all levels, continuity of care has been lost, leading to duplication of interventions, multiple care providers and often poor recognition that a person is becoming severely frail. Thus the need for a change in emphasis of care, to recognise that end of life is approaching, does not always happen We know that accurate prognosis is very difficult. People can live for many months with advanced frailty and be “discharged” from services because their condition is apparently stable. Then, an acute deterioration occurs a few weeks later, leading to inappropriate hospitalisation because the alternatives have not been discussed nor the person’s preferences identified. Conversely, good end of life care can facilitate appropriate hospital admissions and timely discharge - evidence suggests such approaches can extend quantity as well as quality of life.
End of life care is integral to good geriatric medicine and whilst specialist palliative care services are important, we need to develop and extend integrated working across care sectors which recognise the value of both disciplines. Geriatric medicine is, at its heart, a balancing of (patient centred) objectives – prolonging life, reducing disability, improving symptom control, whilst acknowledging that life is finite and may be nearing its end. A significant proportion of our work is palliative, but because we don’t always use this terminology, our skills and expertise in this area have, in the past, been under-estimated, by ourselves as well as perhaps by others.
As part of our work as BGS leads for End of Life Care, we are creating good practice guidance on End of Life Care for Older People Living with Frailty, but we want to do more. We would like to create a BGS Special Interest Group in order to gather expertise, stimulate research, wrestle with the complexities of living and dying in old age, link with external organisations working in palliative care and continue to develop and share good practice in this important area. We want to work with you to promote a vision of palliative care for older people which is holistic, personalised and involves those caring for the older person; adding life to years, not just years to life.
If you are passionate about providing the best possible care for people approaching the end of life and think that there should be an End of Life Care special interest group then please email Jo Gough scientificofficer [at] bgs [dot] org [dot] uk to express your interest.