18. CGA in Primary Care Settings: End of life care issues
Many of the principles of care at the end of life are shared with comprehensive geriatric assessment, however the philosophy of treatment is likely to shift even further towards symptom management rather than long-term disease treatment and health maintenance.
A key component in the assessment of the dying patient is recognition by the healthcare team, the person themselves, and their family and friends that the person is near to the end of life. This can be relatively clear with a well-recognised, progressively terminal diagnosis such as metastatic cancer, but can be more difficult if the underlying problem is less well circumscribed and widely understood, such as in advanced frailty. Frailty correlates with prognosis but even in advanced states, this is often missed due to its insidious progress and the difficulties differentiating frailty from ‘normal’ ageing.
End of Life care refers specifically to the last few days or hours of life, when maintenance of comfort and dignity, and avoidance of pain and distress take priority. Efforts to codify an approach to this are challenging, not least due to cultural attitudes to death and dying. It is not disputed though that, with or without a formal tool to assist the assessment and treatment of a person at the end of their life, an individualised approach is key. Local guidelines and documentation standards may be useful here.
Coordinate My Care Record: An online clinical record to document information and clinical plans for people at the end of their lives.
See also the Good Practice Guide in this series: Care and support planning in CGA.