High-quality end of life care will enable older people with frailty to live well and die well

Covering the final year of life in people living with frailty, the guidelines address issues such as uncertainty faced by patients and their families, advance care planning, law and ethics, as well as management of common symptoms at the end of life such as pain, delirium, incontinence and swallowing difficulties.

The guidelines also highlights the need for good communication between healthcare providers, with patients and their families. It has been recognised that good communication from health care professionals can relieve families’ anxiety in circumstances whereby a patient’s interest in eating and drinking declines resulting in significant weight loss.

Support is also on offer to those caring for frail patients who are suffering from Covid-19 and are at the end of their lives. The guidance notes that clinicians and carers will need to give both the best physical care possible and also provide the human contact and comfort to older people who are dying - ideally provided by those they love.

 The guidelines are the result of 18 months’ work involving more than 30 contributors with expertise in a wide range of issues which affect older people towards the end of life.

Caroline Nicholson, Professor of Palliative Care and Ageing at the University of Surrey and Co-End of life Lead for the British Geriatric Society, said: “It is important that in a difficult area of medicine such as palliative care that health care professionals have the resources they need to make difficult decisions. As patients move towards their end of life, it is imperative that their wishes and needs are listened to and acted upon, it is important that healthcare professionals are supported in helping ensure these needs are met.”

Co-Editor of the guidelines, Dr Eileen Burns, commented: “Too often the clinical response to an acute deterioration in a frail older person is protocol or pathway driven, especially during an unprecedented crisis such as the one we are experiencing at the moment. This can lead to invasive and sometimes distressing treatments without pausing to reflect on the values and wishes of the older person who is being cared for. Even when the need for end of life care is recognised, its delivery can challenge clinicians.

“Providing high-quality, person-centred end of life care for older people with frailty must remain a priority for all healthcare professionals, during the current pandemic and in future.”