New research from the University of Cambridge, and funded by Marie Curie, shows that frail, elderly people without an ‘end of life’ diagnosis are missing out on care compared to people with single conditions such as cancer. Marie Curie’s Chief Nurse, Julie Pearce, looks at comments made by nurses who took part in the study, and reflects on how to make sure elderly people get the care they need at the end of their lives.
“A cancer diagnosis opens up so many doors for people, regardless of your age but if you’re frail and elderly and just dying what have you got?” – Community Nurse
In healthcare, cancer pathways are well recognised and patients receive timely diagnosis and evidence-based treatments. The comment that cancer opens doors is one I recognise. Sadly, if someone is elderly, has a number of underlying conditions and is becoming frailer, it is not always easy to recognise when the person’s health is reaching the end of life phase. If there is no ‘end of life’ marker then they don’t easily fit with a clear referral for end of life care.
Given the uncertainty of prognosis of the elderly, healthcare professionals should look at the person in front of them and focus on the needs of the individual instead of their diagnosis.
This shift would inform a more nuanced approach and allow for conversations about ‘what matters most to you’, which will identify needs and care priorities. Everyone deserves to get the care and support they need at the end of their life, regardless of their age or diagnosis.
The key learning here is that proximity to death, or the condition someone has, should not be the sole criteria for accessing good care.
“There’s a clear line of what happens if the patient is end of life – they get their preferred place of care, ‘Just in Case’ meds and we’ve contacted the next of kin” – Community Out of Hours Nurse
It’s clear from this comment that the ‘end of life’ tag opens up several other services and a clear plan. What we must do is look at how we can extend this to every older person who would benefit.
The research tells us that some care homes are very good at this because there is a reasonable expectation that residents may die soon, regardless of whether or not they are ‘end of life’.
The process of sitting with someone, sensitively talking through their wishes and, crucially, what is important to them, is a powerful experience. It helps cement person-centred care as the focus.
While your area of care might not involve Advance Care Planning, the ethos of person-centeredness and the question ‘what is important to them’ is possibly our best guide in addressing all of someone’s needs, as opposed to solely addressing the disease and symptoms that the person has.
How Coronavirus has helped collaboration
The current pandemic has pulled into sharp focus the importance of good care for all older people. We must ensure that everyone gets timely access to the right care. This may require advice from the GP and palliative care team about the best way of managing symptoms or any distress the person may be experiencing.
In recent months we’ve seen our hospice and community teams supporting residential and care home staff virtually in giving advice and facilitating advance care planning conversations, and in person through rapid response services. My view is that now more than ever we must continue to work together in a collaborative way to ensure that both staff and residents feel well supported.
For information and support resources on how to improve palliative and end of life care in all settings, please visit Marie Curie’s knowledge zone www.mariecurie.org.uk/professionals