Unlike other conditions, most people with dementia, including Alzheimer ’s, die in care homes. Of those who died with one of these conditions recorded as the main underlying cause of death, some 59% died in a nursing or residential home compared to 32% in hospital. The report also shows that people who die from cardiovascular disease, cancer or respiratory illness are significantly more likely to die in a care home if dementia including Alzheimer ’s is a contributory factor in their death.
“ Caring for people at the end of their lives is an important role for many health and social care professionals. One of the key aspects of this role is to discuss with individuals their preferences regarding the type of care they receive and where they wish to be cared for”
“ Contrary to concerns by GP’s about patients becoming distressed or rejecting the conversation, the study found 90% choose to continue the conversation when initiated by their GP. Patients who talked about their preferences with their GP were more likely to be placed appropriately on the EoL register, and have their preferred place of death & core preferences added to their medical records.”
NCPC Project (2010) - ”dying to talk to your GP?”
Identification of EoL patients that may benefit
Many with chronic illness(s) reach a point where it is evident they are going to die from their condition.
Other conditions can be difficult to accurately predict.
Taken from GSF Prognostic Indicator guide 2008 High Low Function Time Cancer High Low Function Time Fraility/Dementia High Low Function Time Organ Failure GP ’s Workload Ave 20 Deaths per GP per year
I now have MND and benefit from PEG feeding. As my condition deteriorates, if I should lose consciousness and am not expected to recover after 24hrs, I wish feeding, hydration and any other life prolonging treatment such as antibiotics to be withdrawn or withheld although medication such as painkillers for my immediate comfort can be used. This decision to apply even if my life is at risk ”
Valid ADRTs I wish to refuse the following specific treatments:- In these circumstances:- Artificial (mechanical) breathing machine If I have had a severe stroke with little chance of recovering consciousness Antibiotics If my dementia means that I cannot not make the decision, in the event that I have a severe chest infection that might threaten my life. Artificial feeding (via a tube or drip) When my dementia has deteriorated to the point that I cannot swallow safely, even with the help of others
The process of ACP can enable people to think about, discuss and have their wishes recorded in advance of an anticipated decline in their health.
ACP conversations and documents can be referred to if/when a person lacks the capacity to make a decision about their care and treatment. However, it also guides and can instruct loved ones, health and social care staff to plan and deliver appropriate and realistic care for each individual.
Not desirable for everyone. We need to think critically about if, how and when we implement ACP into practice and our assessments.
So..ACP is more likely to benefit people when it takes place:-