The geriatrician’s role in end-of-life care

Ahmed, Nisar; Ahmedzai, Sam H; Harwood, Rowan H

Abstract

Healthcare aims to help older people to live well, but ultimately must also support them to die well. Most people die in old age, but predicting death in both short- and long-term is impossible for many, although not all, older people. Frail older people live with hope and pride in coping, and often anticipate recovery when ill. Key objectives of healthcare for older people are to maintain independence, minimise suffering and preserve dignity, which requires active medical, mental health and rehabilitation management, even when extending life is not the main goal. Thorough medical diagnosis and appropriate treatment and rehabilitation minimises disability, physical and mental distress and problems resulting from acute illness and crises. In these terms, ‘health gain’ can be achieved from medical intervention, even when life expectancy is short. Assumptions derived from cancer care about lack of reversibility with medical interventions are sometimes unwarranted. This has to be balanced against investigation- and treatment-burden, including that associated with hospital admission and the adverse effects of drugs and therapy interventions, and the need to respect the identity and autonomy of individuals. The resolution of these tensions requires anticipation of care options, multi-professional assessment, judicious and targeted treatment, good communication with patients and stakeholders and rigorous shared decision-making. In this commentary, we compare geriatric and palliative medicine, and describe how the geriatric medical approach can deliver appropriate healthcare towards the end of life. This is well-supported by the broad knowledge, skill-set, flexibility and professional values displayed by geriatricians working in multi-professional teams.

• Journal Article Type: Article
• Acceptance Date: Nov 11, 2020
• Online Publication Date: Dec 10, 2020
• Publication Date: 2021-03
• Deposit Date: Nov 13, 2020
• Publicly Available Date: Dec 11, 2021
• Journal: Age and Ageing
• Print ISSN: 0002-0729
• Electronic ISSN: 1468-2834
• Publisher: Oxford University Press
• Peer Reviewed: Peer Reviewed
• Volume: 50
• Issue: 2
• Pages: 366-369
• DOI: https://doi.org/10.1093/ageing/afaa266
• Keywords: end of life care, frail older people, geriatric medicine, guidelines, palliative medicine
• Public URL: https://nottingham-repository.worktribe.com/output/5039541
• Publisher URL: https://academic.oup.com/ageing/advance-article-abstract/doi/10.1093/ageing/afaa266/6029716
• Additional Information: This is a pre-copyedited, author-produced version of an article accepted for publication in Age and Ageing following peer review. The version of record Nisar Ahmed, Sam H Ahmedzai, Rowan H Harwood, The geriatrician’s role in end-of-life care, Age and Ageing, , afaa266is available online at: https://doi.org/10.1093/ageing/afaa266