Tag Archives: dying

Let’s talk about death and dying

Let's Talk about Death and Dying! cover

This blog post was contributed by Lesley Carter, Joint Head of Health Influencing at Age UK. 

“How people die remains in the memory of those who live on”, Cicely Saunders (1918-2005), founder of the modern hospice movement. 

Positive advances in health care and public health mean that most of us will die later in life. Hooray! Yet most of us have never had a conversation with someone we love about death and dying and actually most of us don’t really want to. I think it’s a generational thing. But this is not the best place to be – this approach will not help us cope with our own death, or that of a loved one, or to manage our own feelings during death and bereavement.

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Dying in hospital and the Liverpool Care Pathway

There has been a great deal of press interest recently in the Liverpool Care Pathway for the dying patient (LCP). It has been described in more colourful language, which I will return to later, but I should start out by explaining what it is – and just as importantly what it isn’t.

The LCP was developed in the late 1990s by a hospital in Liverpool and a local Marie Curie hospice. The aim was to bring high-quality hospice care for cancer patients to hospital settings. Later, this was expanded to non-cancer patients and has been adopted by a large number of hospitals throughout the NHS and other countries.

Why was (and is) this necessary? Modern hospice care emerged in the 1960s out of a desire to improve the experience of dying for terminally-ill patients. Hospitals are traditionally very good at delivering curative care, but do less well at caring for people whose greatest need is to be as pain-free and as comfortable as possible, and to have the reassurance that their families are supported to prepare and come to terms with a loved-one passing away.

The reality today is that the majority of people are in hospital when they die.  Though the circumstances may vary – for example they may have been recently admitted as an emergency, or they were being treated for an illness that they may not recover from – past reports have shown that poor experiences can be very similar.

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The NHS must do more to help patients have a good death

Death is often said to be the last taboo, despite being the one event that we all have coming to us at some point. Talking about dying can be very difficult for many people, not just the individual and their loved ones but also medical professionals who may be equally uncomfortable approaching such a sensitive topic or regard death as the ultimate failure of their skills.

The NHS has over its lifetime played perhaps a leading role in this country in bringing up life expectancy to the point where  of the  nearly  half a million people who die annually, around four fifths are over 65 and two thirds are 75 plus. The major workload of the NHS has changed from treating working age adults with single acute problems to treating patients in later life – about of every ten patients in hospital around 6 will be over the age of 65. In later life, patients are more likely to be frail or living with more than one serious condition and so require a different  approach to their care.

The recent national confidential inquiry into perioperative deaths (NCEPOD) showed that the  NHS has yet to grasp universally that its success in making sure that most of us don’t die before we get old requires a rethink of its medical model and how it approaches care.

According to the report less than a third of acutely ill patients admitted to hospital got good care when they had a cardiac arrest. Whilst the report did not solely focus on older patients, the vast majority were over 65 and the mean age of people in the study was 77. And most people had at least one co-morbidity.

In nearly half of the admissions, patient assessment was deficient and in over a third of cases did not pick up warning signs that the patient was deteriorating and might arrest. Better training and understanding of geriatric care would, we believe, help medical staff to see beyond the immediate presenting problem and understand that an older person is likely to have other serious underlying medical issues, helping to better anticipate deterioration. All health professionals need to have the skills required to deliver healthcare in the 21st century. Continue reading