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