RT Journal Article
SR Electronic
T1 The frailest of the frail? Addressing the palliative care needs of frail older patients
JF Future Healthcare Journal
JO Future Healthc J
FD Royal College of Physicians
SP 10
OP 14
DO 10.7861/futurehosp.5-1-10
VO 5
IS 1
A1 Ray Hyatt
A1 John Dean
A1 Marie O'Neill
A1 Nikesh Patel
A1 Mustafa Abu-Rabia
A1 Joanne Taylor
YR 2018
UL http://www.rcpjournals.org/content/5/1/10.abstract
AB Managing patients with frailty is an increasing element of acute hospital care, constituting around 40% of acute hospital inpatients. Up to half of these patients may be approaching the end of their life, and many also have repeated hospital admissions. We therefore undertook a quality improvement project to help us identify the prevalence of frail older inpatients approaching end of life and to better identify these patients in advance. We also developed and evaluated a pro forma to assist in initiating an advance care planning conversation with the patient and/or family. Fifty percent of our frail older inpatients were assessed as approaching end of life. Factors identifying older inpatients as more likely to die during the hospital admission included residence in a care home, two or more hospital admissions over the preceding 12 months, and a diagnosis of some form of dementia for more than 3 years. A novel goals and priorities of care (GPOC) document was found to support and guide palliative care conversations. Acute hospital care could be organised more effectively to recognise the potential need for palliative care in frail older patients. Identifying those at higher risk and using structured interviews and documentation is helpful, ultimately resulting in more appropriate care. Well-developed communication skills are needed for these complex care planning conversations.