High-quality end-of-life care will enable older people with frailty to live well and die well

New “End of Life Care in Frailty” guidelines have been published by the British Geriatrics Society to help doctors, nurses and allied health professionals provide high-quality, person-centered care for older people approaching the end of their lives, both during the pandemic and in the future. The guidelines aim to improve end of life care for all older people with frailty, not just those diagnosed with COVID-19.

The planning and delivery of good end of life care, magnified as a key issue for healthcare professionals caring for older patients during the COVID-19 pandemic, is explored in depth in the new guidelines. Covering the final year of life in people living with frailty, the guidelines address issues such as uncertainty faced by patients and their families, advance care planning, law and ethics, as well as management of common symptoms at the end of life such as pain, delirium, incontinence and swallowing difficulties. A key aim of this new guidance is to prompt and support timely discussions about preferences for care with the older person themselves and their family.

The guidelines also cover the unique considerations applicable in specific settings, such as urgent care, care homes and prisons. They explore issues such as cultural and spiritual needs, and the importance of social and psychological support. The guidelines are the result of 18 months’ work involving more than 30 contributors with expertise in a wide range of issues which affect older people towards the end of life.

Co-Editor of the guidelines, Dr. Eileen Burns, commented:

“Too often the clinical response to an acute deterioration in a frail older person is protocol or pathway driven, especially during an unprecedented crisis such as the one we are experiencing at the moment. This can lead to invasive and sometimes distressing treatments without pausing to reflect on the values and wishes of the older person who is being cared for. Even when the need for end of life care is recognized, its delivery can challenge clinicians. Providing high-quality, person-centered end of life care for older people with frailty must remain a priority for all healthcare professionals, during the current pandemic and in future.”

Professor Tahir Masud, President of the British Geriatrics Society, commented:

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