GPs told to quiz the elderly about ‘how they want to die’

By
Sophie Borland

Last updated at 12:13 AM on 25th January 2012


Questions: Doctors are being told to ask elderly patients with serious health problems if they want 'do not resuscitate' orders put in their medical files (posed by models)

Questions: Doctors are being told to ask elderly patients with serious health problems if they want ‘do not resuscitate’ orders put in their medical files (posed by models)

GPs must ask the elderly with serious health problems if they want ‘do not resuscitate’ orders put in their files, according to senior doctors.

They should also find out if patients want to die at home and whether they would rather refuse certain drugs or treatment in their final hours.

Doctors who carried out a study found discussions about death helped prevent thousands of elderly patients being admitted to hospital against their will.

There are concerns frail patients are being forced to remain on wards until they die and are given medical treatment that only prolongs their agony.

But many doctors are reluctant to talk to their patients as death is seen as a taboo subject.

Last week figures from the Office for National Statistics showed just a fifth of patients are dying at home – even though nearly three quarters wanted to. This number is far lower than in countries elsewhere in the Western world.

Dr Adrian Baker and researchers from the Universities of Aberdeen and Stirling are calling for more GPs to draw-up ‘end of life’ plans for seriously-ill patients.

This includes those with a range of health problems such as dementia, cancer, heart disease or diabetes, who are frequently in and out of hospital.

The researchers – whose recommendations are backed by the Royal College of GPs and published in the British Journal of General Practice – say family doctors should ask patients and their relatives if they would rather not be resuscitated should their condition suddenly deteriorate.

They also want GPs to help patients draw up ‘living wills’ whereby they can decide to refuse antibiotics, being fed through a tube or put on a ventilator. And they want doctors to check patients know they are dying and ensure they make a record of where they want to end their lives.

All about choice: Dr Adrian Baker said the plans were good way of looking at options available so that the wishes of loved ones are fully respected

All about choice: Dr Adrian Baker said the plans were good way of looking at options available so that the wishes of loved ones are fully respected

The researchers carried out a study of 10,800 elderly patients which showed those with so-called ‘anticipatory care plans’ were more than three times as likely to die at home. In addition they were less likely to be taken to hospital – but if they were admitted they tended to be discharged sooner.

Dr Baker, who practises as a GP in Nairn in the Scottish Highlands, said: ‘Today’s NHS is all about choice, but few patients seem to understand the choices available to them in their final few months.

‘Anticipatory care plans are a good way of looking at the options available with a view to ensuring the wishes of loved ones are fully understood by everyone involved in their care, so unplanned hospitalisation can be avoided. 

‘We are faced with an ageing population, which is estimated to see 22 per cent of the population aged over 65 years by 2035.

‘GPs have knowledge of a patient’s full medical history and often have a relationship based on trust. They are uniquely placed to broach this issue to help ensure their final wishes are met.’

Davina Hehir, director of policy at Dignity in Dying, said: ‘There is no doubt that discussing end-of-life preferences can be difficult both for the patient and their doctor.

‘However, such conversations have an important part to play in helping ensure that dying patients’ wishes are respected.’

Last year the RCGPs asked family doctors to pledge to treat dying patients with dignity. They were urged to promise to preserve patients’ ‘independence, dignity and sense of personal control’.

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I think this is a good idea as I dont get on very well with some of my family who Im sure would just tell the doctors to euthanasie me if I was unconscious.

It is a very positive step and in the right direction. But, I am a bit concerned about the way it will be implemented. Again, it will be shambolic. There will not be any sympathy, empathy or time to LISTEN to their final wishes from the NHS side. ALready the amount of time a GP can spend with a patient has been cut down to 7 minutes. I don’t know how much of information a GP can extract from the patient, how much time will a GP need to give the information and then you have to give time to the patient to assimilate the information and come to a informed FINAL decision. As usual, all these will be followed by a HUGE PILE of paperwork just to avoid any legal challenge from the relatives who look at NHS as white milking cow. In my opinion, it is best left for the organisations like age UK to deal with it and then let NHS know.

Underneath a beautiful young woman please.

The last thing I want to do is to is die in an NHS hospital, I have been in NHS hospitals 2 times in the last 2 years, I could not get any peace in day or sleep at night there was noise all the time, in the end I used my own money and my family had me moved to a private hospital in Harley Street, the NHS hospial seemed tobe acting as the world health service and was full of people who had not payed anything into the uk tax system and due to there lack of english took up great deal of staff time.

I think it’s an excellent idea. There are many elderly people who have no family so how is anyone supposed to know what they want if no one asks?

The more one reads the newspapers and looks in on tv programmes the more we, the elderly seem to be in the way and stopping progress. We need to have money spent on us which according to some would be better spent elsewhere on other people and much younger yet we, the elderly paid in over many years for what we thought would be care in our old age and times of need. How the picture has changed.

It might be useful too to add “When they want to die”.

How long before they pop the over 65’s off because they are a burdon on society. This group THE INTERGENERATION FOUNDATION a lobbying group
associated with the Labout party has a manifesto that is ageist. Their aim is to reduce the money available to the elderly for health care and also tax elderly people out of their homes.

Dr Baker, who practises as a GP , ONE ALSO ASSUMES THAT THE ESTEEMED DOCTORS POLITICS ARE TO THE FAR RIGHT UP THERE IN NEVER NEVER LAND, YET ONE MORE SNIDE MOVE TO SAVE MONEY
IN THE N.H.S. LOOK AFTER THE OLD AND INFIRM, THATS WHY I HAVE PAID MY DUES OVER THE LAST FORTY NINE AND HALF YEARS

Well said James, Morpeth.
The minute we retire we are bombarded with questions and decisions about how long we expect to live and how to arrange our finances to suit. Poo tests, Saga leaflets and ads for stair lifts arrive in the post. Insurance companies want to know about pre-existing conditions, medication, investigations, and if you don’t keep them up to date, you’re uninsured.
Now this suggestion ! How the hell do I know how I will feel and what my circumstances and those of my family will be when the time comes. I change my views on most things on a daily basis as more information emerges.
You can’t plan everything. Leave us to take each day as it comes for goodness sake !! Learn to analyse situations and select from available actions “on the wing” instead of following a preagreed and politically correct decision charts.

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