Lesley Bainbridge, Lead Nurse Care Home Vanguard Programme, Newcastle Gateshead Clinical Commissioning Group,
Watching the Invictus Games last week prompted me to draw parallels between sudden onset disability and that associated with old age. While watching I was reminded of two patients I’d cared for over a decade ago whose problems in old age were attributed to the trauma of war. Working as a nurse specialist for older people in a community intermediate care team both men were referred by their GPs for further assessment.
What led to the ‘diagnosis’ of war trauma was comprehensive geriatric assessment [CGA] and the fact that I worked in a multidisciplinary [MDT] team that meant my patients were speedily referred to others when necessary. CGA is the best evidence base we have for providing care for older people with complex needs and it is well accepted that those that have access to MDTs do best.
CGA considers the whole person, covering 5 domains of their life including medical, social, mental health, environmental and functional. It allows us to gather information about usual and present state to identify problems and draw up a care plan to address each issue in turn in order to optimise overall health and wellbeing.
Death and preferred end of life care can be a difficult discussion for any individual living with terminal illness. However, when that conversation is with someone diagnosed with dementia – and therefore, may not have the mental capacity to plan and organise for the future – it can become a lot more challenging.
Advanced Care Planning (ACP) is instrumental in ensuring a patient with dementia – and any other individual living with a life-limiting illness – has the right care and support in place to enable them to live their last days in peace and dignity. Yet, despite its obvious benefits, the responsibility of ACP doesn’t directly lie with one specific healthcare professional. Instead, it is up to any healthcare professional to raise the conversation when they think it is most appropriate for the individual.
‘Sorrow that finds no vent in tears may make other organs weep’
Sir Henry Maudsley, 1835 – 1918
According to the British Pain Society, almost 10 million Britons suffer pain almost daily resulting in a major impact on their quality of life and more days off work at a cost estimated at around £5billion per annum, with around 20% of all new consultations involving pain. Long term pain is both disabling and distressing. The story of Gill Pharoah, a former palliative care nurse who passed away at the age of 75 at an assisted dying clinic in Switzerland in 2015 with chronic back pain raises important questions about euthanasia and the traumas that can come with old age not just in the context of terminal illness, but also for conditions which can ruin people’s quality of life. It also raises important questions about ageism and how society values elderly people.