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When medicine can’t offer a cure, let our elderly die with dignity

Australian medical researchers call for restraint on use of aggressive treatments for elderly people near the end of their natural lives

A study, published in the Joint commission Journal on Quality and Patient Safety, has shown that 40% of 80+ year-olds are subjected to aggressive emergency procedures in hospital.

The study, led by Associate Professor Magnolia Cardona, PhD, MPH from Bond University's Centre for Research in Evidence Based Practice (CREBP) on the Gold Coast, reviewed the medical records of 733 admitted patients who received calls for medical emergency teams during hospitalisation. The median age was 68 years, but a third were more than 80 years.

Analysis uncovered that these aggressive procedures - such as intubation, intensive monitoring, intravenous medications, transplants, and painful resuscitation attempts – were administered to some elderly patients who had previous medical orders for limitation of treatment and not-for-resuscitation orders. 

“Some risk factors - such as history of presenting to the emergency room, or several hospital admissions in the past few months, and not-for-resuscitation orders - are clearly linked with poor clinical prognosis and death,” Dr Cardona said.

“Yet, these calls for emergency team specialists in hospital are still being placed.

“The skills of life-saving specialist teams are being used to issue end-of-life management orders.

“Instead, these high-risk flags could be used as a guide to refrain from using the emergency team, and as a result spare patients aggressive unnecessary treatments and allow them a less traumatic, more dignified natural death.

“These often-costly, aggressive treatments bring about unnecessary suffering to patients, their families and the health system. 

“Patients or families can help by discussing their values and preferences with clinicians before a health crisis takes place.

“If patients explain in writing how they wish to be cared for, by completing an Advance Care Directive, clinicians will be better able to guide shared treatment decisions.

“Half of the deaths in the study occurred within two days of the medical emergency call, suggesting they were predictable. All remaining patients with a not-for-resuscitation order were dead within three months.

“Our findings strongly indicate that admission to the ICU and invasive procedures for elderly people dying of natural causes need reconsideration.

“When death is inevitable, other more appropriate pathways of care can be offered such as symptom management, pain relief and psychosocial support”.

Other co-authors of the JCJQPS article were: Robin M. Turner, PhD, MSc; Amanda Chapman, BN, GradDip (Acute Care); Hatem Alkhouri, PhD, MSc; Ebony T. Lewis, MIPH, BN; Stephen Jan, PhD, ME; Margaret Nicholson, MoN (Nurse Practitioner), DipAppSc; Michael Parr, MBBS, FCICM; Margaret Williamson, MPH, BPharm; Ken Hillman, MD, FCICM. 

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