“If hospital staff were trained for earlier recognition of when death is inevitable, patients could be spared such aggressive treatments.
“If hospital staff were trained for earlier recognition of when death is inevitable, patients could be spared such aggressive treatments." LPETTET

Dying elderly need comfort to avoid 'traumatic' end

WE all want a dignified end to life.

But a new study has revealed that senior Australians at the end of their lives are suffering aggressive life-saving treatments when a more comforting approach is required to bring them peace and maintain their dignity.

University of NSW researchers reviewed over 700 medical records of admitted patients who received calls for medical emergency teams during hospitalisation and found that a third of them were aged over 80.

And nearly 40 per cent of that 80-year-old age bracket had been subjected to aggressive procedures such as intubation, intensive monitoring, intravenous medications, transplants, and painful resuscitation attempts.

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UNSW Adjunct Associate Professor Magnolia Cardona, who led the study, which is published in the Joint commission Journal on Quality and Patient Safety, said this pattern of invasive treatment over a gentler approach showed a lack of awareness by the medical profession.

And it was time the practice was stopped.

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

"Such high-risk flags could be used as a guide to refrain from using the emergency team.

"If hospital staff were trained for earlier recognition of when death is inevitable, patients could be spared such aggressive treatments and allowed a less traumatic and more dignified end."

Associate Professor Cardona said treatments to prolong the lives of elderly patients were costly and gave little benefits to them, their families and the health system.

Half of the deaths in the study occurred within two days of the medical emergency call, while all patients with a not-for-resuscitation order died within three months.

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

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

Associate Professor Cardona said elderly patients should be on the front foot and talk to their families about possible scenarios should a disaster strike.

"If patients put these in writing in an Advance Care Directive explaining how they wish to be cared for towards the end, clinicians will be better equipped to guide shared treatment decisions," she said.


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