Carouselle: Tissue Viability, SALT, Dietetics, PT Flashcards
What is a PEG?
percutaneous endoscopic gastrostomy (PEG) feeding tube
Risks include bowel perforation, wound infection, peritonitis, aspiration, death
Risk of death in first month for this individual approx 30%
Evidence that artificial nutrition in patients with advanced dementia neither prolongs nor improves quality of life
Beneficence, non-maleficence, autonomy and justice
Who is involved in decision making? - legal summary
The decision belongs to the patient unless they lack the capacity to make it.
In that case a ‘best interests’ decision should be made, involving all the relevant people. If the patient is unbefriended, you must appoint an IMCA.
Nobody (patient, family, LPA, IMCA) can demand medical treatment judged to be futile/inappropriate.
When can we withdraw treatment
Oral food/fluid is basic care.
Tube feeding/parenteral fluids is medical treatment.
Basic care must always be offered.
Medical treatment must if offered if it will be of ‘overall benefit’ to the patient.
What is involved palliative care?
Pain
Bereavement
Drugs
Difficult situation
Emotionally charged
Suffering
Dying
Cancer
What is palliative care?
“…an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual
Features of Palliative care in geriatrics
More people are dying of chronic disease
They often have multiple co-morbidities
In their last years of life they often suffer from
pain, anorexia, low mood, confusion, constipation, insomnia and problems with bladder and bowel control
“…older people suffer unnecessarily, owing to widespread underassessment and under treatment of their problems and lack of access to palliative care.”
Why is palliative care important?
Only get care at the last days of life
should be offered support from diagnosis
Focusing on too much intervention with little benefit especially in end stage dementia
Difficulty with prognosis
What is advance care planning?
Advance care planning offers people the opportunity to plan their future care and support, including medical treatment, while they have the capacity to do so.
“‘Advance care planning can make the difference between a future where a person makes their own decisions and a future where others do”
What is advanced care planning involved in?
Advance care planning has been defined as a process of formal decision making that aims to help people establish decisions about future care that take effect when they lose the capacity to make informed decisions.
In many cases that will lead to decisions about the extent of treatment, location of treatment and cardiopulmonary resuscitation.
Some people may also instruct their families and friends and/or delegate power of attorney for such decisions.
Why are advanced care plans important
More people are dying of chronic disease
They often have multiple co-morbidities
In their last years of life, they often suffer from
pain, anorexia, low mood, confusion, constipation, insomnia and problems with bladder and bowel control
“…older people suffer unnecessarily, owing to widespread underassessment and under treatment of their problems and lack of access to palliative care.”
What is the evidence base?
There is no evidence in the UK for economic evaluation i.e. cost benefit
One study estimated the support required for death in usual place of residence was £2107, with the support of an hospital admission resulting in death being £3587.
Healthcare isn’t always about cost!
ACPs are about patient centred care
3 RCTs
Reduce ED visits
Reduced Admissions to hospital
Increased family satisfaction
Reduces decision burden on families when the patient looses capacity
Improves bereavement experiences for families
