S5: fraility and end of life care

Question 1

List specific challenges in achieving a ‘good death’

Answer 1

Death is a ‘taboo subject’
Truthfulness with patients
Enabling informed consent
Allowing time to prepare
Avoiding isolation
Overcoming a wall of silence
Maintaining hope by accompanying them on the journey

Question 2

List principles of a ‘good death’

Answer 2

To be warned when death is coming & learn what can be expected
To be able to retain control of what happens
To be afforded dignity and privacy
To have control over pain relief & other symptom control
To have choice and control over where death occurs

Question 3

List services offered by hospices for patients with life-limiting illnesses

Answer 3

Pain and symptom control
Psychological and social support
Rehabilitation, physio & occupational therapy
Spiritual care

Question 4

Define frailty

Answer 4

Clinically recognizable state of increased vulnerability resulting from aging
Associated decline in reserve and function across multiple physiologic systems such that the ability to cope with everyday or acute stressors is compromised

Question 5

List indicators which clinicians can use to detect frailty

Answer 5

Fried frailty phenotype
Gait speed
Grip strength measurements

Question 6

Outline how frailty is measured

Answer 6

Geriatric giants

Clinical frailty scale

Question 7

Describe the comprehensive geriatric assessment

Answer 7

Multidimensional, interdisciplinary diagnostic process to determine the medical, psychological & functional capabilities of a frail older person
-environment, functional, social networks, medical, psychological cognitive
Allows a care plan to be generated that can modify trajectories

Question 8

Define euthanasia

Answer 8

The act of deliberately ending a person’s life to relieve suffering
Illegal under English law

Question 9

Outline ethical issues of euthanasia

Answer 9

Is it ever right to end the life of a terminally ill patient?
Is there a moral difference between killing someone and letting them die?
Individual autonomy
Reducing needless pain and suffering

Question 10

Describe anticipatory grief stages

Answer 10

Denial 
Anger
Bargaining – imagining things to be different, those who like to a high power may make promises in return for healing 
Depression
Acceptance