Do older people at the end of their lives really want every measure used to keep them alive, or should they be allowed to die peacefully?
That’s the question researchers are asking after it was found elderly people near the end of their lives are receiving hospital treatment that is too aggressive.
The findings by UNSW have seen medical researchers calling for restraint on the use of aggressive life-saving treatments. Instead, researchers are arguing that frail and elderly people near the end of their lives should be made as comfortable and their death as dignified as possible.
The study, published in the Joint Commission Journal on Quality and Patient Safety, saw researchers analyse the medical records of 733 admitted patients who all received calls for medical emergency teams during their hospital stay. The median age was 68, although a third of patients were older than 80.
It was found that around 40 per cent of those over the age of 80 were subjected to aggressive procedures to keep them alive including intubation, intensive monitoring, intravenous medications, transplants and painful resuscitation attempts.
Lead researcher Professor Magnolia Cardona claimed hospital and emergency staff were using invasive treatment, despite patients’ history showing gentler approaches would be more appropriate. These treatments are often costly and aggressive, causing pain and suffering of those admitted to the ICU.
“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,” 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.”
Cardona added that patients and families should discuss their values and preferences before a major health crisis takes place and before they can’t make a decision.
“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 and shared treatment decisions,” Cardona said, while adding that requesting intensive interventions for elderly people already going through the natural end-of-life process could cause further pain and discomfort.
The study found half the reordered deaths occurred within two days of a medical emergency call, while 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.”