Lothian Pilot Project Targets End-of-Life Care for Elderly

By Adam Morris, the Scotsman

August 27, 2008

Scotland

Terminally ill elderly patients are being given the right to die in their care home or hospice instead of being rushed to hospital for emergency treatment, under a scheme being trialled in the Lothians.

An 18-month pilot scheme has seen patients given the chance to make a choice along with family about how they are treated near the end of their life. It means they may not be taken to hospital for emergency treatment which may only prolong their life for a short time. 

This has reduced unnecessary hospital admissions from care homes by 40 per cent.

The trial has also been welcomed by health professionals and families across the Lothians.

The Thornlea nursing home in Loanhead was one of seven Midlothian nursing homes involved in the Edinburgh University study, alongside St Columba's Hospice in north Edinburgh and The Marie Curie facility in Fairmilehead.

Nurse manager at Thornlea, Pat Summers, said: "The whole point of this is to give people nearing the end of their lives the chance to die with dignity in a place of their choice. The reality is old and frail people come to nursing homes to die, they know they are not going to move on from there, and it's amazing how so many of them accept this when they arrive."

The majority of patients who have benefited from this palliative care initiative suffer from dementia or Alzheimer's, and the decision to waive hospital treatment is taken with family members. There are numerous cases where a patient has been physically frail but mentally sound and have made the choices themselves.

More than 130 elderly people were involved in the project, which saw illnesses like chest infections and pneumonia treated in the home itself with controlling drugs rather than a hospital.

In cases where a patient broke a limb or suffered unexpected illness or injury they would still be taken to hospital. And while a hurried admission to hospital may increase a frail person's life by a few days, it is increasingly accepted in medical circles that most people prefer to pass away in familiar surroundings, even if it is slightly earlier.

Professor Scott Murray, who leads Edinburgh University's palliative care research group, said initiatives like this significantly improved people's end-of-life care.

He added: "This work is essential to guarantee that we are giving elderly people the dignified and respectful care programme they deserve."

Dr Jo Hockley, another researcher involved in the project, added: "This study shows that with better training and improved care frameworks, older people can now expect a better standard of care around dying in these nursing homes."

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