University:
University of Edinburgh
Course:
NUST10053 | Nursing people with complex needs: Life Sciences and Nursing Care 3
Academic year:

2024
Views:

88

Pages:

14
Author:

mofuatajtbt

Demography of death and dying World Mortality Rate 100% 100% 100% 100% Profile of People who die UK1900 / Age at death 46 • Top 3 causes 1. Infectious diseases 2. Accident 3. Childbirth UK 2020 Age at death 78 • Top 3 causes 1. Cancer 2. Organ failure 3. Frailty/ dementia • Disability before death Not much Disability before death Months - many years The three main trajectories of decline at the end of life 3 trajectories Function High Function High Death Low Organ failure GP has 20 deaths per list of 2000 patients per year Acute Low Months or years 6 2 Death Weeks, months, years 5 7 Function High Death Low Many years “Cancer” Trajectory, Diagnosis to Death Cancer Specialist palliative care available Function High Low Onset of incurable cancer Death Time -- Often a few years, but decline often < 4 months Generally predictable course, short decline Relatively well resourced hospice care fits well Organ failure trajectory Organ System Failure Trajectory (heart, lung, liver … failure) Function High Low Frequent admissions, selfcare becomes difficult Death Time ~ 2-5 years, but death usually seems “sudden” Needs: acute care for exacerbations, chronic care, support at home*. No service designed to routinely meet the needs of this pattern of decline *No one seems to believe we have got this even half right. Delamothe T. BMJ 2009;338:b11457 Frailty trajectory Dementia/Frailty Trajectory High Function Low Onset deficits in activities of daily living, speech, ambulation Death Time Variable up to 6-8 years Needs: Integrated clinical care Long term support at home, carer support, possibly nursing care. Care homes with reliably good end-of-life care When to shift gear? Function High Caring for people with organ failure: 3 stages Stage 1 Physically well Stage 2 Active supportive and palliative care Stage 3 Terminal care Sentinel events Death Low Time Function High Caring for people with organ failure: 3 stages Stage 1 Physically well Stage 2 Active supportive and palliative care Care Plan Stage 3 Terminal care Liverpool Care Pathway Sentinel events Death Low Gold standards Framework Time When is a patient palliative? • Would you be surprised if Mrs A were to die within the next 12 months? • Study in cardiology ward revealed that this question identifies 60 -70% of admissions • Avoid “prognostic paralysis* ”