The longer trajectory of dying due to increasing life expectancy resulting from public health and technological advances means health services need to respond to a larger demand for services from the very elderly. Frail elderly can now live longer with chronic conditions and disability which often contribute to poor quality of life and generate unsustainable health care costs. Our program of research on end-of-life aims to address the early identification and response to frail elderly dying patients to prevent non-beneficial treatments i.e. those that do not improve survival and can impair remaining quality of life. This talk will highlight that administration of these unnecessary treatments can be due to prognostic uncertainty, delayed clinicians’ recognition of the patient nearing death, low confidence in sensitive communication of bad news, pressure from relatives to do ‘everything’, and absence of advance care directives specifying patient wishes. But achieving a ‘good death’ is everyone’s responsibility. And since frailty is an independent predictor of death, screening for frailty in the emergency department is a first step in the right direction to implement best practice on safe management of this population.
About Ebony Lewis
Ebony Lewis, a Master of International Public Health graduate from the SPHCM UNSW, has recently joined the School of Public Health and Community Medicine but has spent many of her clinical years as Emergency and Practice Nurse working with elderly patients, their caregivers and clinicians. Her aim as a clinician and as gerontology and geriatric researcher is to improve the end of life experience for the frail elderly. For the past 3.5 years she has been involved in systematic reviews, cohort studies, cross-sectional surveys, retrospective record audits and qualitative consultations investigating quality end-of-life care and prevention of overtreatment near the end of life. Under the supervision of A/Prof Magnolia Cardona at the South Western Sydney Clinical School, Ebony was the lead research nurse in the implementation and validation of the CriSTAL checklist (Criteria for Screening and Triaging to Appropriate aLternative care). This risk prediction tool aimed at identifying terminal elderly patients and facilitating clinicians’ conversations with patients and caregivers about end-of-life care values and preferences.