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Poster presentations / European Geriatric Medicine 6S1 (2015) S32
–
S156
S81
2014. It was designed and implemented as an experiential
medical education learning model whereby medical students were
“admitted” into the local Hospice Home to live there for 48 hours.
Until this project, palliative and end of life care education at US
Medical Schools were accomplished through traditional medical
education methods.
Methods:
The project utilizes qualitative ethnographic and
autobiographic research designs, whereby a unique environment
or “culture” (Hospice Home) is observed and life experiences of
the medical student before, during, and immediately after the
immersion are reported by him/her.
Results:
Students report new found skills in patient care such as the
1) importance of physical touch; 2) significance of communication
at the end of life for the patient, family, and staff; 3) the value of
authenticity and sincerity that comes from being comfortable with
oneself, which allows silence to communicate caring; 4) connection
with and awareness of the person (rather than their terminal
illness) and their family; and 5) the importance of speaking with
patients and their families about end of life plans in advance.
Conclusion:
This project humanizes dying and death, solidified
student realization that dying is a part of life and what an honor
it is to be a part of the care process that alleviates pain, increases
comfort, values communication, and human connections. Medical
education in death and dying is advanced; essential in preparing
our future physicians.
P-184
Advanced care planning in the elderly, are we doing it?
T. Imam
1
, S. Raje
2
, S. Afolayan
3
, T. Jones
3
1
Basildon Hospital, Mitcham, United Kingdom;
2
Basildon Hospital,
Basildon, United Kingdom;
3
Basildon Hospital, Basildon
Objectives:
The aim was to highlight that elderly patients nearing
the end of their life should have an advanced care plan (ACP) as
per national guidelines. This helps patients approaching the end of
their life to plan for their future care and affairs. This should be
discussed before patients become unwell and in the community
whilst they have mental capacity.
Method:
The National Gold Standards Framework (GSF) for ACP was
used on 3 wards for older people. The criteria measured were:
•
General indicators of decline and increasing needs
•
Signs of frailty
•
Signs of late stage dementia.
Results:
27 cases were examined.
•
56% had 5 or more general indicators.
•
85% had 3 or more out of 6 signs of frailty.
•
89% had 2 or more signs of late stage dementia.
•
41% were discharged without mention of care planning and 45%
of these had multiple readmissions.
•
33% had palliative discharges and 15% died in hospital.
•
None of the patients had an advanced care plan from the
community.
Conclusion:
ACP aids in planning for future care and a better
patient experience. Our study has shown the practice of ACP
needs to be improved in patients with poor prognostic indicators.
Care plans in hospital and in the community could potentially be
clearer and more integrated. One possible solution is to use online
platforms to store this information. It is the responsibility of all
clinicians at all levels to encourage and participate in ACP.
P-187
Elderly patient insight into deactivation of ICD devices
R. Jones
1
, S. Hollis-Smith
2
, A. Cai
3
1
1988, London, United Kingdom;
2
Kings College London, London,
United Kingdom;
3
Kings College London, London
ICD implantation is associated with improved mortality in primary
and secondary prevention of cardiac death. However patients
perceptions have not been well looked at. We studied 22 elderly
patients (age up to 87) with prior device implant (ICD and CRT-D)
and explored their understanding with a 15 point questionnaire.
These patients were interviewed in an outpatient and inpatient
setting as part of a quality improvement survey. We found that
deactivation was rarely discussed with patients before implant.
Patients erroneously believed that an ICD would improve their
quality of life. However most patients had not thought about
deactivation and appeared to want a box change regardless of
age.
P-188
Timeliness and quality of capacity assessments amongst
geriatric inpatients
J. Mirams
1
, S. Saber
2
1
Mid Essex Hospital Services NHS Trust, Chelmsford, United Kingdom;
2
Broomfield Hospital, Chelmsford, United Kingdom
Objectives:
Many elderly patients have transient or permanent
defects in cognition and/or communication that impair their
capacity for medical decision-making. We sought to discover how
swiftly capacity assessments are completed for geriatric inpatients
at our institute, how accurately they are documented and who
performs them.
Methods:
We performed a snapshot analysis over a single day of
all capacity assessments performed on patients on three geriatric
wards at our institute. We measured the delay between medical
decision-making and assessment, the quality of documentation
using an approved auditing tool and noted the demographics of
the assessor.
Results:
A total of 35 assessments were analysed. The mean
delay between medical decision-making and assessment was
3.8 days. Quality of documentation varied greatly, from correct
completion by all assessors in some sections to correct completion
by only two in another. 32 assessments (91.4%) were completed by
junior doctors and 28 (60%) were completed by single assessors.
29 assessments (82.8%) were completed by doctors working in
geriatrics.
Conclusion:
Our study indicates an average delay of over 90 hours
between medical decision-making and completion of a capacity
assessment for geriatric patients at our institute. These assessments
are of variable quality and are often completed by junior staff
members working alone once the patient has been admitted to a
geriatric ward. We hypothesise that routine screening for confusion
amongst elderly patients presenting to hospital, simplification of
documentation and formal training in its use will facilitate timely,
accurate and standardised capacity assessments in this vulnerable
patient group.
P-189
Are elderly patients with cancer always informed of the
diagnosis of cancer?
J.-Y. Niemier
1
, A. Benetos
2
, C. Perret-Guillaume
3
, F. Claudot
4
1
CHU de Nancy, Service de G´eriatrie, Vandoeuvre-l`es-Nancy, France;
2
France;
3
CHU de Nancy, Vandoeuvre-l`es-Nancy Cedex, France;
4
Ethos-EA 7299, Facult´e de M´edecine de Nancy, Vandoeuvre-l`es-Nancy,
France
Introduction:
The aim of Oncogeriatric is to adapt the therapeutic
management to the general status of the patients. Most of the time,
the patient is addressed to the geriatrician after consultation with
the cancer specialist. However, the patient does not always know
why he’s addressed in geriatrics, and what the nature of his illness
is.
Objectives:
To assess whether the patient knows firstly the reason
for the geriatric oncology consultation, and secondly what is the
exact nature of his illness.