Thoughts from Age UK

Tom GentryTom Gentry, Health Services Policy Adviser for Age UK, reflects on some of the challenges linked to advance care planning.

A familiar line runs through work on end of life care over the last decade. Help the Aged in a 2006 report focused heavily on the impact of poor communication at the end of life, echoed in the National End of Life Care Strategy two years later; two reports from the Health Ombudsman; Neuberger Review; and last year in Ambitions for Palliative and End of Life Care. To name just the major reports.

When we talk to older people about these issues, some of the underlying reasons for not being able to have meaningful discussions about end of life become all too obvious. In one discussion, someone said “I wouldn’t think about this. You don’t need to do this until you’re really ill”. Asked about planning, another said they wouldn’t, “your doctor would know what is right for you”.

Say “advance care planning” to someone, and in our experience it is taken in quite a literal sense. It is often seen as something more akin to planning finances and future living arrangements rather than planning for changes in your health.

At the other end of the scale, there can be a perception that in talking about dying and difficult topics like refusing treatment, it is seen as being about cost-saving, with some people finding it difficult to foresee a time when they wouldn’t want everything possible done for them.

In the face of these factors, it is sadly less of a surprise that the recent found that only 4% of people admitted to hospital, who went on to die there, had an advance care plan.

We are really pleased to be working with the Communitybaptistpa on raising awareness of these issues. Poor communication is a fundamental barrier to care planning, and both health professionals and older people themselves need to change how they approach this topic. Creating a better understanding of where each side is coming from will be crucial in improving care at the end of life.

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