We read with interest your review of advance care planning decisions with frail and older individuals.1 As two geriatric registrar trainees we have found a spectrum of good and bad practice in hospital and variation in the opinions of patients and families towards advance care planning.
It can be easier to initiate conversations about future care when the elderly have been admitted acutely, which often focuses thoughts on mortality. However, they themselves are often too unwell to participate in such conversations, or they may make a different decision than if asked when they had been stable and in their own home.2
Within geriatrics there has been an increasing interest in advance care planning coupled with more geriatricians working in the community. We are well placed to initiate conversations about advance care planning but equally it may also be done by GPs with a long-term relationship with the patients. A collaborative approach with improved communication across sectors may be the way forward.
We recently conducted an audit into admissions from nursing homes and found our communication on discharge of DNACPR decisions and advance care planning done in hospital was extremely poor: only 24% of decisions were documented on the initial discharge letter to GPs. However we did find that when advance care planning was done and communicated on discharge it was largely successful in ensuring that the preferred place of care was met.
This is a difficult and highly emotive area which needs more time and development but has the potential to improve the quality of life for older patients.
- © British Journal of General Practice 2013