Hong Kong West Community Geriatric Assessment Team End of Life Team
Tung Wah Group of Hospitals Fung Yiu King Hospital

Fulfil the final blessing of life

In traditional Chinese culture, there are ‘Five Blessings’ of life, namely longevity, wealth, health, virtue and peaceful passing. Many spend their whole life striving for the first four, but the Hong Kong West Community Geriatric Assessment Team End‑of‑Life Team focuses on the fifth blessing of a peaceful passing for elderly patients with life-limiting diseases. The team helps patients go through the final journey of lives with dignity based on their preferences, accompanied by their loved ones in a familiar environment.

Team leader Dr James Luk, Chief of Service, Department of Medicine and Geriatrics at Tung Wah Group of Hospitals Fung Yiu King Hospital (FYKH) points out that there are currently 8.5% of elderly patients living in residential care homes for elderly (RCHEs). They tend to be troubled by five to six chronic irreversible diseases such as cancer, organ failures, advanced cognitive impairment and advanced Parkinson’s disease, which require them to make frequent visits to hospital for treatment, blood taking, intravenous drip and antibiotics injection, or even invasive intubation. However, not only do these treatments bring little effects, but they also bring about physical and mental suffering to both patients and their families, which depart from the principle of ‘peaceful passing’.

Therefore, the team collaborated with two subsidised Care & Attention Homes to pilot the ‘End of Life Programme in RCHEs’ in 2009. Through understanding the background, habits, preferences, wishes and expectations of elderly patients, the team discusses over ‘Advance Care Planning’ with patients and their families, including whether to receive cardiopulmonary resuscitation, artificial enteral feeding, use of intravenous drip for hydration, use of antibiotics and non-invasive positive pressure ventilation. Moreover, they can also choose between the ‘Accident and Emergency Department (A&E) Pathway’ and ‘FYKH Pathway’ (see the diagram for details) for the arrangement of end of life care.

There was once an elderly couple living in the same room of the RCHE. The wife had chronic renal failure while the husband was suffering from end stage pancreatic cancer. Both of them joined the programme in RCHE. The husband’s condition deteriorated quickly, with poor appetite, jaundice and abdominal pain. The team supported the patient by frequent attendances, prescription of morphine, and educating staff and wife to perform careful hand feeding instead of putting in a nasogastric tube. The husband was cared by his wife with staff support 24 hours a day without the need to be admitted to hospital. The patient finally passed away peacefully in A&E via A&E Pathway. Bereavement care and psychological support were given to his wife afterwards. Soon she was out of bereavement and actively engaged in activities organised by the RCHE. One year later, she also passed away peacefully via A&E Pathway. Sparing no effort to fulfil the wishes of patients with advanced diseases and their families, the team hopes that both dying and the living will have no regrets.

There are currently 26 RCHEs taking part in the programme, serving 260 patients in total. The team seeks to expand the programme to four more RCHEs, sowing the seed of ‘peaceful departure’ citywide to preserve and fulfil the wishes of patients with end stage diseases.