Page 179 - Hospital Authority Convention 2017

Masterclasses

M14.3 Geriatric Pearl 13:15 Room 423 & Room 424

End-of-life Care for Frail Elderly Patients with Multi-morbidity in the Hospital Setting
Luk JKH
Department of Medicine and Geriatrics, Tung Wah Group of Hospitals Fung Yiu King Hospital, Hong Kong HOSPITAL AUTHORITY CONVENTION 2017
The older population was projected to grow to 15% of the total population by mid-2014 and to 30% (2.43 million) in 2034.
Older people tend to have multiple co-morbidities, and end-of-life (EOL) issues are unavoidable. Patients with heart failure,
Parkinson’s disease, and advanced dementia may experience distressing symptoms similar to patients dying of a terminal
condition. In order to improve the service to dying older patients at Fung Yiu King Hospital (FYKH), an EOL working group (EOL
WG) chaired by a consultant geriatrician and consisted of senior and frontline ward nursing staff was formed in 2012. In June
2012, the EOL WG established the End-of-life Clinical Plan for Inpatients (EOL CPi) to improve patient and carer satisfaction,
carer communication, and patient comfort in their last days of life. After EOL-CPi is launched, unnecessary medications and
interventions were avoided in order to enhance patient’s comfort, with a marked reduction in use of intravenous antibiotics,
broad-spectrum antibiotics, blood tests, blood product transfusions, regular medications and “as needed” medications.
Painful yet unnecessary vital sign monitoring with haemoglucostix was reduced, as was the use of physical restraints. In
August 2015, a mix gender EOL Ward with eight beds was established to manage EOL patients. The EOL ward provides a
comfortable environment with privacy for EOL patients, with adequate space for family members to stay at bed side. TV
and washing basin are available at each bed for patients and family members. Flexible visiting hours are allowed. A small
side room with sofa was available for relatives to take a rest in privacy or to calm down during the period of bereavement. In
February 2017, the EOL WG started the Careful Hand Feeding Programme for EOL patients who have chosen to continue oral
feeding until the last moment of their life.

Wednesday, 17 May

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