Table of Contents Table of Contents
Previous Page  114 / 290 Next Page
Show Menu
Previous Page 114 / 290 Next Page
Page Background

are associated with poor prognoses. In such situations, physicians

tend to find themselves helpless, being able to offer very few if any

treatment options and instead finding themselves settling and offering

information and support to the patients and their family, symptom

and pain management, emotional and spiritual support, all in an effort

to make the patient as comfortable as possible. Most such cases with

poor outcome are treated actually according to the principles of

end-of-life care. These decisions are part of the day-to-day fabric of

treatment in the Geriatric department and fall under the principles of

palliative care. The Geriatrics department at the Western Galilee

Hospital in Naharia has become the flagship department for providing

palliative care to elderly patients in non-oncological settings. As a

result, patients in need of such care have been transferred to our ward

from internal medicine and other wards Our presentation will include

a detailed description of the principles of palliative care that we

implement in non-oncological settings in the Geriatrics ward, the

significance of such a treatment model, and howwe can transform the

Geriatrics wards in every general hospital into departments capable of

providing this kind care.


Considerations on the feasibility and acceptability of an advance

care planning intervention for dementia residents in UK care


K. Brazil


, G. Carter


, D. McLaughlin


, G. Kernohan


, P. Hudson



M. Clarke


, P. Passmore


, K. Froggatt





s University Belfast,


University of Ulster, Newtownabbey,


Lancaster University, Lancaster, UK


The purpose of this study was to articulate a family focused

Advance Care Planning (ACP) intervention and evaluate its impact in

dementia care nursing homes.


As part of a cluster randomised controlled trial including 25

care homes, carers of residents living with dementia in 13 of these

homes were exposed to an ACP intervention comprising: an ACP

facilitator; family education; a family meeting; documentation of ACP

decisions; and, orientation for GPs and care home staff about the


A feature of the evaluation included documentation on the inter-

vention delivery and stakeholder interviews to assess the feasibility

and acceptability of the intervention. The ACP Facilitator maintained a

narrative journal and activity log associated with tasks during the

intervention delivery. They also completed an interview to discuss

their perceptions of the implementation, challenges and benefits of

the ACP model. Participating care home managers (n = 10) and family

carers (n = 20) also completed an interview to determine their

perceptions of such a model.


On average, administration of each ACP intervention took

two hours. Findings from the interviews highlighted the accept-

ability of the intervention, also the importance of such a role to be

fulfilled within the care home environment was stressed, however

time and staff restraints were noted as key barriers. Nonetheless,

the interest and motivation of staff to make such a role possible

was clear.


This presentation identifies the feasibility and perceived

acceptability of an ACP intervention suitable for dementia residents in

UK care homes.


Antibiotics at end-of-life

D. Cardoso, L. Fernandes, R. Morais, M. Malheiro, C. Rodrigues,

J. Dantas, J. Rodrigues, J. Pereira, E. Cacheira, I. Verdasca, A. Botella,

A. Leitão, C. Fonseca, L. Campos.



Literature suggests that antibiotics are commonly

prescribed at the end-of-life, despite lack of evidence of its benefit,

in the absence of clinical symptoms of a bacterial infection. Apart of

this, there are also public health issues regarding antibiotic resistance.


Characterize and quantify the use of antibiotics at the end-



Retrospective, observational study evaluating the last 5 days

of life of all patients who died in an internal medicine service, in a

period of 13 months. Characterize the use of antibiotics prescription

regarding microbacterial isolation and the functional status of patients

(ECOG-PS). Data was collected after consultation of clinical charts.


Were included 70 patients, in 46% the etiology of death was

infectious. 86% of were under antibiotics within the last 5 days of

life. In 72% there were no microbacterial isolation, and only in23%

the antibiotic was prescribed according to antibiotic sensivity test.

Reserve antibiotic were used in 92% of patients. In the study

population 48,6% had an ECOG-PS score



Despite the absence of microbacterial isolation or even

clinical benefit, 86% of patients were under antibiotic in the last 5 days

of life. The indiscriminate use of antibiotics and its clinical benefit

at the end-of-life are questionable, unless the utilization aiming

symptom control. We should rethink the indiscriminate prescription

of large-spectrum antibiotics and the consequences for public health.


The introduction of advance care plans into care home settings

L. Cottrell.

East Lancashire Hospital Trust, Ribble Valley, United Kingdom


the aimof this Quality Improvement Project was to improve

palliative and end of life care for patients within care home settings

through the introduction of advance care planning (ACP) through an

initial pilot.


34 bed care home and a 47 bed nursing home. These catered

for patients with physical disabilities, general frailty and varying

degrees of cognitive impairment.


Quality Improvement Methodology was used for this pilot.

A review of the literature was undertaken alongside stakeholder

interviews and process mapping in order to gather opinion. A pre

hospital admission audit was undertaken to provide a baseline for

comparison in 12 months time. Plan Do Study Act cycles enabled

theories to be tested and adapted.


76 out of 79 patients and their families engaged with the

process of ACP. 52 Do Not Attempt Resuscitation forms were completed

in line with patient wishes. All patients had a frailty score documented

on their medical record to aid risk stratification and end of life care



care home staff and the majority of patients and their

relatives welcomed the introduction of ACP. This enabled patient

wishes to be documented, improved multi-disciplinary communi-

cation and end of life care planning through the use of frailty scores.

It is too early to say whether the project has reduced avoidable hospital

admissions. The project will now be rolled out across the remaining

seven care homes and the data analysed in full at the end of the project

in 12 months time.


Can the Charlson co-morbidity index guide inpatient resuscitation

and escalation discussions?

O. David


, B. Patel


, C. Baulch


, K. Broomfield




RBCH, England NHS, UK


The Charlson comorbidity index (1) is a prospectively

applicable weighted estimate of future mortality that takes account

of the number and seriousness of comorbid disease. It is not used

routinely in NHS (UK) geriatrics to help facilitate end of life planning

or discussion.


We conducted a scoping audit of co-morbidities, resusci-

tation and escalation documentation on several of our geriatrics

wards to see if gathering additional data on co-morbidity might be a

practical aid to guide patient, family and clinician discussion.


Sixty nine (n = 69) patient escalation and resuscitation forms

were reviewed, with ages ranging from 73 to 102. Resuscitation

wishes were either




in 42% (29/69). Those opting

not for resuscitation

had clear documentation in only 21% (14/69).

Ward escalation decisions to deteriorating health were not clear in 55%

(37/69), and often not discussed with patient or relatives. 73% (50/69)

Poster presentations / European Geriatric Medicine 7S1 (2016) S29