Caring for Frail Older People on Acute Hospital Wards (CFFOP)
This RLO uses data from recent research into the care of patients dying on acute hospital wards to explore some of the issues about how patients and carers experience death in hospital.
CFFOP was a three year study funded by the Alzheimer’s Society. It took place on 4 acute wards of a UK general hospital: Oak, Ash, Elm and Fir, and was based on:
- 245 hours of ward observation
- 38 interviews with ward staff
- 13 interviews with bereaved family carers
- 42 patient case record reviews.
The Good Death
What is the Good Death?
During the course of our research we found that in a number of cases families were initially keen to have their relative home for the last days of their lives. However, this often did not happen. Sometimes a patient’s condition deteriorated more swiftly than the support services could be put in place to allow this to happen.
Often, once family carers thought through what was involved in looking after someone at home whilst dying, they decided that hospital was the best place for the individual to be.
It is important for health professionals to allow time and space for patients and their family carers to assimilate all that is going on in what is a very stressful situation. It is only when people have understood the implications of any possible decisions that they are in a position to make an informed choice.
However, in the pressured environment of the acute hospital ward relatives who are anxious and distressed may find it difficult to take in what is happening, or communicate effectively with staff. Health professionals may find it difficult to give time and privacy needed to support families of dying patients. And always, there is immense pressure from management for staff to free up bed space for other patients.
Hospital as a preferred place of death
Although it is important to realise patients’ and families’ preference for place of death, and to support patients to die at home if this is what they want, hospital can be a good – or at least a ‘good enough’ – place of death and patients and carers can have positive experiences of end of life care on hospital wards.
The study findings suggest that most carers did not consider hospital to be an inappropriate place for their relative to die.
Some families who initially expressed a preference for a home death changed their minds as death became more imminent.
Many dying patients express a very strong desire not to impose a burden on their families.
Regardless of people’s preferences, as the population continues to age, the hospital will continue to be the place where most people die for the foreseeable future. Consequently, it is important that hospitals adapt to provide excellent end of life care to all dying patients, including those who have dementia.
|Advance Care Planning (ACP)||The process of discussion between patients affected by terminal and life limiting illness, their family members and health professionals, about treatment options and future plans for care.|
|Alzheimer’s Society||Support for anyone affected by dementia|
|Amber Care Bundle Pathway||Pathway developed to aid decision making and care management|
|Caring for frail older people (CFFOP) research project page||Frail older people (including those with dementia) and their families|
|Common Core Competences in End of Life Care||Frail older people (including those with dementia) and their families|
|End of Life Care Strategy, 2008||Patient choice and involvement in decision making|
|EPAC||End of life care pathway|
|Liverpool Care Pathway||Support for patients and their families in the last days and hours of life|
|Marie Curie Palliative Care Institute, Liverpool||Support for patients and their families in the last days and hours of life|
|SCE Dementia Gateway||Resource for anyone supporting people with dementia|
|Sue Ryder Care Research Group for the Study of Supportive, Palliative and End of Life Care (SRCC)||Research on end of life care|
|Transform Programme||Research on end of life care|
|International Observatory for End of Life Care||Research to improve palliative and end of life care for patients and family carers|