When the end of life is near, comfort, not aggressive treatment, is best

We can understand the desire to keep our loved ones alive and with us for as long as possible, but when the end of life is near, life-saving hospital treatments can cause more pain and suffering than necessary. Are we better off focusing on providing love and comfort when the end of life is near?

The author of new research suggests that hospital staff should be trained to recognise when death is inevitable, so aggressive life-saving treatments are avoided, and instead patients can have a comfortable and dignified end of life.  

Research: those at the end of life still receiving aggressive treatment

The research by the University of New South Wales found that elderly people who are known to be at the end of their life are still receiving aggressive life-saving treatments in hospital.

The study involved examining the records of 773 elderly patients who had been admitted to hospital after making an emergency call. The median age of the patients was 68, but a third of the patients were over the age of 80.

About 40 percent of the patients over 80 years were given aggressive treatments in hospital, including intravenous medications, transplants, and resuscitation.

The researchers suggested that older people who are known to be at the end of their life would be better served with comfort, symptom control, pain relief, and the support and care of those they love.

Signs the end of life may be near

Adjunct Associate Professor Magnolia Cardona suggested that if hospital staff considered the patient’s medical history, they would be better informed to judge if death was imminent, and therefore could opt to take a less aggressive approach with the patient.

She said flags such as the number of recent hospital or emergency admissions or not-for-resuscitation orders could be a sign to medical staff that the emergency response was not the most appropriate.

“If hospital staff were trained for earlier recognition of when death is inevitable, patients could be spared such aggressive treatments and allowed a less traumatic and more dignified end,” she said.

Aggressive treatments also placed a burden on families and were a heavy cost to the health system, she said.

Talking about end-of-life choices

Professor Cardona suggested that families should discuss end of life wishes while those who are unwell are still able to make choices. Putting these plans in writing in an Advance Care Directive means that hospital staff are equipped to make care choices in line with what the patient wants.

Dying is a process that can occur slowly over days or weeks. Though it may be hard to let go of those we love, life-saving treatment may only have the effect of drawing out the process of dying, and may cause unnecessary additional pain and suffering.

“When death is inevitable, other more appropriate pathways of care can be offered, such as symptom control, pain relief and psychosocial support,” says Professor Cardona.

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  1. The article says “If hospital staff were trained for earlier recognition of when death is inevitable, patients could be spared such aggressive treatments and allowed a less traumatic and more dignified end”. But can hospital staff really be trusted to make this call? Nursing staff at a private hospital could not tell the difference between a dementia patient wanting to get out of bed to use the toilet and agitation, so they repeatedly gave him an antipsychotic drug to chemically restrain him. Trust me – this puts elderly patients much nearer to the end of their life than they should be. Their comfort and dignity is give little thought way before death is inevitable.

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