Death on the Beach
The First World
Conference on End
of Life Psychiatry,
1 March 2018
Death on the Beach was the theme for the First
World Conference on End of Life Psychiatry
which brought together a range of expert
speakers from around the world in psychiatry,
palliative care, geriatrics, intensive care and
law to extend the concept of successful or
healthy ageing to “Positive Dying”.
Topics discussed at the Sydney-based conference, range from
‘State of the Art in Dying’, Palliative Psychiatry - a new job in the
21st century, Cognitive issues at the end of life, Capacity issues,
euthanasia and assisted dying and Why older New Zealanders
refuse resuscitation.
MHSOP Consultant Psychiatrist Dr Fiona Miller (currently acting
Medical Leader) and colleagues Kerry Capelin and Claire
McGowan Blair were invited to the Conference to present their
research on End of life care in Dementia.
This research started its journey at a 2015 workshop hosted
by Hospice and Ministry of Health on palliative care. It became
apparent at that workshop that more thought needed to be given
to elderly with dementia and palliative care. There was a clear
expectation that those dying with dementia would have their
palliative care needs met in residential care. However there was
no extra resourcing expected to go with this despite a growing
older population and 70% of people living with dementia residing
and dying in Aged Residential Care.
The End of Life Care in Dementia research looked at what good
quality end of life care actually looked like in terms of resourcing,
skill and time. The research gained ethics approval and was
conducted as follows:
•
Time in motion study of the care provided, skill mix, education
training and resources
Dr Fiona Miller, Registered Nurse, Community Team Leader MHSOP
Kerry Capelin, and MHSOP Service Manager Claire McGowan Blair.
• Family Perception of Care Survey
• Medications used in last days of life.
The research was undertaken in three sites -: Mental Health
Services for Older People MHSOP) In-Patient unit, Psychogeriatric
Care and a secure dementia care facility within the Bay of Plenty.
The research showed that care hours spent providing palliative
care was statistically higher in the MHSOP In-patient unit possibly
due to higher levels of frailty and expressed distress. The mean
average time spent with a patient was 11.9 hrs per day, slightly
higher in the MHSOP ward 13.8 vs 9.9 in the Aged Residential
Care (ARC) facility. The majority of cares were completed by
nurses. With regard to training, research showed a significant
difference between MHSOP In-Patient compared to ARC in the
End of Life Care pathway. The satisfaction scale on the whole was
positive.
This research highlighted that providing good quality End of Life
Care is intensive in nature and demands significant resources.
Training within ARC for End of Life pathway care and specifically
dementia care, should be addressed in order to meet the palliative
care needs in ARC.
The conference highlighted the complexity of issues related to
ensuring a good death for those living with dementia as well as
the quality of care from early diagnosis across the trajectory of the
disease.
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