BOPDHB Checkup August 2018 | Page 5

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. 5