Compared to younger people, older people and those with frailty are more likely to die from acute infections, such as COVID-19, and less likely to survive intensive care.
Advance care planning conversations rarely took place with older or frail people before the pandemic, but have now become prominent in the media amidst concerns about denial of treatment.
Some care home residents have even received standardised letters asking them to specify their treatment preferences without prior individual conversations with their clinicians. Understandable distress and confusion have been caused.
In their BMJ editorial, Sarah Hopkins and colleagues emphasise that advance care planning discussions need to be more person-centred and less plan-centred, avoiding a “tick-box” exercise. The literature indicates that some of the main benefits are strengthened relationships and support through the experiences of living and dying. These are derived from the process of advance care planning, rather than the plan it produces.
The authors draw on their recent systematic review of advance care planning with hospitalised frail adults, which found that a majority are receptive to such conversations but that current rates are very low (0-5%).
We suggest that advance care planning should focus on encouraging people to voice their concerns and priorities, providing the information they want, and facilitating conversations between loved ones at this emotionally and logistically difficult time”
– Sarah Hopkins, Clinical Research Fellow, Specialty Registrar in Geriatric and General Internal Medicine, Cambridge Palliative and End of Life Care Research Group
S Hopkins, R Lovick, L Polak, B Bowers, T Morgan, M Kelly, S Barclay Reassessing advance care planning in the light of covid-19. BMJ 18 May 2020
S Hopkins, A Bentley, V Phillips, S Barclay Advance care plans and hospitalized frail older adults: a systematic review. BMJSupp Pall Care. 2 April 2020
Lucy Lloyd, Communications, Primary Care Unit