Palliative care has been polluted by politics as governments seek to reduce the cost of health care. Faced with an ageing population and limited resources, end-of-life care is high on the political agenda. Terminal or palliative sedation is potentially dangerous yet it is widely used in hospitals, hospices, care homes and nursing homes. Care homes for the elderly have been targeted to reduce emergency admissions to hospitals at the end of life. The Liverpool Care Pathway for the Dying Patient (LCP) can be lethal.
Sick elderly people often present with dehydration. If hydration is withheld they will inevitably die. (1, 2)
Palliative carers and geriatricians should try to improve care for the elderly.
Community nurses and doctors must be trained to recognise dehydration and should rehydrate the patient as necessary.
Anticipatory prescribing of drugs such as diamorphine, midazolam and haloperidol should not be permitted in care homes. If sedation is required a doctor should assess the patient and prescribe as necessary.
No Water- No Life: Hydration in the Dying. Craig GM (Ed) Fairway Folio (2005) ISBN 0 9545445 3 6. E mail: books341@ clara.co.uk. Also available to order from good bookshops in the UK.
Craig GM. Palliative Care in Overdrive: Patients in Danger. American Journal of Hospice & Palliative Medicine, Vol. 25 Number 2, April/May 2008 p155- 160. © Sage Publications 10.1177/1049909107312595
(Notes by Gillian Craig. MD, FRCP Retired Consultant Geriatrician. UK)