Your views: Why are we hospitalising these elderly patients?

In our role as crematorium medical referees, we have become aware of occasions when the deceased had an established diagnosis of dementia, was living in a care-providing institution, but died in an acute hospital following an emergency medical admission.

In a prospective survey of the medical certificates received at a crematorium during the three months, we identified seven such patients out of a total of 621 cremations. Their average age was just over 89.

The reasons for admission were bronchopneumonia (three cases), aspiration pneumonia (two), unsafe swallow (one) and not eating (one). Specifically recorded medical interventions were antibiotics (three), IV fluids (three) and dialysis (one).

The average time from admission to death was seven days.

Our limited data do not, of course, allow us to understand the particular circumstances in each case which led to the emergency hospital admission, but we are left with the feeling that these seven people may have suffered a bewildering end to their life and that the emergency services and the hospital were in turn left to deal as best they could with a demented and dying patient.

In order to protect both the patient and acute NHS services, perhaps in addition to DNAR - Do Not Attempt Resuscitation, it would be helpful to make use of a second advance patient directive: DNH - Do Not Hospitalise?

  • Three retired GPs, who have asked to remain anonymous.

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