On Wednesday 17 May 2023, Dying with Dignity NSW hosted a very informative webinar entitled - Empowering the Elderly - How to Avoid the End-of-Life Conveyor Belt.
We were delighted to have two very experiences guest speakers, Intensive Care Specialist, Professor Ken Hillman AO and Geriatrician, Associate Professor Gideon Caplan giving their thoughts on how the elderly can best navigate the medical system in their last months, weeks or days to ensure that their wishes are respected. Over 550 people participated, with many more expressing an interest in watching the recording.
You can watch the full webinar below.
It was incredibly refreshing to have two highly regarded specialists speak in such a frank and approachable way about the challenges many elderly people face in hospital and how they might be overcome. The system is skewed toward keeping people alive and often imposes futile and burdensome treatments on those who are nearing the end of their lives.
Unfortunately, patients often feel powerless and are reluctant to question their treatment or express their wishes to their treating doctors and their loved ones. However, it is vital that we have those difficult conversations and document our wishes while we are well enough to do so.
More useful resources
Below are some of the resources which were discussed in the webinar including Ken Hillman’s wonderful book and TEDx talk, along with DWD’s Advance Care Planning materials (including our last webinar on that topic).
'A GOOD LIFE TO THE END - Taking control of our inevitable journey through ageing and death' by Professor Ken Hillman (2016)
We cannot recommend this book highly enough. It explains how the medical system often deals with the elderly and provides invaluable support for patients and their loved ones to give them the tools and confidence to ensure that their wishes are respected. Link here
We’re Doing Dying All Wrong - TEDx Talk Professor Ken Hillman (2016)
Professor Ken Hillman compares the experience of his grandfather who died peacefully at home, with the death of his mother 30 years later after 6 months on the “end-of-life conveyor belt”. With incredible advances in medicine, doctors are better at keeping people alive but have difficulty dealing with the frail elderly, who are approaching the end of their lives and need support and care during the dying process rather than curative treatment. Link here
Shared Decision Making Tools
Both Ken and Gideon stressed the importance of shared decision making, which involves discussion and collaboration between a patient and their treating doctor. This should be an integral part of all healthcare, but is especially important when approaching end-of-life. The aim is to ensure that patients are aware of all their treatment options and have realistic expectations of possible benefits and harms so that they can make fully informed decisions.
Unfortunately this does not always occur, but we should not be afraid initiate these conversations with our doctors. Here is a link to some resources which includes tools for preparing questions for your doctor, determining goals of care and making decisions about treatment options.
About the Presenters
Ken Hillman AO is Professor of Intensive Care at the University of New South Wales (UNSW). Ken graduated from Sydney University and trained at St Vincents Hospital in Sydney and St Bartholomews Hospital in London.
He was one of the first formally trained intensive care specialists and became the Director of Intensive Care at Charing Cross Hospital in London before returning to Australia to become Director at Liverpool Hospital in Sydney.
He has over 210 peer reviewed publications; approximately 90 chapters in textbooks; co-authored an intensive care textbook; co-edited several textbooks; written two books aimed at the general public; and has acquired over $23 million in peer reviewed grants.
He has been invited to address over 130 international conferences and over 140 national conferences. Ken has held many professional positions related to health and is the Director of the Simpson Centre for Health Services Research. He has an Order of Australia and has a high public profile in the area of end of life and has given a TEDx talk at the Sydney Opera House on the subject.
Associate Professor Gideon Caplan is Director of Post Acute Care Services and Director of Geriatric Medicine at Prince of Wales Hospital and a Conjoint Associate Professor at UNSW in Sydney. He is editor of the most recent textbook of Geriatric Medicine in Australia and has researched and written about Advance Care Planning, as well as providing end of life care for many people. He has served as a consultant to Commonwealth and State Health Departments including the Australian Health Ministers Advisory Council.
Associate Professor Gideon Caplan is Director of Post Acute Care Services and Director of Geriatric Medicine at Prince of Wales Hospital and a Conjoint Associate Professor at the University of New South Wales in Sydney, Australia. He is editor of the most recent textbook of Geriatric Medicine in Australia and has researched and written about Advance Care Planning, as well as providing end of life care for many people. His research also involves –
1. developing and rigorously testing new health services, he has been a chief investigator on 7 investigator-initiated Randomised Control Trials (RCT)s, and
2. the pathophysiology of delirium, where he works with a consortium of international investigators.
He has served as a consultant to Commonwealth and State Health Departments including the Australian Health Ministers Advisory Council.