End-of-life services for older people in residential care homes in Hong Kong.

Good end-of-life care is needed for older people living in residential care homes with advanced irreversible chronic medical illnesses and cancers. At present, the usual practice of residential care homes is to send older residents to acute care hospitals when they are unwell, and some residents will die in hospital. Dying in hospital without choice for older people may not be in alignment with the principle of 'good death'. There are many barriers for older people to die in the place of their choice, particularly in a residential care home. In the community, to enhance end-of-life care for elderly people living in residential care homes, pilot end-of-life programmes have been organised by community geriatric assessment teams. In 2015, the Hong Kong Hospital Authority started the 'Enhance community geriatric assessment team support to end-of-life patients in residential care homes for the elderly' programme in four clusters. In the hospital setting, an end-of-life clinical plan and end-of-life ward in geriatric step-down hospitals may improve the quality of death of elderly people. In September 2015, the Hospital Authority guideline on life-sustaining treatment for terminally ill people was updated. Among other key end-of-life issues, careful (comfort) hand feeding was first mentioned in the guideline. The possible establishment of enduring powers of attorney for health care decision-making and enhancement of careful (comfort) hand feeding are new developments in the coming years.

The feeding paradox in advanced dementia: a local perspective.

Feeding problems are common in older people with advanced dementia. When eating difficulties arise tube feeding is often initiated, unless there is a valid advance directive that refuses enteral feeding. Tube feeding has many pitfalls and complications. To date, no benefits in terms of survival, nutrition, or prevention of aspiration pneumonia have been demonstrated. Careful hand feeding is an alternative to tube feeding with advanced dementia. In Hong Kong, the Hospital Authority has established clear ethical guidelines for careful hand feeding. Notwithstanding, there are many practical issues locally if tube feeding is not used in older patients with advanced dementia. Training of doctors, nurses, and other members of the health care team is vital to the promulgation of careful hand feeding. Support from the government and Hospital Authority policy, health care staff training, public education, and promotion of advance care planning and advance directive are essential to reduce the reliance on tube feeding in advanced dementia.

Geriatric screening in acute care wards--a novel method of providing care to elderly patients.

OBJECTIVE: To assess a nurse-implemented geriatric screening system. DESIGN: Descriptive study. SETTING: University teaching hospital, Hong Kong. PATIENTS: All (5080) elderly patients admitted between 1 January 1996 and 31 December 1996. MAIN OUTCOME MEASURES: Patient characteristics such as disease, prior admission, living quarters, and regular medications; interventions taken; and morbidity and mortality. RESULTS: The most common interventions were referral to a convalescent hospital, patient education, and carer contact. The overall death rate was 8.5% and the diseases with the highest mortality rates were renal failure, liver cirrhosis, and cancer. Approximately one quarter of patients had been admitted to hospital in the previous month. The death rate was higher among women than men (10.8% versus 6.7%, P<0.001; odds ratio=1.68; 95% confidence interval, 1.38-2.05), as was the percentage of those with a history of admission in the previous month (32.8% versus 20.0%, P<0.001; odds ratio=1.95; 95% confidence interval, 1.71-2.21). Patients with multiple pathologies and polypharmacy had a greater frequency of previous 1-month admission compared with those who did not have these features (37.5% versus 20.0%, P<0.001; odds ratio=2.37; 95% confidence interval 2.0-2.7). Patients living in old-age homes had a higher death rate and more previous 1-month admissions than home dwellers, and patients living in private old-age homes had a higher death rate but lower number of previous 1-month admissions than those living in subsidised old-age homes. CONCLUSIONS: This study has collected important data from one form of integrated geriatric practice, which can be used for future service provision.