The Importance of End of Life Planning Balmore Park Surgery PPG Wednesday 22nd March 2017

“Death is a very dull, dreary affair, and my advice to you is to have nothing whatever to do with it.” W. Somerset Maugham

1917 1/5 all deaths due to infection 1/3 all deaths under 5 years of age Life expectancy 50 Death was an expected and accepted occurrence Most deaths then would be considered preventable now

1950s Heart disease leading cause of death Largely untreatable 37% deaths occurred in hospital

2013 Cancer, as a broad group, leading cause of death Men 1. Heart Disease 2. Lung Cancer 3. Dementia Women 1. Dementia 2. Heart Disease 3. Stroke

Dementia Dementia is only the leading cause of death in women in the >80 age group 63% women age of death >80

Place of Death (%) Place 1984-92 2001-2010 Hospital 64.7 57.3 Home 24.1 19.0 Hospice N/A 5.1 Care Home 17.2 Other 11.1 1.4

Society Changes Less nuclear families Children further away More women working More secular Therefore, people are often more isolated, with less family or community support, during the end of life period

Patient Autonomy Patients are increasingly encouraged, and expected, to be involved in their management

21st Century End of Life Causes of death have changed Death often seen as medical failure to be avoided End of life period longer Cognitive impairment common Patients expected to be involved more