Many older people in care die prematurely, and not from natural causes
Many older people in care, who are already vulnerable and at a greater risk of ill health, are dying prematurely and not from natural causes. Research has shown that although the majority of people in care homes die as expected, due to age and medical conditions, a significant minority die earlier than anticipated, often from neglect or abuse. While this is a tragedy for the individuals and their families, it is also a reflection of the failings of our care system. In this article, we take a look at the causes of premature death among those in care, and what can be done to ensure that these vulnerable people are given the best possible chance of living a full and healthy life.
Causes of premature death in care
We’ve looked at the social factors that lead to premature death in care. Now let’s examine the three medical causes of death – infection, malnutrition, and dehydration. Infections - Infections such as pneumonia, urinary tract infections, and gastroenteritis are among the most common causes of death among older people in care. The reasons for this are multiple. One is that many are prescribed antibiotics for long periods of time for conditions that would clear up on their own. Another is that there is a lack of hand washing, and therefore a lack of hygiene, among some staff. And another is that older people are particularly vulnerable to the side effects of antibiotics, and yet many receive them inappropriately. Malnutrition - Malnutrition, especially protein malnutrition, is another cause of premature death among older people in care. This is often seen in individuals with dementia who mostly eat alone and are therefore likely to skip meals. There are also other reasons as well. Dehydration - Dehydration is still another cause of premature death among older people in care. Again, one reason for this is that those with dementia are not always given drinks at the right times. Another is that some staff rush the feeding and toileting process, and don’t allow enough time for drinking. Yet another is that some residents are not physically able to hold a cup or a glass.
How to prevent premature death in care
If we want to reduce the number of people dying prematurely in care, we have to tackle the causes of these deaths. This means improving hygiene standards, and eating and drinking patterns, as well as reducing the use of antibiotics in those who don’t need them. It also means paying attention to the social factors that lead to premature death in care. For example, people with dementia need to eat alone, and staff need to have enough time to feed them. There’s also a need to ensure that people with dementia have access to drinks at all times. Finally, it also means paying attention to the cultural needs of residents from different backgrounds. For example, there may be certain drinks or foods that are important for specific cultural groups, and these need to be provided.
Social factors contributing to premature death in care
- Eating alone - People with dementia often eat alone, and this can lead to malnutrition and, in the worst cases, death. But dining alone is not just a problem in people with dementia. It can also be a problem for people with other conditions, including mental health problems. There are a number of reasons why people eat alone. They may have other health problems that mean they can’t eat with others; they may have carers looking after them who are not able to eat with them; or they may choose to eat alone. Eating alone is often associated with loneliness, and it is important to try to reduce this. Eating with others can help to break down isolation, and it can also be a good way to eat a healthy meal.
- Limited access to food and drink that is culturally important - Just as some people choose to eat alone, others may feel uncomfortable eating food that is not part of their cultural tradition. For example, people from the Hindu, Sikh, and Muslim communities may not feel comfortable eating non-halal meat, and people from the Jewish and vegetarian communities may not feel comfortable eating non-kosher food and food containing animal products, respectively. Respecting people’s cultural food preferences is important so that they feel comfortable in their care environment. But care homes need to be aware that catering to cultural food preferences can pose a challenge since they often have to cater to a wide range of dietary requirements.
Medical causes of premature death in care
- Prescribed antibiotics - Some older people in care are given antibiotics for long periods of time. This is especially common among people who are in care for long-term conditions, such as diabetes or heart disease. While antibiotics can be an important treatment for certain conditions, they should be prescribed for only short periods of time. And, if possible, they should be given in the least frequent and lowest dose possible. Unnecessary prescribing of antibiotics is a common problem. Although doctors prescribe antibiotics for good reasons, some may prescribe them because they are unsure about how to approach a certain condition, or because they want to be seen as helpful.
- Poor hygiene - Poor hygiene practices that lead to the transmission of infections are also common in some care homes. This can be due to poor training, unhygienic conditions, or lack of resources. Poor hygiene can lead to infections, which in turn can lead to death. - Excessive use of restraints - Some people in care have to be restrained. But excessive use of restraints can lead to bed sores and malnutrition, and can also be a sign of poor training. It is important to pay attention to the use of restraints, and to make sure that they are only used when absolutely necessary.
Role of staff in care homes in reducing premature death
- Adequate training - It is important that care staff are appropriately trained. This can help to ensure that they use the best possible hygiene practices, that they make the best dietary choices, and that they know how to deal with challenging behaviours.
- Adequate supervision - Care homes need to have adequate supervision and monitoring of the care provided. This can help to ensure that staff are doing their jobs properly. It can also lead to earlier detection of medical problems, and timely interventions.
Role of families and carers in reducing premature death
- Healthy eating and drinking practices - Families and carers are in the best position to ensure that the person in care is eating and drinking properly. They can make sure that they eat alone, and they can also make sure that they have the best possible food and drink available. Eating and drinking habits can be very difficult to change once someone is in care, especially if they have serious health problems, but it is important to try. If a person in care is eating and drinking unhealthily, it can lead to malnutrition and dehydration, as well as infections.
- Appropriate use of antibiotics - Families and carers can also make sure that the person in care is not prescribed antibiotics inappropriately. Antibiotics have saved many lives and are a valuable medical tool, but they are overused. This can lead to infections that antibiotics can’t cure, and even death.
Government policies to reduce premature death in care
It is important to remember that the majority of people in care die as expected, but a significant minority die earlier than anticipated, often from neglect or abuse. To address this, the government has created the National Health and Social Care Strategy. The strategy aims to improve health and social care for everyone in England. It is hoped that this will reduce the number of people who die prematurely from neglect or abuse. The strategy also includes a commitment to reducing the number of people who die prematurely from conditions that are currently poorly addressed in health and social care. This means tackling the three main causes of premature death: infections, malnutrition, and dehydration. The government is also committed to improving cultural diversity in health and social care services. And, finally, it is committed to improving training, supervision, and monitoring in health and social care. These are all important factors in reducing the number of premature deaths in care.
Sadly, many older people in care die prematurely, and not from natural causes. We’ve looked at the social factors that lead to premature death in care and the medical causes of death. We’ve also examined how to prevent premature death in care. Finally, we’ve looked at government policies to reduce premature death in care.
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