#156 How can geriatricians join the dots in Advance Care Planning with Professor Jugdeep Dhesi

I am delighted to open the new season with Professor Jugdeep Dhesi, geriatrician and President of the British Geriatrics Society. Listen in as we explore the changing demographics of dying and the vital role geriatricians play in joining the dots in Advance Care Planning.

This episode is a personal one. I  have recently experienced how easily care can become fragmented - and focus on isolated problems rather than seeing the whole person.

I am dedicating this episode to the geriatrician who chose to see the whole person - and in doing so, made all the difference. In her own words: “I am just one of many Geriatricians across the country doing this work every day. I am sure Jugdeep will agree this is 'bread and butter' geriatric medicine that the whole profession should get credit for.”

Key messages

• More people are dying in older age, with multiple conditions and complexity.

• Statistics: 650,000 deaths a year; projected 25% rise by 2040; around 75% of deaths are in people over 70.

• Dementia is now a leading cause of death, alongside heart disease, cancers and lung disease.

• Most people do not die in hospices; the majority die in hospital, then at home and in care homes.

• Older people are dying with multiple conditions, which changes how we must plan care.

• Dementia has a typical 5–7 year trajectory, offering time and opportunity for earlier advance care planning.

• Geriatricians understand the “story of an illness” – recognising early, middle and late stages – but this is often not discussed openly.

• Patients consistently say they want honest, transparent, holistic conversations about illness, prognosis and care.

• End of life care is delivered by a continuum of people: families, communities, care homes, generalists and specialists, not just palliative care teams.

• There is a strong need to move from fragmented, body-part-focused care to joined‑up, person‑centred care.

• The Comprehensive Geriatric Assessment (CGA) is an evidence‑based, cost‑effective way to address medical, functional, social and psychological needs.

• Education and training gaps: medical students often have only four weeks in geriatric medicine despite caring mostly for older people.

• Geographical variation in access to geriatricians across the UK raises issues of equity.

• Frailty scores should trigger deeper assessment, planning and shared decision making, and not just be a tick‑box.

• Advance Care Planning includes talking with family and arranging a Lasting Power of Attorney.

• The UK must upskill the whole workforce and wider community to support older people as they approach the end of life.

Resource

• British Geriatrics Society (BGS) – main professional society for geriatric medicine in the UK, with extensive resource:  www.bgs.org.uk

• BGS e‑learning modules are available with short and longer online learning on topics such as frailty, perioperative care, cancer, continence, palliative and end of life care.

• Using illness trajectories to inform person centred, advance care planning 

• The Model Acute Pathway: standards for care of acutely unwell patients in their first 72 hours in hospital 

• Research papers mentioned in this episode: 
  Cost–benefit analysis of implementing comprehensive geriatric assessment enhanced shared decision making into aortic aneurysm pathways 

• Understanding variation in the management of AAA in the UK: composition and function of multidisciplinary team meetings and information resources provided to patients 

• Preoperative clinical characteristics and 12-month outcomes following operative or non-operative management of asymptomatic aortic aneurysms  

Bio

Professor Jugdeep Dhesi

Jugdeep Dhesi is a consultant geriatrician at Guy’s and St Thomas’ NHS Foundation Trust and Professor of Geriatric Medicine at Kings College London. She is currently President Elect of the BGS, (from November 2022) and will take on the role of President from November 2024.

Jugdeep’s clinical work focuses on improving outcomes for older people undergoing elective and/or emergency surgery. Over the past 20 years, she has led the development and evaluation of the innovative and award-winning Perioperative medicine for Older People undergoing Surgery (POPS) service in the United Kingdom. This model of care first established at GSTT has been shown to deliver better outcomes for older people undergoing surgery, with value for the NHS. Jugdeep has supported the establishment of POPS services at numerous NHS hospitals and internationally.

Jugdeep has published widely on preoperative assessment and optimisation, perioperative approaches to frailty and delirium, and health services research examining perioperative pathways. She has a wide education and training portfolio, having established the first medical, nurse and allied health professional training programmes in perioperative medicine for older people. She has co-authored e-learning modules, MSc modules and multiple textbook chapters.

Jugdeep is Deputy Director for the Centre for Perioperative Care, contributes to a variety of steering, advisory and guideline groups (NELA, RCoA, BGS and NICE) and is committed to influencing policy to improve health and social care for older people.

She Tweets as @JKDhesi