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Many of the principles of care at the end of life are shared with CGA." /> <meta name="abstract" content="End of life care refers specifically to the last few days or hours of life, when maintenance of comfort and dignity, and avoidance of pain and distress take priority. Many of the principles of care at the end of life are shared with CGA." /> <link rel="canonical" href="https://www.bgs.org.uk/resources/18-cga-in-primary-care-settings-end-of-life-care-issues" /> <link rel="shortlink" href="https://www.bgs.org.uk/node/4156" /> <meta http-equiv="content-language" content="en" /> <meta property="og:site_name" content="British Geriatrics Society" /> <meta property="og:title" content="18. CGA in Primary Care Settings: End of life care issues | British Geriatrics Society" /> <meta property="og:description" content="End of life care refers specifically to the last few days or hours of life, when maintenance of comfort and dignity, and avoidance of pain and distress take priority. 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CGA in Primary Care Settings: End of life care issues </div> </h1> <span property="dc:title" content="18. CGA in Primary Care Settings: End of life care issues" class="rdf-meta element-hidden"></span><span property="sioc:num_replies" content="0" datatype="xsd:integer" class="rdf-meta element-hidden"></span> <div class="resource-header-details"> <div class="card-resource-type-i"> <div class="card-resource-type"> Good practice guide </div> <div class="resource-type-i-icon">i</div> <div class="resource-type-info-arrow"></div> </div> <div class="resource-type-info"><div class="resource-type-info-text">Good practices guides focus on providing information on a clinical topic.</div></div> </div> <div class="node-header-details"> <div class="card-authors-wrapper"><div class="label">Authors:</div><div class="author-details">British Geriatrics Society</div></div> <div class="card-topics-wrapper"><div class="label">Topics:</div><a href="/taxonomy/term/2632">Comprehensive Geriatric Assessment (CGA) in acute settings</a>, <a href="/taxonomy/term/13">End of life care</a></div> <div class="node-header-dates"> <div class="card-date-wrapper"><div class="label">Date Published:</div><div class="card-date"> <span class="date-display-single" property="dc:date" datatype="xsd:dateTime" content="2019-01-29T00:00:00+00:00">29 January 2019</span> </div> </div> <div class="card-date-updated"> <div class="label">Last updated: </div> <span class="date-display-single" property="dc:date" datatype="xsd:dateTime" content="2019-01-29T00:01:00+00:00">29 January 2019</span> </div> </div> </div> </div> <div class="view view-sections view-id-sections view-display-id-main view-dom-id-91241759df4ad97ec560d2b7e364b621"> <div class="view-content view-content-main"> <div class="views-row views-row-1 views-row-odd views-row-first views-row-last section-row palette-default "> <div class="section-inner"> <div class="card-body"> <p>Many of the principles of care at the end of life are shared with comprehensive geriatric assessment, however the philosophy of treatment is likely to shift even further towards symptom management rather than long-term disease treatment and health maintenance.</p> <p>A key component in the assessment of the dying patient is recognition by the healthcare team, the person themselves, and their family and friends that the person is near to the end of life. This can be relatively clear with a well-recognised, progressively terminal diagnosis such as metastatic cancer, but can be more difficult if the underlying problem is less well circumscribed and widely understood, such as in advanced frailty. Frailty correlates with prognosis but even in advanced states, this is often missed due to its insidious progress and the difficulties differentiating frailty from ‘normal’ ageing.</p> <p>End of Life care refers specifically to the last few days or hours of life, when maintenance of comfort and dignity, and avoidance of pain and distress take priority. Efforts to codify an approach to this are challenging, not least due to cultural attitudes to death and dying. It is not disputed though that, with or without a formal tool to assist the assessment and treatment of a person at the end of their life, an individualised approach is key. Local guidelines and documentation standards may be useful here.</p> <h6>Further reading</h6> <p><a href="http://rcnendoflife.org.uk/" rel="nofollow">The RCN Guide to End of Life Care</a>.</p> <p><a href="http://www.goldstandardsframework.org.uk/" rel="nofollow">Gold Standards Framework</a>: A set of resources to promote high quality end of life care may be <a href="http://www.goldstandardsframework.org.uk聽" rel="nofollow">found here</a>.</p> <p><a href="http://coordinatemycare.co.uk/" rel="nofollow">Coordinate My Care Record</a>: An online clinical record to document information and clinical plans for people at the end of their lives.</p> <p>See also the Good Practice Guide in this series: <a href="/resources/8-cga-in-primary-care-settings-care-and-support-planning">Care and support planning in CGA</a>.</p> </div> <div class="card-view-4"> <div class="view view-attachment view-id-attachment view-display-id-main view-dom-id-5f1f21f69687dc07b6529d46128ea7f3"> </div> </div> </div> </div> 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</div> </div> </div> </section> <section class="block block-views"> <div class="view view-sections view-id-sections view-display-id-sidebar view-dom-id-4e7b1fa1740c012af14f4d6c0b622316"> <div class="view-content view-content-main"> <div class="views-row views-row-1 views-row-odd views-row-first side-row "> <div class="section-inner"> <div class="card-title"> <h2 class="field-content">Section 1: CGA in Primary Care</h2> </div> <div class="side-row-wrapper"> <div class="card-body"> <p><a href="/resources/1-cga-in-primary-care-settings-introduction">Introduction</a><br /> <a href="/resources/2-cga-in-primary-care-settings-the-elements-of-the-cga-process">The elements of CGA</a>:<br /> - <a href="/resources/3-cga-in-primary-care-settings-physical-assessment">Physical assessment</a><br /> - <a href="/resources/4-cga-in-primary-care-settings-functional-and-social-assessment">Functional, social and environmental assessment</a><br /> - <a href="/resources/5-cga-in-primary-care-settings-psychological-components">Psychological components</a><br /> - <a href="/resources/6-cga-in-primary-care-settings-medication-review">Medication review</a><br /> - <a href="/resources/7-cga-in-primary-care-settings-creating-a-problem-list">Creating a problem list</a><br /> <a href="/resources/8-cga-in-primary-care-settings-care-and-support-planning">Care and support planning</a><br /> <a href="/resources/9-cga-in-primary-care-settings-involving-social-services">Involving Social Services</a></p> </div> </div> </div> </div> <div class="views-row views-row-2 views-row-even views-row-last side-row "> <div class="section-inner"> <div class="card-title"> <h2 class="field-content">Section 2: Specific Presentations</h2> </div> <div class="side-row-wrapper"> <div class="card-body"> <p><a href="/resources/10-cga-in-primary-care-settings-patients-presenting-with-mobility-and-balance-issues">Mobility and balance</a><br /> <a href="/resources/11-cga-in-primary-care-settings-bone-health">Bone health</a><br /> <a href="/resources/12-cga-in-primary-care-settings-patients-at-risk-of-falls-and-fractures">Falls</a><br /> <a href="/resources/13-cga-in-primary-care-settings-patients-presenting-with-depression">Depression</a><br /> <a href="/resources/14-cga-in-primary-care-settings-patients-presenting-with-confusion-and-delirium">Confusion/delirium</a><br /> <a href="/resources/15-cga-in-primary-care-settings-mental-capacity-issues">Mental capacity</a><br /> <a href="/resources/16-cga-in-primary-care-settings-patients-presenting-with-urinary-incontinence">Urinary incontinence</a><br /> <a href="/resources/17-cga-in-primary-care-settings-weight-loss-and-nutrition-issues">Weight loss and nutrition</a><br /> <strong>End of life care (you are here)</strong></p> </div> </div> </div> </div> </div> </div> </section> </div> </aside> </div> </main> <section class="postscript-first"> <div class="postscript_first"> <section class="block block-views postscript-section-row-block"> <h2 class="block-title">Other resources in this series</h2> <div class="view view-resource-series view-id-resource_series view-display-id-block section-row row-max-4 view-card-default-palette view-dom-id-cd5d4d2e5b9f0decfa22da611e68c592"> <div class="view-content view-content-main"> <div class="views-row views-row-1 views-row-odd views-row-first"> <a class="card resource-card" href="/cgatoolkit"><div class="card-text"><div class="card-content"> <div class="card-title"> <h3>1. CGA in Primary Care Settings: Introduction</h3> </div> <div class="card-date-display-override"> <span class="date-display-single" property="dc:date" datatype="xsd:dateTime" content="2019-01-28T00:00:00+00:00">28 Jan 2019</span> </div> <div class="card-summary"> <div class="card-summary-wrapper"> <div class="card-summary"> An introduction to CGA in primary care settings. This toolkit was developed by the British Geriatrics Society and has been endorsed by the ANCD for Older People and Integrated Person-Centred Care and by the Council of British Geriatrics Society, Scotland. </div> </div> </div> </div><div class="card-footer"> <div class="card-resource-series"> In a series </div> <div class="card-resource-type"> Good practice guide </div> </div></div></a> </div> <div class="views-row views-row-2 views-row-even"> <a class="card resource-card" href="/resources/2-cga-in-primary-care-settings-the-elements-of-the-cga-process"><div class="card-text"><div class="card-content"> <div class="card-title"> <h3>2. CGA in Primary Care Settings: The elements of the CGA process</h3> </div> <div class="card-date-display-override"> <span class="date-display-single" property="dc:date" datatype="xsd:dateTime" content="2019-01-28T00:00:00+00:00">28 Jan 2019</span> </div> <div class="card-summary"> <div class="card-summary-wrapper"> <div class="card-summary"> An overview of how Comprehensive Geriatric Assessment (CGA) is done in the primary care setting, and what to consider when conducting the assessment. </div> </div> </div> </div><div class="card-footer"> <div class="card-resource-series"> In a series </div> <div class="card-resource-type"> Good practice guide </div> </div></div></a> </div> <div class="views-row views-row-3 views-row-odd"> <a class="card resource-card" href="/resources/3-cga-in-primary-care-settings-physical-assessment"><div class="card-text"><div class="card-content"> <div class="card-title"> <h3>3. CGA in Primary Care Settings: Physical Assessment </h3> </div> <div class="card-date-display-override"> <span class="date-display-single" property="dc:date" datatype="xsd:dateTime" content="2019-01-28T00:00:00+00:00">28 Jan 2019</span> </div> <div class="card-summary"> <div class="card-summary-wrapper"> <div class="card-summary"> Examination of older patients incorporates all the typical aspects of clinical examination, although there are some general considerations and emphases that should be borne in mind, and specific examinations that may be more relevant in older people. </div> </div> </div> </div><div class="card-footer"> <div class="card-resource-series"> In a series </div> <div class="card-resource-type"> Good practice guide </div> </div></div></a> </div> <div class="views-row views-row-4 views-row-even views-row-last"> <a class="card resource-card" href="/resources/4-cga-in-primary-care-settings-functional-and-social-assessment"><div class="card-text"><div class="card-content"> <div class="card-title"> <h3>4. CGA in Primary Care Settings: Functional and social assessment</h3> </div> <div class="card-date-display-override"> <span class="date-display-single" property="dc:date" datatype="xsd:dateTime" content="2019-01-28T00:00:00+00:00">28 Jan 2019</span> </div> <div class="card-summary"> <div class="card-summary-wrapper"> <div class="card-summary"> Functional assessment examines factors like mobility and daily living activities, and social assessment looks at social circumstances. Asking what the older person does and what environment they live in adds context to any Comprehensive Geriatric Assessment. </div> </div> </div> </div><div class="card-footer"> <div class="card-resource-series"> In a series </div> <div class="card-resource-type"> Good practice guide </div> </div></div></a> </div> </div> <div class="view-footer"> <div class="card-feed-link"><a href="/resources/resource-series/comprehensive-geriatric-assessment-toolkit-for-primary-care-practitioners">See all resources in this series</a></div> </div> </div> </section> <section class="block block-views postscript-section-row-block"> <h2 class="block-title">You may also be interested in</h2> <div class="view view-resource-series view-id-resource_series view-display-id-related_auto_manual view-dom-id-97b4d48cd2bb4a4de5fa8cc3f714b923"> <div class="view-content view-content-main"> <div class="views-row views-row-1 views-row-odd views-row-first views-row-last"> <div class="card-views-conditional"> <div class="view view-resource-series view-id-resource_series view-display-id-related section-row row-max-4 view-card-default-palette view-dom-id-95bdf9ecc7c61189116eb04332cbf562"> <div class="view-content view-content-main"> <div class="views-row views-row-1 views-row-odd views-row-first"> <a class="card resource-card" href="/resources/8-cga-in-primary-care-settings-care-and-support-planning"><div class="card-text"><div class="card-content"> <div class="card-title"> <h3>8. CGA in Primary Care Settings: Care and support planning</h3> </div> <div class="card-date-display-override"> <span class="date-display-single" property="dc:date" datatype="xsd:dateTime" content="2019-01-28T00:00:00+00:00">28 Jan 2019</span> </div> <div class="card-summary"> <div class="card-summary-wrapper"> <div class="card-summary"> A reference guide to care and support planning within Comprehensive Geriatric Assessment for primary care and community clinicians, including the recommended components and tips for creating a care plan. </div> </div> </div> </div><div class="card-footer"> <div class="card-resource-series"> In a series </div> <div class="card-resource-type"> Good practice guide </div> </div></div></a> </div> <div class="views-row views-row-2 views-row-even"> <a class="card resource-card" href="/resources/7-cga-in-primary-care-settings-creating-a-problem-list"><div class="card-text"><div class="card-content"> <div class="card-title"> <h3>7. CGA in Primary Care Settings: Creating a problem list</h3> </div> <div class="card-date-display-override"> <span class="date-display-single" property="dc:date" datatype="xsd:dateTime" content="2019-01-28T00:00:00+00:00">28 Jan 2019</span> </div> <div class="card-summary"> <div class="card-summary-wrapper"> <div class="card-summary"> Creating a problem list as part of Comprehensive Geriatric Assessment can help identify all the issues to consider and will be helpful in drawing up a care plan. </div> </div> </div> </div><div class="card-footer"> <div class="card-resource-series"> In a series </div> <div class="card-resource-type"> Good practice guide </div> </div></div></a> </div> <div class="views-row views-row-3 views-row-odd"> <a class="card resource-card" href="/resources/9-cga-in-primary-care-settings-involving-social-services"><div class="card-text"><div class="card-content"> <div class="card-title"> <h3>9. CGA in Primary Care Settings: Involving Social Services</h3> </div> <div class="card-date-display-override"> <span class="date-display-single" property="dc:date" datatype="xsd:dateTime" content="2019-01-28T00:00:00+00:00">28 Jan 2019</span> </div> <div class="card-summary"> <div class="card-summary-wrapper"> <div class="card-summary"> CGA needs to consider the impact of social factors on the health and wellbeing of individuals and vice versa. Here we look at working with Social Services and the differences in the four nations of the UK. </div> </div> </div> </div><div class="card-footer"> <div class="card-resource-series"> In a series </div> <div class="card-resource-type"> Good practice guide </div> </div></div></a> </div> <div class="views-row views-row-4 views-row-even views-row-last"> <a class="card resource-card" href="/resources/4-cga-in-primary-care-settings-functional-and-social-assessment"><div class="card-text"><div class="card-content"> <div class="card-title"> <h3>4. CGA in Primary Care Settings: Functional and social assessment</h3> </div> <div class="card-date-display-override"> <span class="date-display-single" property="dc:date" datatype="xsd:dateTime" content="2019-01-28T00:00:00+00:00">28 Jan 2019</span> </div> <div class="card-summary"> <div class="card-summary-wrapper"> <div class="card-summary"> Functional assessment examines factors like mobility and daily living activities, and social assessment looks at social circumstances. Asking what the older person does and what environment they live in adds context to any Comprehensive Geriatric Assessment. </div> </div> </div> </div><div class="card-footer"> <div class="card-resource-series"> In a series </div> <div class="card-resource-type"> Good practice guide </div> </div></div></a> </div> </div> </div> </div> </div> </div> </div> </section> </div> </section> <footer id="site-footer" role="contentinfo"> <section class="footer-first"> <div class="outer-wrapper"> <section class="block block-views"> <div class="view view-footer-sections view-id-footer_sections view-display-id-orgs view-display-grid view-dom-id-d9a6630820fbef1defe07630a9a5f763"> <div class="view-header"> <script> if(jQuery('#Main.CRM_Contribute_Form_Contribution_Main').length > 0){ jQuery('#Main.CRM_Contribute_Form_Contribution_Main').on('submit',function(e){ setTimeout(function(){ e.preventDefault(); 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