Somewhere at the Texas Health Science Centre in San Antonio, there is a mouse known as “UT2598” which is 3 years old and being fed a steady diet of the drug Rapamycin with a view to beating the world’s oldest mouse record, which currently stands at 4 years. Apparently, UT2598 is well on the way to doing that.
Where will this science lead? In a few years will 100 be the new 60? Professor David Sinclair, a geneticist at the Harvard Medical School, observed that in the not too distant future, someone who is showing signs of aging will be able to do something about it and be treated as if it is a disease, which is not something that he expected to see in his lifetime.
Population aging is increasingly becoming an issue for concern throughout the world. People aged 60 and older make up over 11% of the global population. By 2050, that number will rise to about 22% In Japan, which is home to the fastest aging society globally, sales of adult diapers have overtaken sales of baby nappies. Some industries will of course benefit from this demographic shift (including manufacturers of adult diapers) but for others, including the health industry (where there will also be commercial benefits), there are numerous and sizeable challenges in dealing with this fact of global aging.
One of the issues for Australian health care providers and the doctors who are treating patients and making decisions day in/day out, is what steps need to be taken and what decisions need to be made with end of life care.
A recent article by Professor Hal Swerissen published in the Medical Journal of Australia (January 2015) refers to some statistics on dying. Dr Swerissen found, amongst other things, that between 60% - 70% of Australians would prefer to die at home with residential care facilities being the least preferred option. The reality, however, is that dying is highly institutionalised. Over the past century, the proportion of deaths at home has declined and deaths in hospitals and residential aged care facilities has increased so that only about 14% of people die at home, 54% die in hospitals and 32% in residential care. Dr Swerissen sees this issue as becoming more prominent as baby boomers age and the crude death rate doubles over the next 25 years. Something has to change. Dr Swerissen encourages the nation to adopt a scheme of compulsory advanced care plans where people state unambiguously what they want to happen at the end of their lives. What they want before they die.
The fact remains that most deaths occur in hospitals and therefore, doctors and hospital staff need to be equipped to make decisions quickly. Hospitals and health care providers need to have in place carefully worded protocols and policies which are widely communicated and easily understood. The policies need to take into account recent judicial decisions where the central concept is a patient’s “best interests”. It needs also to be borne in mind that treatment that is either futile or overly burdensome is not considered to be in a patient’s best interests, although courts will consider patient and family wishes. Generally however Courts will defer to the views of medical practitioners when it comes to treatment decisions.