Slow euthanasia? The deaths of psychogeriatric patients

Psychogeriatric services reach out to people who are suffering from psychiatric disorders which may persist until death and may bring forward death. It has been suggested that these services should aim at avoiding admitting patients for hospital care whose lives may be ended by the upset of admission or prolonged by inappropriate nursing and medical interventions. A review of the characteristics of patients dying during one year while under the care of a psychogeriatric service showed that one in three died as a psychogeriatric inpatient, the remainder dying at home or as inpatients in a general hospital. Those dying as psychogeriatric inpatients differed in their clinical and social characteristics from those dying elsewhere and it seemed unlikely that they could have been cared for humanely without the resources of the hospital ward. Psychogeriatric practice has many similarities to the work of hospices with other terminally ill patients, but the duration of the terminal illness and the needs arising from it are often more prolonged. Probably the management of dying among psychogeriatric patients will be improved if lessons learnt from other hospice practices are adopted.