Empowering older, frail people to make their own end of life choices

This month we spoke with Senior Geriatrician and Head of the Aged Care Department at Sutherland Hospital, and 2021 SSMRF Grant recipient, Professor Peter Gonski. We discovered more about his career and life away from work as well as gained a deeper understanding of the goals of the research project.

Associate Professor Peter Gonski

Meet Prof Peter Gonski

“Throughout my career, I have had a vast number of different research projects related to older people. These vary from medication compliance to treatment for vertebral fractures to reviewing best models of care to the current study reviewing the empowerment of older people making decisions about their future medical care,” said Prof Peter Gonski.

“Managing older people in the community and in hospital is very gratifying and fulfilling. We find we can help individuals in many ways even if they are deteriorating in health, function and/or cognition. Whether it’s treating an acute deterioration due to infection or a chronic problem such as dementia, or allowing someone to die comfortably and with dignity or improve care at home or support them into an aged care facility we can achieve a lot at a time a person is getting older.”

Prof Gonski’s research is based on answering simple but relevant questions in clinical practice.

Prof Gonski’s most memorable research project was assessing whether injecting cement into a patient’s vertebra helps them recover from the severe pain quicker when they sustain a spine fracture. This study was published in the Lancet, one of the major recognised medical journals of the world.

Outside of work, Prof Gonski spends “a lot of time gardening, restoring our home, long walks and being with family and friends”.

Empowering older, frail people to make their own end of life choices

The project received initial funding of $100,000 from the Sydney Partnership for Health Education, Research and Enterprise (SPHERE) Age and Ageing Clinical Academic Group. The SSMRF, with support from Tynan Motors, contributed an additional $20,000 to Prof Peter Gonski and the ‘Empowering older, frail people to make their own end of life choices’ project, in December 2021.

The project team recommends that people – in addition to nominating power-of-attorney, enduring guardian and have a will drawn up in case of health deterioration – also think about making advanced care directives.

NSW Health defines an advance care directive as a way to say what healthcare treatments you would like to have or refuse, should you be in a position where you are seriously ill or injured and unable to make or communicate decisions about your care and treatment.

People should make these decisions when they have decision making capacity. This removes the need to rely on others to make these decisions when someone is unable to.

The ‘Empowering older, frail people to make their own end of life choices’ project commenced in 2021, following a previous study, for which Prof Gonski was one of the researchers.

“The previous project examined the advance care directives of patients who were seen in outpatient clinics of public hospitals. Nurses visited patients at home and talked to them about their advance medical care directives if they became sick.

“The current study includes patients who attended aged care outpatient clinics or were seen by our own community assessment services. A social worker attends them at home and talks about advance care directives. The importance of the study is to allow the research team to understand the nature of people making decisions for themselves when they are still able to and before they become too ill to make these decisions,” explained Prof Gonski.

“The funding will allow us to determine whether resources should be increased to certain parts of the population to educate and help people to understand and construct their own advance care directives. People’s ability to make decisions for themselves about this very important area of their lives is also under investigation in this study.”

“There have already been some interesting early outcomes but more patients need to be interviewed to confirm these results,” shared Prof Gonski.

With an increasingly aging population, this research is essential to ensure older Australians are empowered when making decisions about their future medical care.

If you require further information about making an advance care directive, please read this NSW Health guide.

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