Caring for frail older patients inthe last phase of life : Challenges for general practitioners in the integration of geriatric and palliative care.

Abstract

The best possible care for frail older patients at the end of life can require the integration of geriatric and palliative approaches, possibly with different accentuations at different times. General practitioners (GP) are particularly important in this context: they provide patients with low-threshold primary care close to their homes and provide both general palliative care and geriatric services. What are the challenges for GPs in caring for frail older patients at the end of their lives? Asecondary data analysis of 52 qualitative interviews was carried out, which were serially obtained at 4 points in time over aperiod of 18months with 14family doctors. In addition, one focus group with five GPs took place. The analysis was carried out according to the principles of grounded theory. The results show that GPs see the care of frail older patients at the end of their lives through a)the growing number of older people, b)multimorbidity and complexity of the problem areas, c)the integration of geriatric and palliative approaches, d)the high average age of general practitioners and the lack of junior staff and e)the problem of ensuring care in rural areas as amajor challenge. The practical transition between geriatric and palliative care is considered by GPs to be fluid and there is adesire for more integration of both disciplines. In this study GPs perceived alarge overlap between geriatric and palliative care. Both approaches should be offered for aselection of patients as acombined service. In the future asystematic network between GPs and geriatricians in practices, clinics, and day clinics will be necessary.