Commercial air travel is one of the safest means of transport. However, the environment within the aircraft cabin may have deleterious physiological effects on passengers, especially those with underlying medical problems and those who are old. With growing affluence, cheaper airfares and an ageing population, there will be more older people travelling by air over extended periods and longer distances, with a concomitant rise in the number of medical illnesses in the air. Older people may encounter various problems during a long journey. Certain actions may help to minimize these problems.

BackgroundAdvance Care Planning (ACP) is an organised process of communication which helps individuals to discuss their preferences for future healthcare decisions. This documented discussion provides a guide for the medical team in making decisions regarding care in the time of a crisis. ACP, therefore, allows healthcare professionals to honour the patient’s wishes nearer the time of death.AimThis paper studies the preferences and outcomes of the first 240 patients who have since passed away after the completion of their ACPs with an acute hospital in Singapore.MethodsWe retrospectively reviewed completed ACP documents for patients’ preferences and compared these preferences with their death outcomes to see if their wishes were honoured. The cases where preferences were not honoured are further examined for reasons.Results88% of the patients died within a year of the ACP and 99% of them had their wishes honoured with regards to CPR. 66% had their choice of the place of death honoured.DiscussionMost of our patients had their final wishes honoured, in terms of the medical interventions given and resuscitation status. However, there were obstacles to honouring patients’ preferred places of treatment and death. Reasons include a lack of availability of immediate home care support, family’s lack of awareness of the dying process, urgent medical conditions, and other limitations of healthcare institutions.ConclusionACP allows patients to exercise their autonomy right to the last moments of their lives. Obstacles to honouring preferences should be considered by healthcare institutions in their efforts to facilitate dying-in-place.

BackgroundAdvance Care Planning (ACP) in Singapore is modelled after the Respecting Choices programme in the United States. Singapore, a multi-ethnic nation with an ageing population, implemented the ACP programme in public hospitals since 2010. AimThis paper studies the profile of the first 450 patients and families with completed ACPs in an acute hospital in Singapore.MethodsWe reviewed retrospectively patients’ demographics, principal diagnosis, choice of substitute decision maker (SDM) and their preferences with regard to medical intervention and their preferred place of treatment and death.ResultsMost of the patients were Chinese (79%) with a median age of 81 years. 52% were female. Adult offspring were most commonly appointed by patients as first SDM (76.4% of the time), followed by spouses (13.3%). 74% of the patients preferred to have limited additional intervention if their condition deteriorates and 58% preferred to pass away at home.DiscussionIt is highly feasible to conduct ACP discussions among patients in an acute hospital, even though it is time-consuming. The large number of geriatric patients represented in this group mirrors the ageing population of Singapore. The racial groups represented conform to the ethnic pattern of Singapore. The tendency to delegate decision-making to offspring is prevalent among the elderly in Singapore. Preferences on medical intervention remain largely conservative among patients and families.ConclusionThere is urgency among the elderly in Singapore to address existential issues by discussing ACP. Further research can be done to assess the correlation between one’s ethnicity and culture with decision-making and preferences.

development of supportive ACP-structures in the field of nursing homes (NH). In the region Würzburg (130.000 inhabitants, Bavaria) there is no ACP-program provided. Major purpose of the project is the conceptualization, implementation and evaluation of an effective, target group-specific concept. Within the project needs of nursing home residents (NHR) concerning the process of ACP are reconstructed, barriers of sustainable implementation of ACP are identified. Methods The study includes problem-centered interviews with NHR (n=24). Maintopics of the interviews: requirements regarding to EoL, communication about needs at EoL, documentation of advance planning, decision-making/-behavior concerning EoLC. Data are analyzed by content analysis. Results NHR have a lack of knowledge relating to scope, reach and potential objects of advance planning for EoL(C) even they have already prepared an advance directive or a power of attorny. Often there is no differentiated reflection of own needs even they remark the wish of self-reflection concerning preferences for their EoL. NHR express the wish to compare notes with non-professionals and at eye level, trustful dialogue partners on EoL-topics and decision-making (informal dialogue). Otherwise, the recording of decisions and responsibilities regarding to the EoL takes place within the family-network and in the dialogue with health professionals (formal dialogue). Conclusion A viable ACP-concept has to close the gap between informal and formal dialogues by creating trustful dialogue spaces and identifying trustful dialogue-partners.

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