Read Standard 8: Living and dying well

Ageing and frailty standards
Healthcare Improvement Scotland

Standard statement

Older people living with frailty are empowered to live well throughout their life, maximise enjoyment and die comfortably.

Rationale

Frailty can change a person’s sense of self. It can affect how they are perceived and treated by others, including health and care staff. Feeling valued, respected and able to take part in meaningful activities can help maintain a person’s quality of life. This can prevent or delay when they might start to experience significant health or social care needs.85 People should be supported and enable to live well, make choices and do things that matter to them as they grow older.

Engaging in mentally stimulating activities can help reduce the risk of cognitive decline and neurodegenerative diseases including dementia.86 Staying mentally active enhances overall brain health, promotes independence and improves quality of life. Maintaining and promoting good brain health involves following a healthy diet, spending time with other people, reducing alcohol intake, getting sufficient sleep and taking regular exercise.87, 88 Social connection and activity, has a positive impact on cognition and may delay the onset of dementia.89

Older people with frailty may have thoughts and questions about their future.90 They can benefit from opportunities to talk about their lives including death, dying and loss, spiritual or cultural matters and what is important to them. Staff that are trained and supported to have open and compassionate conversations with people can help them have these discussions as their health declines. This includes the possible outcomes or benefits of further tests or treatments and how they may align with a person’s values.

Palliative care, which focuses on the person’s quality of life, should be provided along with other treatments and care as people become more frail. People who are dying should have pain or other symptoms well managed to keep them comfortable. This includes prompt access to necessary equipment and medicines. Support for unpaid carers and care partners should not stop at the point of death. They should continue to receive compassionate and effective bereavement support in line with the Scottish Bereavement Charter.91

Criteria

8.1

Organisations support people to access activities which maximise their physical health, social, spiritual and mental wellbeing.

8.2

People are supported to make informed choices about risks in their lifestyle and activities they enjoy.

8.3

People have access to essential daily care, where required, including:

  • maintenance of skin integrity
  • maintenance of good personal hygiene
  • care of teeth and dentures
  • technology and equipment to manage hearing and sight loss.
8.4

People are provided with resources to support their brain health including information and support on:

  • improving sleep
  • staying connected
  • stopping smoking
  • reducing alcohol intake
  • managing blood pressure.
8.5

Organisations work with partners and third sector agencies to signpost or refer to community-based services to prevent and reduce social isolation.

8.6

People are offered advice and support to manage symptoms such as pain, breathlessness, fatigue, anxiety or poor appetite.

8.7

People living with frailty feel safe, involved and well cared for in their care environment.

8.8

People are enabled and supported to have:

  • honest, compassionate conversations about living well with deteriorating health
  • early discussions about palliative care and the holistic support available for them and their unpaid carers or care partners
  • conversations about what happens when they are dying
  • information about care and treatment options when they are dying.
8.9

Unpaid carers and care partners can access support and information about anticipatory grief, grief and bereavement support.

8.10

People who are dying are involved in developing an holistic assessment of their needs and receive responsive, personalised advice, care and support.

8.11

Future care plans are:

  • reviewed and updated as required in the final days or weeks of life
  • communicated with everyone involved in a person’s care.
8.12

When a person with frailty is dying, this is openly acknowledged and staff offer sensitive and compassionate support in line with their values and wishes.

8.13

Staff have 24/7 access to advice from specialist palliative care services when someone is dying at home, in a care home or in hospital.

8.14

Organisations provide bereavement education, training and support for staff including peer support and signposting to support services if required.

What does this standard mean for

What does the standard mean for young people?

  • Your life and how you want to live it will be maintained as long as possible.
  • You will receive the support and care you need for daily activities and things that are important to you.
  • You will be supported to maintain your social networks, activities and contact with your local community.
  • If your health declines, you will be supported in ways that matter to you.
  • If you are dying, you will be cared for in ways that mean you are comfortable and safe, with the people that matter to you close to you.
  • You can talk to staff about death and dying if and when you wish to.

What does the standard mean for staff?

Staff, in line with roles, responsibilities and workplace setting:

  • support people to live their lives as well as possible
  • are able to talk with people about healthy living and wellbeing as well as declining health, loss, dying and death
  • signpost or refer to voluntary and community initiatives which promote a person’s wellbeing
  • recognise and respond to the cultural and spiritual needs of people living with frailty from diagnosis to death and bereavement
  • recognise when a person is dying
  • provide sensitive and compassionate palliative care.

What does the standard mean for the organisation?

Organisations:

  • plan and design services to promote wellbeing
  • enable daily activities that matter to people
  • actively promote effective relationships between statutory and voluntary organisations, communities, public bodies and other agencies that facilitate wellbeing for older people living with frailty
  • have referral pathways to specialist palliative care across all settings.

Examples of what meeting this standard might look like

  • Use of mental wellbeing screening and scores to measure effect of wellbeing support interventions.
  • Documenting referral onto other agencies to support wellbeing.
  • Commissioning data for community wellbeing and healthcare services.
  • Commissioning data for community support services promoting wellbeing and social connection.
  • Evidence of social prescribing.
  • Update of staff training including bereavement support relevant to their roles.
  • Adoption of the Scottish Bereavement Charter.