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Advance care planning in severe frailty with pneumonia — SCE Acute Medicine MCQ

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ModeratePerioperative and End-of-Life CareAdvance care planning in severe frailty with pneumoniaSCE Acute Medicine

A 90-year-old care-home resident with severe frailty presents with fever and cough. She is bedbound, has advanced dementia, is not distressed, and has an advance care plan requesting comfort-focused treatment in hospital if needed. Observations show RR 24, SpO2 91% on air and BP 108/66 mmHg. What would you advise the family?

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Correct answer: A — Explain that active comfort-focused care can include symptom relief and proportionate antibiotics aligned with her plan

Comfort-focused care is active care directed at relief of distress and may include proportionate treatments such as oxygen, opioids for breathlessness or antibiotics when aligned with goals. It does not mean abandoning nursing care or hydration decisions. CPR and ICU may be burdensome and inconsistent with the advance plan in severe frailty. The communication task is to translate ceilings of treatment into positive goals of care.

Reference: NICE NG142, GMC end-of-life care guidance