Editor’s View – Older people’s goals of care and person-centredness

Geriatricians rightly pride themselves on being person-centred. It is easy to lose sight of what really matters to the people we serve as we navigate a sea of protocols, pathways, bed pressures and a prerogative to keep people out of hospital. In our May edition, van der Klei and colleagues investigate older people’s goals of care and report how these change according to their frailty status [1]. It turns out, frailty had minimal impact on goals of care. The most important goals across people with a range of frailty were preventing nursing home admission, rated as ‘very important’ to 87% of respondents, with only slightly lower rates for ‘staying independent’ (84%) and ‘preserving quality of life’ (83%). Interestingly, less than a third of respondents thought extending life was very important to them. I was reflecting on the mismatch between this and the prevailing attitude of most specialist clinicians I encountered during my general medical training, where keeping the patient alive seemed to be the only thing that really mattered and death of a patient was seen as a failure. With the ageing population living longer lives with disease, it is important clinicians and healthcare systems adapt to keep goals of care relevant and person-centred.