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Professor Dr Ken Hillman is used to the highly medicalised setting of the Intensive Care Unit (ICU) and the capacity of physicians to sustain life even by substituting technology for the most essential human functions.

“I only need you to have a brain and a liver. All your other organs – either I can substitute for them in ICU or you won’t need them lying in bed”.

But many people die in ICU. In one recent study as many as one in three patients are exposed to ICU in their last hospital admission and slightly less die there [1].

Often older frail people are amongst these ICU admissions. Prof Hillman says the average age of patients in his ICU is 75 years. Prof Hillman’s interest is in how older people experience comorbidity and frailty, and how physicians consider the concept of ‘frailty’.

 “In medicine we are trained to focus on the primary diagnosis (and priority is given to the primary diagnosis but) it’s the sum of these chronic conditions which is the most important thing…(that contribute to the experience of) frailty’”.  

 “There are many ways of measuring frailty. We use the Rockwood scale which includes 9 silhouette drawings of a person from 1 in the upright position to 9 in bed/near death…these are very easy for clinicians to use and it helps to define (a patient) in their own terms not in terms of the acute diagnosis”.  

“Palliative care is a specialty, and they do marvellous work…some centres put a lot more resources than others into care in the home. Often older people at end of life don’t need specialist palliative care, they often need someone to support them (like a family member or volunteer) to help with their washing, to help them out of a chair – that’s more about community”.

Professor Hillman spoke to his recently published book on his observations as a physician on aging, frailty and caring for people at end of life – A Good Life to the End.

[1] Kim Devery and Imogen Mitchell, National Policy connecting to practice: end of life care in Australian hospitals, presentation to the Australian Palliative Care Conference 2017.  

Pic: Professor Ken Hillman speaking at the State Library of NSW