Brian Dunlop (chair of CaBic – Cheltenham and Bishop's Cleeve Anna Chaplaincy for older people) reviews a book that has much to offer those encountering frailty – their own or that of a relative or friend – for the first time:
With a light touch: A guide to healthcare in frailty is the book I needed when some years ago my parents became frail. Eventually, I obtained much of the knowledge and many of the insights set out in Dr Ian Donald’s book but they were hard-won and often, frustratingly, followed the event.
Ian Donald is a recently retired specialist in the care of older people and has a deep interest in care in the community. His book opens with a discussion on the nature of frailty and then discusses the many aspects of medical care that can arise. He provides a really helpful discussion on reviewing medicines, as older people can accumulate a range of prescriptions, which are taken cumulatively. I well remember my mother being sent home from hospital with two carrier bags of medicines and only a computer print-out to indicate when, but not why, they should be taken. Reducing the number of pills can reduce the range of side effects and prevent different medicines conflicting.
Similarly, there is almost always another test that can be done but an assessment needs to be made of the value that the results may bring and be balanced against the effect of the test or consequent treatment on the patient. Even a day trip to the hospital can lead to a serious deterioration late in a person’s life. This leads to a recognition that hospital stays can be damaging, particularly for those living with dementia but, equally, ill-considered discharge from hospital can lead to complications.
The message throughout is that doctors should be taking a holistic approach that is appropriate to each person’s situation, desires and life expectancy.
There are a number of illustrative cases taken from Ian’s long career in this field, which not only help to explain the points being made but also show how partners and family form part of the process of determining the best course of action, although a patient with capacity always has the final say on whether or not to accept treatment.
The final chapters look at planning ahead and letting go. Have you made a will, signed a lasting power of attorney or indicated your wishes on resuscitation? Knowing that neither of my parents wanted to be resuscitated was hugely helpful when the time came.
All of this wisdom is held in a strong scaffold of Ian Donald’s Christian faith. He looks at the issues, which may trouble Christians, squarely in the eye, and throughout offers biblical quotes that may help patients and family members explore their worries and concerns. To assist that process each chapter ends with some questions for reflection. The book is extremely accessible and indeed written with a light touch!
With a touch of light is published by Onwards and Upwards publishers at £11.99,
ISBN 9781788159296. Ian Donald can be contacted at ecare@blueyonder.co.uk