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Guideline identifies homeless people in need of palliative care

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Increased jaundice and spontaneous bleeding are key indicators of approaching death among homeless people, according to latest guidance.

Researchers from Marie Curie Palliative Care Research Unit at University College London and the homelessness charity St Mungo’s have developed guidelines for identifying homeless people who are in need of end of life care.

The guidance is largely based on a review of the experiences of 27 hostel residents with advanced liver disease who died last year.

The study found the majority of the deaths of people receiving care from St Mungo’s each year are associated with liver failure – 31 out of 56 deaths in 2009-10.

In this liver failure group there is a high rate of hospital admissions, as well as significant distress in the last six months of life. The average age of death was 55.  

The researchers identified a combination of physical, psychological and behavioural signs and symptoms observed in homeless people with liver disease as their health deteriorates and the end of life approaches. These included memory problems, increased jaundice, spontaneous bleeding, low mood, social isolation and poor self care.

The review also found hostel residents were often in denial about their alcohol intake and its impact on their health. They could be reluctant to take responsibility for their drinking or to work with health or social care services, the researchers said.

Additionally, the review found hostel residents accessed healthcare mostly from secondary services in the last six months of life. But this is “limited by their reluctance to be admitted to hospital because of restrictions placed on their behaviour”.

It noted hostel staff were not often able to plan for end of life care with residents and access to palliative care was minimal.

St Mungo’s palliative care service co-ordinator Peter Kennedy said: “Most commonly, around two months before death, there can be an increase in jaundice, bleeding, social isolation or a reduction in someone’s self-care.

“There are no nationally-recognised indicators in this area and this is very welcome early research into how we can better support people who’ve often experienced much trauma in their lives already.”

Dr Louise Jones, head of the Marie Curie Palliative Care Research Unit, added: “Liver failure runs an unpredictable course. It is often difficult to judge when significant deterioration is occurring and the end of life is approaching.”  

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