To think conservative care is palliative care?

[Foraging4sweet]

I wish doctors would spell it out. Elderly relative in hospital tonignt after a massive stroke. The doctor told me that they would treat the stroke "conservatively". She was really stressing this. I asked if she would die from the stroke and she said probably not. We discussed it and I was informed relative will likely not be going home - she will need a care home instead.

I've googled conservative care and I'm a little confused? I should have asked at the time but I was pretty upset to be honest.

Conservative usually means without physical intervention (such as surgery or interventional radiology). They will still get medical treatment and rehab, as they are not expected to die.
I'm sorry you are going through this.

So sorry for your news.
Having been through end of life of a parent in last few months one of my siblings could not accept at all what was happening.
If allowed full reign would have demanded every single intervention available, despite parent asking actively for peace and sleep.
The grief my sibling was feeling overrode every thought of the actual experience of the parent they were losing.

They cannot be more explicit as the idea of death is so difficult for some....that to say "there is nothing we can do" translates in the mind of the person in grief that if they just fight hard enough then it could all stop.

That's how my sibling thought. Though our parent was in 80's major ongoing health issues and in severe pain. They didn't want our parent to die and was desperate to fight to stop it happening.

Conservatively in my translation means they will ensure your relative is as comfortable as possible.

It's all so difficult.

Conservative and palliative care do have some cross over but they are different.

When getting 'big' news in really stressful times it's absolutely normal not to take it all in. Write down some questions, let them know you were a but in shock/didn't understand or take it all in could they explain again/ answer your questions.

For what it's worth my take on conservative care is what's outlined above already - they're not going to try any aggressive treatments to reverse the stroke. The reasons for this are nuanced and complicated, but if they've made this decision it'll be because when they've weighed the risks and benefits of the various treatments available they either just won't work/improve the situation, or could actively make the situation worse.

Strokes leave a huge variety of effects afterwards, but essentially its possible the symptoms your relative has at the present may persist/improve only slightly over time. If this type of stroke occurs in a young patient then intensive therapy occurs afterwards to rehabilitate as best possible but elderly people often don't have the ability to undertake this in the same way.

Conservative care isn't always palliative. For example, some fractures are treated "conservatively" (ie without surgery/ intervention). It means a watch & wait sort of approach.

I'm not sure about your case I'm afraid though x

Yes, as others have said, conservative treatment means no surgery or invasive treatment. This would be because the patient would not be fit enough for anaesthetic for instance, i.e. the benefit would be outweighed by the risk. It doesn't mean no treatment. Patient would still have any appropriate medication, physio etc.

Thank you all - my relative doesn't even use a walking stick. Is fiercely independent. I don't want them to do anything that will prolong her life as it will be miserable.

I guess I'm trying to gauge what her quality of life will be. At 92, she has had a fantastic life. She will hate being stuck in a hospital bed. So I'm thinking they will give her medication to make sure she is comfortable and a little bit of physio. I'm imagining she will never walk again but perhaps might progress to using her hand a little. That's probably it right? So she will need to move into a care home, if she gets out of the hospital.

I'm very upset today. They said it was caused by an irregular heart beat. She was diagnosed but nobody ever put her on blood thinners. She has been taken to hospital twice over the last couple of months with slurred speech and she briefly lost her sight. She was given no tests and sent home.

I understand she is elderly but this had all the warning signs of coming. All they've done is make it so her last few months will be miserable and stuck in a hospital bed. Stroke doctors aren't impressed. It's not about prolonging her life but she could have remained pretty independent if they had given her the right care.

This happened to an elderly relative of mine and so firstly I just wanted to say I'm so sorry. It's incredibly upsetting to see a relative go from fiercely independent to incapacitated in such a short space of time.

Some questions. Is she able to communicate? Does she understand what's happening? Is there any documentation around her wishes for end of life care?

It's really important that you get all of the information you can from the doctors as you will need to advocate for her. Don't be afraid to ask stupid questions and ask them in detail.

Not in my experience with my dad. He was admitted to hospital after a fall and because of underlying conditions failed to recover for several weeks. At the point it became clear that he was very unwell and was going to die the staff spelled it out bluntly. They never said "he is going to die" but talked about making him comfortable, they sent a (very lovely and caring) palliative care consultant to speak to us, then a McMillan nurse.

If they are talking about discharge to a nursing home that's a different kettle of fish. It's a difficult time - I found that making connection with a sympathetic nurse who could act as a single point of contact was really helpful.

From your description of the conversation, it sounds like the doctors are planning to manage with physio/OT rehabilitation, adjustment of medication.

At 92yo, it would have been a complex decision to start any blood thinners with her recent previous episodes as her age alone would put her at a medium risk for spontaneous bleeding from blood thinners. Risk of bleeding would be increased if she has high blood pressure, or almost any other medical conditions, especially any liver or kidney issues. And the bleeds that happen (brain, or huge bleed inside stomach/intestines) can themselves be life-threatening. Talk to her team, and see if there were any specific concerns/issues about her previous episodes.

It's really difficult to watch such a huge change happen for a beloved family member. Hope she gets some mobility/independence again.

My mum gets conservative care for a condition. It needs a major intervention to actually fix, but she'd be unlikely to survive the operation and/or deal with the recovery. So they medicate and give pain relief.

At 92yo, it would have been a complex decision to start any blood thinners with her recent previous episodes as her age alone would put her at a medium risk for spontaneous bleeding from blood thinners. Risk of bleeding would be increased if she has high blood pressure, or almost any other medical conditions, especially any liver or kidney issues. And the bleeds that happen (brain, or huge bleed inside stomach/intestines) can themselves be life-threatening. Talk to her team, and see if there were any specific concerns/issues about her previous episodes.

The problem is her team were asking ME why she wasn't on blood thinners. I have no idea why not. They asked if there was a particular reason but she is a private woman and none of us know her medical business in detail. I was hoping they might be able to tell me!

Some questions. Is she able to communicate? Does she understand what's happening? Is there any documentation around her wishes for end of life care?

Not sure yet- she has been asleep pretty much the whole time she has been in. She woke up briefly and smiled at me and did recognise me. She can talk a little bit (to say "nice to meet you to the doctor!"). She seems pretty with it when awake but only for minutes at a time. I'm unsure if she knows she has had a stroke.

She is a very Christian woman. She will have written down all her wishes for funeral but not sure around end of life.