Are doctors always upfront when an elderly relative is nearing end of life

[KellyK2026]

In a situation now where my elderly relative is dying. Not that we’ve been told this my doctors but it is as clear as day. They are struggling to breathe, have become immobile, can’t really see or hear, are in pain etc. They are extremely frail. The doctors keep saying that it just takes time to get better. They aren’t getting better but while they are being told that it takes time to get better they aren’t getting the professional help they need. They really need an end of life package and to make them comfortable. Is it normal for doctors to not be upfront? I just feel like it’s made things worse because, while they aren’t being upfront, we cant get the care in place. Anyone else experienced something similar?

I’m surprised at that, I’ve been through this a lot and they are always very honest and blunt
What illness is it OP?

Where are they currently @KellyK2026 ? If they are in hospital I'd suggest contacting PALS for advice.

It’s not one singular illness. It’s been multiple life changing illnesses over several years and each time we were told to expect that they wouldn’t survive. They are ranking at the most frail they can be on the fragility scale. They are currently living at home with round the clock care from family members as they say they are too ill to go to hospital.

Have you got any district nurse support? In my experience they are far better at getting the fast track CHC paperwork and just in case meds sorted out than GPs

When my DF was dying he was asking for chocolate, despite being diabetic. He was in hospital at the time and the doctor said if he wants it to let him have it. I think that it was the doctor's way of saying it was too late to make any difference to his outcome, without actually saying what we were all thinking. Dad got a bit of chocolate.

When was your relative last seen by a GP/practitioner from the GP surgery. They sound as if they should be under the palliative care team. Who has power of attorney?

Can the POA contact their GP surgery saying what you have said above (breathing problems and pain especially, along with any deterioration since the practice last had contact), saying your relative’s needs are not being met, and requesting an urgent consultation and discussion about a referral to palliative care.

It’s amazing how medical professionals that deal with death on a daily basis can’t be upfront with families when their relative is dying.
My MIL was dying and a consultant asked us if we’d heard of anorexia as an explanation for why she wasn’t eating.
Google Dr Kathryn Mannix, she has put a lot of useful end of life information out there that you might find helpful.

Could you ask for the frailty consultant to see them? As they are great with having honest conversations, and then maybe refer to the palliative care team? Then you have a clear plan in place. Have you got a ReSPECT /peace form in place?

In my experience they can be quite obtuse, combination of not always knowing re timescales and differences in definition of when patient is in ' active dying ' stage. 💐

When my dad was dying of cancer I found the doctors were quite vague about how long he had left. The nurses however were much clearer and more accurate. This was in a hospice though so the outcome was known. I'll always be grateful to those nurses who spelled it out and enabled me to prepare and say goodbye. In hindsight I think they just spent so much more time with the patients they were more experienced in seeing little signs. I know the doctors worked their socks off so I have no criticism of them either. I just think they seemed a lot more wary of giving any information that might not be accurate.

Who is relative being assessed by if he isnt in hospital?

The trouble is, it’s so unpredictable. I think it makes them reticent. How would you feel if they said it would be ‘soon’ and then a month later, nothing had happened.

Perhaps prepare some specific questions and ask about probabilities.

They were last seen by a GP a week ago. I do worry that GP’s perhaps can’t diagnose end of life as they can’t run the full tests that they can at hospital. My uncle has POA but he absolutely is going along with his parent’s wishes, which many of us disagree with as we believe they should be taken to hospital. If challenged, he said he is just doing what the elderly relative has requested.

I would have a guess that the elderly relative knows their life is ending and absolutely dont want to die in the shit show of a hospital.
Not easy for family members left trying to navigate all the emotions though.

Some are some aren't but even when they were my family only heard what they wanted to and were in heavy denial.

TBF medical people had been reluctant to treat infections for about 5 years at that point - so it was assumed it was the same.

Dad died at home but by then he'd has some horrifc hospital experiences on geriatric wards and A&E and there was no way to easily get him back into a hospital anyway.

There were issues after death as they hadn't been seen by a doctor within a certain timeframe so coroner needed to be involved but the coroner was lovely in end and the extra steps were got through.

Not normal, when mil had stage 4 cancer the GP came out and was brutally honest that she was one of the worse patients he had ever seen and that she needed to be moved to hospice.

Why do you want them taking to hospital OP? It’s not a restful calm place for an elderly person, if I had a choice I’d want to stay in my own bed too.
You might find this goes on for some time yet - if you’re tough enough to get old in the first place, the body can put up a considerable fight. My relative was “end of life” for a good 9mths, on and off. Cheyne stokes breathing, and then they’d improve for a few days then relapse again. It’s very tough to watch, and very hard to predict I think particularly if its just a matter of dying of too many birthdays rather than a particular illness.

Ime medics are usually brutally honest. Which is probably for the best.

The GP was very blunt when my dad reached end of life. The GP did a home visit and arranged for my dad to be taken to palliative care within a few hours. He was clear this was end of life care.

Yes, I think they are always upfront but depending on the circumstances, they don’t always know. The doctor at my aunts care home told me she had prescribed end of life meds just in case. My aunt rallied and lived for a few more months.

The GPs I work with are very good at being open and honest about end of life, but prediction timescales is notoriously difficult- we can rarely give much accuracy until the very end.

What would be the point of hospital admission? What would you be wanting the outcome to be? There’s rarely tests to see if someone is dying, and investigations are unlikely to be done unless they change the management or outcome (which is unlikely in someone who is very frail and unwell). Hospitals are horrid places to die TBH.

However it would be worth asking the GP to do an assessment for just in case meds, and Community nurse input to help manage pain, comfort, nutrition, hydration etc.

They weren’t upfront with my dad at all

It was bonkers. I still think it was partly because they wanted to do some kind of experimental treatment.

Also in the last couple of days, I think they were short of hospice spaces so they didn’t actually want to say that he was dying.

It was mad he and I knew he was dying for a couple of months before!

With my MIL which was a lingering dementia/uncontrolled diabetes/heart condition combination they were very wishy washy and gave FIL hope that she’d recover. But that was mainly dealing with GP’s and very occasionally the hospital.

FIL the consultant was very upfront and honest with us, which we deeply appreciated and could make plans so he could have a good death.

So I think it very much depends on who you are dealing with.

If the elderly relative is competent and wishes to stay at home then that's okay.

If the person with POA is following the persons wishes then that's okay.

Hospital is to be avoided really for an elderly, frail person, especially one who can't see/hear, who is just generally fading away because of old age etc. Its hard on the relatives standing around waiting for the inevitable as its natural to want action and for 'something to be done'.

There should though be a plan in place to take care of pain relief etc so push for that. Is the GP just sort of shrugging their shoulders and saying there's nowt to be done? Because there is stuff they can /should be implement.

Most healthcare staff are extraordinarily bad communicators. They don't all share the same opinion as to whether someone will recover of if/when they will die. They'll very rarely give you a timeline.

If you believe your relative is actively dying, hospital is definitely not the place for them. They should be somewhere peaceful and calm and made to feel as comfortable as possible. If you think they'd benefit from a care package (it certainly sounds like they need pain management and carers), contact the council's adult social care team for an assessment, ask the GP to refer you to the community nursing team or local hospital or contact the latter directly (e.g Marie Curie). I am sorry about your relative, OP.