Careful limits amid uncertain endings in geriatric medicine

In the United Kingdom, older adults approaching the end of life are routinely admitted to hospital. Here, they are cared for by a number of healthcare professionals including specialists geriatricians. Geriatricians practice a generalist medicine that specializes in the care of older adults who come to hospital. Such patients present with abrupt or acute deteriorations of health or function, against a backdrop of clinical frailty and complex co-morbidity.

Geriatricians work with multidisciplinary teams to an ideal of holism and person-centred care, combining and balancing the practices and ideals of acute, rehabilitative, supportive and palliative care for patients with an uncertain illness trajectory. At the front line of care, such healthcare professionals and their colleagues work within a context of clinical uncertainty. Statistically, half of the patients they care for will die within a year of admission.

This project asks how within this uncertainty, specialists in geriatric medicine strive to deliver good care to patients who may, or may not be, approaching the very end of their life. It does so with an eye to how such care is delivered in practice, alongside ideals, technologies, vulnerable bodies and the careful limits this care involves.

Drawing on ethnographic fieldwork in three hospitals in the UK and qualitative interviews with multidisciplinary healthcare professionals, this project elaborates the nature and logics of non-life prolonging forms of care in geriatric medicine and it's mediation by digital care platforms. By doing so, the project contributes to current debates on "good care", valuation, technologies, critique of medicine, and absence.