End-of-life issues in elderly patients

2006 ◽  
Vol 4 (2) ◽  
pp. 155-157 ◽  
Author(s):  
BENJAMIN LIPTZIN
Keyword(s):  
Literature Review ◽  
Elderly Patients ◽  
End Of Life ◽  
End Of Life Care ◽  
Life Care ◽  
Case Examples ◽  
Great Heterogeneity ◽  
Life Issues ◽  
End Of Life Issues

Objective: To describe elderly-specific issues in end-of-life care.Methods: Literature review and case examples.Results: There is great heterogeneity in elderly patients' responses to end-of-life care.Significance of results: Developmental and individual issues need to be considered in end-of-life discussions.

Interviews on End-of-Life Care With Older People

2011 ◽  
Vol 21 (11) ◽  
pp. 1588-1600 ◽  
Author(s):  
Sabine Pleschberger ◽  
Jane E. Seymour ◽  
Sheila Payne ◽  
Reginald Deschepper ◽  
Bregje D. Onwuteaka-Philipsen ◽  
...  
Keyword(s):  
Qualitative Research ◽  
Older People ◽  
End Of Life ◽  
End Of Life Care ◽  
Ethical Review ◽  
Life Care ◽  
The United Kingdom ◽  
Life Issues ◽  
Key Issues ◽  
End Of Life Issues

Qualitative research provides important insights into the experiences and perspectives of older people on end-of-life issues, but such research is methodologically and ethically complex. We offer a set of reflections from six end-of-life care studies conducted with older people in four European countries: Belgium, Germany, the Netherlands, and the United Kingdom. The reflection process was informed by four full-day meetings between the authors and referral to sources including the study interview guides, summary “pen portraits” about key issues encountered in the interviews, and key sections of the interview transcripts. We identified as major challenges accessing people, the introduction of end-of-life issues in an interview, managing emotions, the presence of companions, and reciprocity. Formal ethical review committees rarely take into account these complex issues. We concluded that is it necessary to maintain an ongoing reflexive stance to enhance qualitative research practice in the intersecting fields of aging and end-of-life studies.

scholarly journals End-of-Life Care and Circumstances of Death in Patients Dying As a Result of Cancer in Belgium and the Netherlands: A Retrospective Comparative Study

2011 ◽  
Vol 29 (32) ◽  
pp. 4327-4334 ◽  
Author(s):  
Koen Meeussen ◽  
Lieve Van den Block ◽  
Michael A. Echteld ◽  
Nicole Boffin ◽  
Johan Bilsen ◽  
...  
Keyword(s):  
The Netherlands ◽  
End Of Life ◽  
End Of Life Care ◽  
Treatment Preferences ◽  
Life Care ◽  
Patients With Cancer ◽  
Life Issues ◽  
End Of Life Issues ◽  
Retrospective Comparative Study ◽  
At Home

Purpose To examine and compare end-of-life care in patients with cancer dying in Belgium and the Netherlands. Patients and Methods A mortality follow-back study was undertaken in 2008 via representative nationwide sentinel networks of general practitioners (GPs) in Belgium and the Netherlands. By using similar standardized procedures, GPs reported on aspects of end-of-life care and the circumstances of nonsudden death of patients with cancer in their practice. Results Of the 422 reported patients with cancer, most resided at home during the last year of life (Belgium, 91%; the Netherlands, 95%). Death occurred at home in 34% (Belgium) and 61% (the Netherlands) and in the hospital in 29% (Belgium) and 19% (the Netherlands). In the last month of life, end-of-life issues were more often discussed in the Netherlands (88%) than in Belgium (68%). In both countries, physical problems were discussed most often (Belgium, 49%; the Netherlands, 78%) and spiritual issues least often (Belgium, 20%; the Netherlands, 32%). Certain end-of-life treatment preferences were known for 43% (Belgium) and 67% (the Netherlands) of patients. In the last week of life, treatment was most often focused on palliation (Belgium, 94%; the Netherlands, 91%). Physical distress was reported in 84% (Belgium) and 76% (the Netherlands) of patients and psychological distress in 59% and 36%. Most distressing was lack of energy (Belgium, 73%; the Netherlands, 71%) and lack of appetite (Belgium, 61%; the Netherlands, 53%). Two thirds of patients were bedridden (Belgium, 67%; the Netherlands, 69%). Conclusion Although place of death and communication about end-of-life issues differ substantially, a palliative treatment goal is adopted for the vast majority of patients in both countries. However, GPs reported that the majority of patients experienced symptom distress at the end of life, which suggests important challenges remain for improving end-of-life care.

scholarly journals Breaking the Silence Associated With Death and Dying: New Directions in End-of-Life Research

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 647-647
Author(s):  
Sara Stemen ◽  
Peter Lichtenberg
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Life Experiences ◽  
Death And Dying ◽  
Illustrative Case ◽  
Life Care ◽  
Comprehensive Overview ◽  
Life Issues ◽  
End Of Life Issues ◽  
Demographic Shifts

Abstract Conversations surrounding end-of-life care and bereavement continue to remain relatively silenced within gerontology and the general population. The purpose of this symposium is to break the silence associated with death, dying, and bereavement by sharing emerging perspectives and interventions related to end-of-life experiences. This symposium features four presentations that examine bereavement and end-of-life care from the viewpoints of individuals, families, practitioners, and researchers. Carr provides a comprehensive overview of the current state of research regarding death, dying, and bereavement - mapping out how current technological and demographic shifts have changed the nature of end-of-life experiences. Stemen presents an illustrative case study that examines how cause of death (e.g., chronic illness, suicide) shapes grief and subsequent social relationships for surviving individuals. Utz explores conversations that occur between families and professionals embedded within the hospice system, showcasing reactions from families who experienced live discharge from hospice services. Last, Ogle sheds light on the roles taken on by state tested nursing assistants (STNAs) in end-of-life care as well as the training and education they receive and need on end-of-life issues. Lichtenberg, our discussant, will tie these emerging perspectives together in order to initiate an important dialogue with attendees regarding the actions needed to break the silence associated with death and dying so that we can better serve individuals, families, and professionals.

scholarly journals Talking About End-of-Life Care: How Should Physicians Act

2021 ◽  
Vol 9 (1) ◽  
pp. 38-42
Author(s):  
Abu Sadat Mohammad Nurunnabi ◽  
Nezamuddin Ahmad ◽  
Shuchana Chakma ◽  
- Md Asaduzzaman ◽  
Arif Mohammad
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Review Paper ◽  
Good Death ◽  
Life Care ◽  
Dying Patients ◽  
Life Issues ◽  
End Of Life Issues ◽  
Common Understanding ◽  
Dying Patient

Physicians should be adept in communication and familiar with the various end-of-life issues and their implications. However, physicians in Bangladesh usually receive very little training or guidance on how to communicate with the dying patients and their families. Since death is a common phenomenon, for physicians in their day-to-day practice, it sometimes becomes difficult to engage in end-of-life discussions in a death-averse society. This review paper aims to discuss a pragmatic step-by-step approach to discussing end-of-life care in a Bangladeshi context maintaining local social and cultural views. Specifically outlined in each of these four steps, a physician should seek a common understanding with the patient and family. Moreover, if any disagreement arises, overt conflict can often be avoided by reviewing what was discussed earlier with the patient or family. We all know that providing a supportive care for a dying patient is challenging. However, when it is done well, it becomes a meaningful and gratifying experience for the physician. As we know, helping someone die in comfort and with dignity signifies a good death and one of the best gifts of life that theoretically leads him/her to rest in peace. CBMJ 2020 January: Vol. 09 No. 01 P: 38-42

Critical care nurses' perceptions of obstacles and helpful behaviors in providing end-of-life care to dying patients

2000 ◽  
Vol 9 (2) ◽  
pp. 96-105 ◽  
Author(s):  
KT Kirchhoff ◽  
RL Beckstrand
Keyword(s):  
Critical Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Life Support ◽  
Critical Care Nurses ◽  
Life Care ◽  
Dying Patients ◽  
Life Issues ◽  
End Of Life Issues ◽  
Nurses Perceptions

BACKGROUND: Little is known about nurses' perceptions of obstacles or helpful behaviors ("helps") in providing end-of-life care in the intensive care setting. OBJECTIVE: To determine the importance of various obstacles and helps in providing end-of-life care as perceived by critical care nurses. METHODS: A questionnaire was mailed to 300 members of the American Association of Critical-Care Nurses. Nurses were asked to rate obstacles and helps in giving end-of-life care, and additional obstacles and/or helps, and answer demographic questions. RESULTS: Six of the top 10 obstacles were related to issues with patients' families that make care at the end of life more difficult, such as the family's not fully understanding the meaning of life support, not accepting the patient's poor prognosis, requesting more technical treatment than the patient wished, and being angry. Added obstacles related mostly to problems with physicians' behavior. Most helps were ways to make dying easier for patients and patients' families, such as agreement among physicians about care, dying with dignity, and families' acceptance of the prognosis. Added helps included allowing music, pets, and so forth into the patient's room. CONCLUSIONS: Nurses have difficulties with patients' families and physicians concerning end-of-life issues, especially when the behaviors remove the nurses from caring for a patient or cause the patient pain or prolong suffering. Nurses do not acknowledge having difficulty providing care to dying patients aside from conflicts that arise because of patients' families and physicians.

Randomized Controlled Trial of a Prompt List to Help Advanced Cancer Patients and Their Caregivers to Ask Questions About Prognosis and End-of-Life Care

2007 ◽  
Vol 25 (6) ◽  
pp. 715-723 ◽  
Author(s):  
Josephine M. Clayton ◽  
Phyllis N. Butow ◽  
Martin H.N. Tattersall ◽  
Rhonda J. Devine ◽  
Judy M. Simpson ◽  
...  
Keyword(s):  
End Of Life ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
End Of Life Care ◽  
Controlled Trial ◽  
Life Care ◽  
Advanced Cancer Patients ◽  
Randomized Controlled ◽  
Life Issues ◽  
End Of Life Issues

Purpose To determine whether provision of a question prompt list (QPL) influences advanced cancer patients’/caregivers’ questions and discussion of topics relevant to end-of-life care during consultations with a palliative care (PC) physician. Patients and Methods This randomized controlled trial included patients randomly assigned to standard consultation or provision of QPL before consultation, with endorsement of the QPL by the physician during the consultation. Consecutive eligible patients with advanced cancer referred to 15 PC physicians from nine Australian PC services were invited to participate. Consultations were audiotaped, transcribed, and analyzed by blinded coders; patients completed questionnaires before, within 24 hours, and 3 weeks after the consultation. Results A total of 174 patients participated (92 QPL, 82 control). Compared with controls, QPL patients and caregivers asked twice as many questions (for patients, ratio, 2.3; 95% CI, 1.7 to 3.2; P < .0001), and patients discussed 23% more issues covered by the QPL (95% CI, 11% to 37%; P < .0001). QPL patients asked more prognostic questions (ratio, 2.3; 95% CI, 1.3 to 4.0; P = .004) and discussed more prognostic (ratio, 1.43; 95% CI, 1.1 to 1.8, P = .003) and end-of-life issues (30% v 10%; P = .001). Fewer QPL patients had unmet information needs about the future (χ21 = 4.14; P = .04), which was the area of greatest unmet information need. QPL consultations (average, 38 minutes) were longer (P = .002) than controls (average, 31 minutes). No differences between groups were observed in anxiety or patient/physician satisfaction. Conclusion Providing a QPL and physician endorsement of its use assists terminally ill cancer patients and their caregivers to ask questions and promotes discussion about prognosis and end-of-life issues, without creating patient anxiety or impairing satisfaction.

Talking about sensitive topics during the advance care planning discussion: A peek into the black box

2015 ◽  
Vol 13 (6) ◽  
pp. 1669-1676 ◽  
Author(s):  
Pernille Andreassen ◽  
Mette Asbjørn Neergaard ◽  
Trine Brogaard ◽  
Marianne Hjorth Skorstengaard ◽  
Anders Bonde Jensen
Keyword(s):  
End Of Life ◽  
Advance Care Planning ◽  
End Of Life Care ◽  
Special Focus ◽  
Care Planning ◽  
Life Care ◽  
Sensitive Topics ◽  
Life Issues ◽  
Advance Care ◽  
End Of Life Issues

AbstractObjective:Advance care planning (ACP) discussions are emphasized as a valuable way of improving communication about end-of-life care. Yet we have very little knowledge of what goes on during actual ACP discussions. The aim of our study was to explore how the sensitive topics of end-of-life decisions are addressed in concrete ACP discussions, with special focus on doctor–patient interactions.Method:Following a discourse-analysis approach, the study uses the concept of doctor and patient “voices” to analyze 10 directly observed and audiotaped ACP discussions among patients, relatives, and a physician, carried out in connection with a pilot study conducted in Denmark.Results:Previous studies of directly observed patient–physician discussions about end-of-life care show largely ineffective communication, where end-of-life issues are toned down by healthcare professionals, who also tend to dominate the discussions. In contrast, the observed ACP discussions in our study were successful in terms of addressing such sensitive issues as resuscitation and life-prolonging treatment. Our analysis shows that patients and relatives were encouraged to take the stage, to reflect, and to make informed choices. Patients actively explored different topics and asked questions about their current situation, but some also challenged the concept of ACP, especially the thought of being able to take control of end-of-life issues in advance.Significance of Results:Our analysis indicates that during discussions about sensitive end-of-life issues the healthcare professional will be able to pose and explore sensitive ACP questions in a straightforward manner, if the voices that express empathy and seek to empower the patient in different ways are emphasized.

Palliative and end-of-life care in elderly subjects with cardiovascular disease

ESC CardioMed ◽  
2018 ◽  
pp. 2940-2944
Author(s):  
Piotr Sobanski
Keyword(s):  
Quality Of Life ◽  
Decision Making ◽  
End Of Life ◽  
End Of Life Care ◽  
Life Care ◽  
Ventricular Assist ◽  
Assessment And Treatment ◽  
Life Issues ◽  
End Of Life Issues

Palliative care (PC) is holistic care that encompasses prevention, assessment, and treatment of symptoms, and addresses the psychological, social, and spiritual problems of ill people and their relatives with the goal of improving quality of life and, finally, dying. It is not an alternative but a supplement to curative treatment, making symptom alleviation and quality of life equally important goals for management and care as healing along the whole disease trajectory. The SENSE model describes elements of PC: Symptom management, dEcision-making, Networking, Support, and End-of-life care. People with heart disease, particularly those with advanced heart failure (HF), benefit from PC care. Pain, breathlessness, tiredness, depression, anxiety, and dry mouth are frequent symptoms among people with HF and could be effectively alleviated with PC. Many of these symptoms, almost constantly present in HF patients, are usually not specifically targeted by medical interventions. Preparedness for anticipatory death improves quality of life during dying for patients and their relatives, and improves satisfaction with care. The greatest challenge still lies in recognizing unmet PC needs and involving a PC team appropriately early, not simply in the very last hours of life. A number of specific issues, such as the modification of implantable cardioverter defibrillator activity or withdrawal of ventricular assist device support, can be addressed by preparing advance directives leading to protecting patients from unwished, usually futile, therapies when they become imminently dying and/or incompetent for decision-making. PC also gives support to cardiology teams in difficult communications on end-of-life issues. Modern PC manages or prevents suffering in people with advanced diseases, independent of diagnosis and prognosis and care for their relatives. It can be provided additionally to disease-specific management as a parallel care, or sometimes as the main care pathway in people close to death as end-of-life care. Parallel PC care should be needs driven; end-of-life care can additionally be prognosis driven. In the majority of cardiological patients PC can/should be delivered by the cardio team that has been treating the person to date and who applies the general PC rules (symptom and distress assessment and management). The PC specialist should ensure consultations in case of difficult/resistant problems, and take the lead in treatment only rarely, if needed. PC acknowledges four dimensions influencing a person’s quality of life: physical, psychological/emotional, spiritual, and social. Each of them needs to be addressed effectively which may require the involvement of a multidisciplinary team. A PC team can provide important support to the treatment team in analysing/solving complex management-related ethical issues.

Sign in / Sign up

Export Citation Format

Share Document