ABSTRACT
Background Despite the importance of functional status to older persons and their families, little is known about the course of disability at the end of life.
Methods We evaluated data on 383 decedents from a longitudinal study involving 754 community-dwelling older persons. None of the subjects had disability in essential activities of daily living at the beginning of the study, and the level of disability was ascertained during monthly interviews for more than 10 years. Information on the conditions leading to death was obtained from death certificates and comprehensive assessments that were completed at 18-month intervals after the baseline assessment.
Results In the last year of life, five distinct trajectories were identified, from no disability to the most severe disability: 65 subjects had no disability (17.0%), 76 had catastrophic disability (19.8%), 67 had accelerated disability (17.5%), 91 had progressive disability (23.8%), and 84 had persistently severe disability (21.9%). The most common condition leading to death was frailty (in 107 subjects [27.9%]), followed by organ failure (in 82 subjects [21.4%]), cancer (in 74 subjects [19.3%]), other causes (in 57 subjects [14.9%]), advanced dementia (in 53 subjects [13.8%]), and sudden death (in 10 subjects [2.6%]). When the distribution of the disability trajectories was evaluated according to the conditions leading to death, a predominant trajectory was observed only for subjects who died from advanced dementia (67.9% of these subjects had a trajectory of persistently severe disability) and sudden death (50.0% of these subjects had no disability). For the four other conditions leading to death, no more than 34% of the subjects had any of the disability tra...
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# Lunney JR, Lynn J, Hogan C. Profiles of older Medicare decedents. J Am Geriatr Soc 2002;50:1108-1112. [CrossRef][Web of Science][Medline]
# Gazelle G. Understanding hospice -- an underutilized option for life's final chapter. N Engl J Med 2007;357:321-324. [Free Full Text]
# Bandeen-Roche K, Xue QL, Ferrucci L, et al. Phenotype of frailty: characterization in the Women's Health and Aging Studies. J Gerontol A Biol Sci Med Sci 2006;61:262-266. [Free Full Text]
# Weiss CO, Boyd CM, Yu Q, Wolff JL, Leff B. Patterns of prevalent major chronic disease among older adults in the United States. JAMA 2007;298:1160-1162. [Free Full Text]
# Ives DG, Samuel P, Psaty BM, Kuller LH. Agreement between nosologist and cardiovascular health study review of deaths: implications of coding differences. J Am Geriatr Soc 2009;57:133-139. [CrossRef][Web of Science][Medline]
However it can also make room for medical, legal and ethical dilemmas. Advances in medical technology enable individuals to delay the inevitable fate of death, overcome cancer, diabetes, and various traumatic injuries. Our advances in medical technologies now allow these individuals to do things on their own terms. The “terminally ill” state is described as having an incurable or irreversible condition that has a high probability of causing death within a relatively short time with or without treatment (Guest, p.3, 1998). A wide range of degenerative diseases can fall into either category, ranging from, HIV/AIDS, Alzheimer’s disease and many forms of cancer. This control, however, lays assistance, whether direct or indirect, from a
Increasingly, people know from their own experience some painful dilemmas involving elderly or handicapped individuals who are in pain. While the achievements of modern medicine have been used to prolong and enhance life for many, they have also helped create an often dreaded context for dying. Costly technology may keep persons alive, but frequently these persons are cut off from meaningful relationships with others and exist with little or no hope for recovery. Many fearfully imagine a situation at the end of their lives where they or their trusted ones will have no say in decisions about their treatment.
Medcohealth. Women and Aging: Our lives due change (2002). Retrieved November 18, 2002 from the World Wide Web: http://www.medcohealth.com
Being in hospice care is a better alternative than being stuck in the hospital to try to avoid the unavoidable. Common misconceptions about Hospice could include that hospice makes life more miserable; however, a physician expressed his findings in Hospice,“You can only fail a patient if you fail to understand and respond to their needs. We may not be able to cure all of our patients, but if we can make them comfortable in the last moments of their lives, we will not have failed them”..Hospice care gradually emerged in the 1970s, when groups like the National Hospice Organization were formed “in response to the unmet needs of dying patients and their families for whom traditional medical care was no longer effective.”Herbert Hendin, an executive director of the American Suicide Foundations illustrates a story of a young man diagnosed with acute myelocytic leukemia and was expected to have only a few months before he died. He persistently asked the doctor to assist him, but he eventually accepted the medical treatment. His doctor told him he can use his time wisely to become close to his family. Two days before he died, Tim talked about what he would have missed without the opportunity for a
Hospice always patient and families the automaty to decide a choice of end of life care. It allows who prefer to end life in their homes, pain free, surrounded by family and loved ones: Hospice works to make this happen. The focus in on caring, not curing. Hospice utilizes an interdisciplinary team of healthcare professionals and trained volunteers that address symptom control, pain management, and emotional and spiritual support expressly tailored to the patient's needs and wishes. Hospice is not “giving up,” nor is it a form of euthanasia or physician assisted
The aim of this study sought to determine how death and dying were understood and managed in two intensive care units in the UK. This was easily located for the reader as was stated in both the abstract and introduction. However, the reader only found out the narrower aim - concerning the resolutions that occurred following the problematic definitions between euthanasia, treatment withdrawal, and natural death – played a more integrated part of the study at the end of the introduction. Although it was introduced in the abstract, it could have been made clearer to the reader so they understood that it was a pivotal factor in the study, not just part of the literature review. If corrected this would have accounted for a more comprehensible and broader scope going into the article.
The Public Health Imperative measures the quality of life of an individual during times of severe chronic illness. This health imperative is characterized by: the potential to prevent suffering caused by the illness, major impact, and high burden. In the recent past is has become evident that care for older people, who have potential to become terminally ill, must be focused on. The types of patients may also lose the capability to make some of their most important decisions which include actions made by health professionals that are related to their end of life situation. Luckily actions were made to identify certain priorities pertaining to the public health and end of life issues. These priorities were established by the National Association of Chronic Disease Directors and the Healthy Aging Program at the Centers for Disease Control and Prevention. These end of life health priorities which address short-term, medium-term and long-term needs are also called advanced care planning. It can be concluded that communication between professionals and among families about the patient can enhance the effectiveness of advanced care planning.
Disability Trends. Advancements in medical science, technology, education, public health, and public policy, have placed the United States and other developed countries at the forefront of a new demographic trend—aging with a disability acquired before age 65—which is uniting the aging and disability populations (Washko, Campbell & Tilly, 2012). By 2050, it is anticipat...
The care of patients at the end of their live should be as humane and respectful to help them cope with the accompanying prognosis of the end of their lives. The reality of this situation is that all too often, the care a patient receives at the end of their life is quite different and generally not performed well. The healthcare system of the United States does not perform well within the scope of providing the patient with by all means a distress and pain free palliative or hospice care plan. To often patients do not have a specific plan implemented on how they wish to have their end of life care carried out for them. End of life decisions are frequently left to the decision of family member's or physicians who may not know what the patient needs are beforehand or is not acting in the patient's best wishes. This places the unenviable task of choosing care for the patient instead of the patient having a carefully written out plan on how to carry out their final days. A strategy that can improve the rate of care that patients receive and improve the healthcare system in general would be to have the patient create a end of life care plan with their primary care physician one to two years prior to when the physician feels that the patient is near the end of their life. This would put the decision making power on the patient and it would improve the quality of care the patient receives when they are at the end of their life. By developing a specific care plan, the patient would be in control of their wishes on how they would like their care to be handled when the time of death nears. We can identify strengths and weakness with this strategy and implement changes to the strategy to improve the overall system of care with...
The purpose of this essay is to analyse various theories on ageing, death, dying, and end of life issues from different perspectives such as: biophysiological theories, psychosocial theories; and taking in consideration the cultural, historical, and religious implications around the aforementioned life stages. One will also discuss important issues relevant to social work practice such as dignity, autonomy, and their relationship with the concept of a successful ageing and a good death. One considers these areas important since they upheld anti-discriminatory practice and may perhaps promote the development of personalised care pathways, as well as fair and justifiable social policies.
Today, world’s population is aging at a very fast pace and United States is no exception to this demographic change. According to the U.S Census Bureau, senior citizens will be accounted for 21% of the American population in 2050 (Older Americans, 2012). Although living longer lives may not seem like a negative sign, living longer does not necessarily mean living healthier. Older adults of today are in need of long-term and health care services more than any generation before them (Older Americans, 2012). Because of the growing need for senior care, millions of families are facing critical decisions on how to provide care for their parents. In addition, declining birthrates may cause people to have less familial care and support as they age. To be able to provide the necessary care for senior citizens government funded long term care insurance program is needed.
Green, P. (1984). The pivotal role of the nurse in hospice care. CA: A Cancer Journal for Clinicians, 34(4), 204-205.
New York State OASAS. (2013). Seniors and Health: Risk and Protective Factors. Retrieved May 5, 2014, from https://www.oasas.ny.gov/prevention/senior/RPFactors.cmf
According to (Miller, 2009), dementia is the most accurate expression which illustrates the development of cognitive impairment. ¬¬¬¬¬¬¬¬¬¬It exemplifies the diverse brain anarchies which ultimately lead to severe brain dysfunction (Alzheimer Australia, 2011). Dementia is the leading cause of disability in older adults in Australia accounting for 17 percent of the cases (Australian Institute of Health and Welfare, 2004). Alzheimer’s disease (AD), Vascular Dementia (VD), Frontotemporal Dementia (FD) and Dementia with Lewy Bodies (DLB) are the well known forms of this disease. This usually occurs in older adults aged above 65; however it is a disability and not a normal symptom of aging. Chances of inheritability are present but it depends on the individual and the type of dementia (Alzheimer Australia, 2011). The Global Deterioration Scale provides a detailed explanation regarding the seven stages of cognitive decline in Dementia (Alzheimer’s Association of Canada, 2005).
The patient care research available for use in nursing on frailty is sparse. Frailty is fairly a new geriatric syndrome. Current literature on frailty is limited and therefore well-conducted studies are needed in order to be benefit the older community.