Posts Tagged ‘end-of-life’

End-of-Life Healthcare Decisions

Tuesday, February 3rd, 2015

CPR: Doing CPR on an elderly, debilitated patient with a terminal illness may do more harm than good. Risks include broken ribs, collapsed lungs, brain damage, and permanent need for a ventilator. The chance that it would return the patient to his or her former quality of life is practically nil. If you decide you don’t want CPR to be conducted on your loved one, you’ll need to ask the person’s physician to put a DNR order in the chart.

Antibiotics, Hospitalization, Ventilator: It’s probably best to make decisions about these issues at the time of need rather than in advance. The decisions have to take into account the patient’s general condition. Is the patient alert and responsive? Is he or she in pain? What is the person’s quality of life? Is the patient likely to recover from whatever is causing the need for the antibiotic, hospitalization or ventilator? For example if a frail patient has pneumonia, you can try antibiotics and a ventilator if needed, but if the patient continues to get worse, you can then withdraw the medication and ventilator and allow the person to die in peace.

Hospice: In order to receive hospice services you have to agree to forego aggressive treatment for the terminal diagnosis. This means that the patient would not be put on a ventilator, for example. Or if the patient is hospitalized, it would only be for comfort care.

Symptoms that the Patient Qualifies for Hospice Care: It may be time to consider using a hospice service if the patient is showing any of the following: 1) Two or more episodes of pneumonia or other serious infections during the past 6-months, 2) Difficulty eating and swallowing, even with feeding help, that results in weight loss of 10% or more over the preceding 6 months and 3) One or more skin pressure ulcers that are not healing.

The “Real” Issue: All of these decisions are very difficult, but the real issue is to stop focusing on the person’s approaching death and start figuring out how to do everything you can to help the patient have the highest possible quality of life in the time that’s left. This dynamic shift in thinking – from death to life – will benefit both the patient and the caregiver.

 

Preparing Emotionally for the End

Wednesday, March 20th, 2013

There are many emotional issues facing family members and friends when a loved one is terminally ill. These include things such as communicating the terminal diagnosis to others; overcoming denial that the person is in fact terminally ill; feeling the need to “be strong” for that person’s benefit; dealing with anticipatory grief; and deciding when or if to engage hospice care services – just to name a few.

I want to share my experience near the end of Ed’s life. After I started hospice care for him I consulted Doug Smucker, MD, a family physician at the University of Cincinnati who specialized in end-of-life care.

After answering all my questions, he told me something that completely changed my thinking and feelings about the situation. He said that rather than focus on Ed’s impending death, I should focus on doing everything I could to help him have the highest possible quality of life in the time that was remaining.

That turned me around and led me to focus on all the special things I could do for Ed – visiting him more often, taking my little Shih Tzu to see him, having the violinist come back and play another concert for him, and buying him even more of the stuffed animals he loved so much. This helped both me and Ed have a beautiful, pleasant months-long conclusion of our life together

 

Make End-of-Life Decisions Long Before They Are Needed

Sunday, October 14th, 2012

It’s important for people with Alzheimer’s to have a living will, a power of attorney and a durable power of attorney for health care. If they don’t these documents should be prepared early in the course of the illness when the person is still mentally competent to make such decisions.

When people with Alzheimer’s have not executed advance directives and are unable to make end-of-life healthcare decisions on their own, the caregiver will need to make the decisions for them. These include several different issues over time, such as the use of CPR, antibiotics, hospitalization, a ventilator, use of a feeding tube and, ultimately, engaging hospice care services.

For detailed information about each of these issues see my Huffington Post article, “Make Alzheimer’s End-of-Life Decisions Long Before They Are Needed.”

Hospice Care for Alzheimer’s Patients Near the End of Life

Wednesday, October 3rd, 2012

It’s Not Just for Cancer Patients: When we think of hospice care we often associate it with cancer patients, but it’s also valuable for advanced stage Alzheimer’s patients. In that stage the person is unable to walk, dress or bathe without help; has trouble controlling urine and/or bowel functions; and only rarely speaks meaningful sentences.

More Specific Signs that You Should Consider Hospice Care: According to Gregg Warshaw, MD, Director of Geriatric Medicine at the University of Cincinnati and Past President of the American Geriatric Society, if your loved one with advanced Alzheimer’s is exhibiting any of the following symptoms, it’s time to talk to his or her doctor about considering hospice care:

1.  Two or more episodes of pneumonia or other serious infections during the past 6-months

2.  Difficulty eating and swallowing, even with feeding help, that results in weight loss of 10% or more over the preceding 6 months

3.  One or more skin pressure ulcers that are not healing

Although starting hospice care for a loved one is a somber and painful experience, just remember it will help both you and your loved one have the highest possible quality of life during the precious time that is left.

Where to Find Additional Information: The Hospice Foundation of America (www.hospicefoundation.org) is an excellent source for more information on this topic.

 

Hospice Care for People With Dementia

Saturday, September 22nd, 2012

It’s Not Just for Cancer Patients: When we think of hospice care we often associate it with cancer patients, but it’s also valuable for advanced stage Alzheimer’s patients. In that stage the person is unable to walk, dress or bathe without help; has trouble controlling urine and/or bowel functions; and only rarely speaks meaningful sentences.

More Specific Signs that You Should Consider Hospice Care: According to Gregg Warshaw, MD, Director of Geriatric Medicine at the University of Cincinnati and Past President of the American Geriatric Society, if your loved one with advanced Alzheimer’s is exhibiting any of the following symptoms, it’s time to talk to his or her doctor about considering hospice care:

1. Two or more episodes of pneumonia or other serious infections during the past 6-months

2. Difficulty eating and swallowing, even with feeding help, that results in weight loss of 10% or more over the preceding 6 months

3. One or more skin pressure ulcers that are not healing

Although starting hospice care for a loved one is a somber and painful experience, just remember it will help both you and your loved one have the highest possible quality of life during the precious time that is left.

Where to Find Additional Information: The Hospice Foundation of America is an excellent source for more information on this topic.

 

 

Hospice Care for Alzheimer’s Patients near the End of Life

Wednesday, November 30th, 2011

It’s Not Just for Cancer Patients: When we think of hospice care we often associate it with cancer patients, but it’s also valuable for advanced stage Alzheimer’s patients. In that stage the person is unable to walk, dress or bathe without help; has trouble controlling urine and/or bowel functions; and only rarely speaks meaningful sentences.

 More Specific Signs that You Should Consider Hospice Care: According to Gregg Warshaw, MD, Director of Geriatric Medicine at the University of Cincinnati and Past President of the American Geriatric Society, if your loved one with advanced Alzheimer’s is exhibiting any of the following symptoms, it’s time to talk to his or her doctor about considering hospice care:

      1.  Two or more episodes of pneumonia or other serious infections during the past 6-months

      2.  Difficulty eating and swallowing, even with feeding help, that results in weight loss of 10% or more over the preceding 6 months

      3.  One or more skin pressure ulcers that are not healing

 Although starting hospice care for a loved one is a somber and painful experience, just remember it will help both you and your loved one have the highest possible quality of life during the precious time that is left.

Where to Find Additional Information: The Hospice Foundation of America (www.hospicefoundation.org) is an excellent source for more information on this topic.