END-OF-LIFE CARE
End-of-life care describes the support and medical care given during the time surrounding death. Older people often live with one or more chronic illnesses and may need care for days, weeks, and even months before death. The goals are to prevent or relieve suffering as much as possible and to improve quality of life while respecting the dying person’s wishes.
A patient who can defend their judgments has the right to make decisions that do not coincide with what the physician believes is beneficial to that patient. Physicians are obligated to comply with the refusal of life-sustaining treatment by a competent patient who has been adequately informed of the consequences of refusal and has applied their own values in making a decision to refuse or who has prepared an advance directive or living will.
Likewise, clinicians may refuse to provide care if:
- There is no medical rationale for the treatment
- The treatment has proven ineffective for the person
- Expectation of survival is low
- The person is unconscious and will likely die in a matter of hours or days even if treatment is given
Treatments that have been started can also be stopped. This is appropriate if the treatments are not beneficial or are not consistent with an individual’s wishes and priorities. Even if life-sustaining treatments have been refused or stopped, the individual can still receive care to treat symptoms such as pain or shortness of breath (Health in Aging, 2020; Olejarczyk & Young, 2023).
Preparing older adults and their families to plan and anticipate making decisions regarding end-of-life care and treatment is important, especially in the event that the older adult is not able to make decisions for themself. Older adults should plan and discuss their preferences with significant others, family, and healthcare providers to communicate their wishes through planning advance directives, a living will, and appointing a healthcare proxy.
Palliative Care
Palliative care is the active, holistic care of individuals across all ages with serious health-related suffering due to severe illness, and especially of those near the end of life.
The goals of palliative care are to:
- Provide relief from pain and other physical symptoms
- Maximize the quality of life
- Provide psychosocial and spiritual care
- Provide support to help family during the patient’s illness and in their subsequent bereavement
(IAHPC, 2023)
Hospice Care
Hospice provides comprehensive comfort care as well as support for the family, but attempts to cure the persons’ illness are discontinued. Hospice is provided for those with a terminal illness whose physician believes they have six months or less to live if the illness runs its natural course. Hospice can be offered at home or in a facility such as a nursing home, hospital, or a separate hospice center.
Hospice care includes a team of people with certain skills, including nurses, doctors, social workers, spiritual advisors, and trained volunteers. They work together with the dying person, the caregiver, and/or family to provide medical, emotional, and spiritual support. A member of the hospice team visits regularly, and someone is usually always available by phone. Along with coaching family members on how to care for the dying person, it provides respite care when caregivers need a break. Respite care can be for as short as a few hours or for as long as several weeks (NIA, 2021a).
(See also the Wild Iris Medical Education course “End-of-Life, Palliative, and Hospice Care.”)