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Care Near the End of Life

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Geriatric Medicine

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Abstract

Advances in medical science during the past half century have allowed people to survive many acute illnesses that previously would have resulted in death. Yet success is often incomplete, substituting a chronic disease rather than curing the disease. Most Americans age with one or more degenerative or disabling diseases, and many will require daily assistance toward the end of life. In many chronic disease states, it may be difficult or impossible to identify a point at which a gradually worsening patient becomes terminally ill. In the process of ongoing care, however, physicians and patients often become aware that the likely benefits of certain treatments or diagnostic tests are outweighed by the discomfort and other burdens associated with them and that an overall palliative approach has become preferable. For some patients, no treatment offers hope for prolongation of life or restoration of function, but palliation of symptoms and maintenance of function are virtually always important.

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References

  1. The President’s Commission for the Study of Ethics and Medicine. Deciding to forgo Life-Sustaining Treatment. Washington, DC: US Government Printing Office; 1983.

    Google Scholar 

  2. Guidelines on the Termination of Life-Sustaining Treatment and the Care of the Dying: A Report by the Hastings Center. Bloomington, IN: Indiana University Press; 1987.

    Google Scholar 

  3. Current Opinions of the Council on Ethical and Judicial Affairs of the American Medical Association. Chicago: AMA; 1986.

    Google Scholar 

  4. Emanuel EJ, Emanuel LL. The economics of dying. The illusion of cost savings at the end of life. N Engl J Med. 1994; 330 (8): 540–544.

    Article  PubMed  CAS  Google Scholar 

  5. Teno J, Murphy D, Lynn J, et al. Prognosis-based futility guidelines: does anyone win? J Am Geriatr Soc. 1994; 42: 1–6.

    Google Scholar 

  6. Emanuel EJ, Weinberg DS, Gonin R, et al. How well is the Patient Self-Determination Act working?: an early assessment. Am J Med. 1993; 95 (6): 619–628.

    Article  PubMed  CAS  Google Scholar 

  7. Uhlman RF, Clark H, Pearlman RA, et al. Medical management decisions in nursing home patients. Principles and policy recommendations. Ann Intern Med. 1987; 106: 879–885.

    Google Scholar 

  8. Holtzman J, Pheley AM, Lurie N. Changes in orders limiting care and the use of less aggressive care in a nursing home population. J Am Geriatr Soc. 1994; 42: 275–279.

    PubMed  CAS  Google Scholar 

  9. Fried TR, Gillick MR. Medical decision-making in the last six months of life: choices about limitation of care. J Am Geriatr Soc. 1994; 42: 303–307.

    PubMed  CAS  Google Scholar 

  10. Murphy DJ, Burrows D, Santilli S, et al. The influence of the probability of survival on patients’ preference regarding cardiopulmonary resuscitation. N Engl J Med. 1994; 330 (8): 545–549.

    Article  PubMed  CAS  Google Scholar 

  11. Uhlmann RF, Pearlman RA, Cain KC. Physicians’ and spouses’ predictions of elderly patients’ resuscitation preferences. J Gerontol. 1988; 43: M115 - M121.

    Article  PubMed  CAS  Google Scholar 

  12. Seckler AB, Meier DE, Mulvihill M, et al. Substituted judgment: how accurate are proxy predictions? Ann Intern Med. 1991; 115: 92–98.

    PubMed  CAS  Google Scholar 

  13. Teno J, Hakim RB, Knaus WA, et al. Preferences for CPR: physician-patient agreement and hospital resources. J Gen Intern Med. 1995; 10 (4): 179–186.

    Article  PubMed  CAS  Google Scholar 

  14. Schmitz RN, O’Brien M. Observations on nutrition and hydration in dying cancer patients. In: Lynn J, ed. By No Extraordinary Means. Bloomington, IN: Indiana University Press; 1989: 29–40.

    Google Scholar 

  15. Cruzan Director, Missouri Department of Health, 110 S. Ct. 284; 1990: 2855.

    Google Scholar 

  16. Mullen MT, van der Wal G, van Eijk JThM, et al. Voluntary active euthanasia and assisted suicide in Dutch nursing homes: are the requirements for prudent practice properly met? J Am Geriatr Soc. 1994; 42: 624–629.

    Google Scholar 

  17. Bernât JL, Gert B, Mogielnicki RP. Patient refusal of hydration and nutrition: an alternative to physician-assisted suicide or voluntary active euthanasia. Arch Intern Med. 1993; 153: 2723–2728.

    Article  PubMed  Google Scholar 

  18. Teno J, Lynn J. Voluntary active euthanasia: the individual case and public policy. J Am Geriatr Soc. 1991; 39: 827–830.

    PubMed  CAS  Google Scholar 

  19. Sanger MA, Easterling DE, Kindig DA, et al. Changes in the location of death after passage of Medicare’s prospective payment system. N Engl J Med. 1989; 320 (7): 433–439.

    Article  Google Scholar 

  20. Pritchard R, Teno J, Fisher E, et al. Regional variation in site of death. J Gen Intern Med. 1994;9:suppl. 1: 64.

    Google Scholar 

  21. Christakis NA. Timing of referral of terminally ill patients to an outpatient hospice. J Gen Intern Med. 1994; 9: 314–320.

    Article  PubMed  CAS  Google Scholar 

  22. The Hospice Help Line 1–800–658–8898 or The National Hospice Organization, 1901 North Moore Street, Suite 901, Arlington, VA 22209, to locate hospice programs.

    Google Scholar 

  23. Foley C. The treatment of cancer pain. N Engl J Med. 1985; 313 (2): 84–95.

    Article  PubMed  CAS  Google Scholar 

  24. Ferrell BA. Pain management in elderly people. J Am Geriatr Soc. 1991; 39: 64–73.

    PubMed  CAS  Google Scholar 

  25. WHO Expert Committee. Cancer Pain Relief and Palliative Care. Technical Report Series 804. Geneva: World Health Organization; 1990.

    Google Scholar 

  26. Daut RL, Cleeland CS, Flanery RC. The development of the Wisconsin Brief Pain Questionnaire to assess pain in cancer and other diseases. Pain. 1983; 17: 197–210.

    Article  PubMed  CAS  Google Scholar 

  27. Graham C, Bond SS, Gerkovich MM, et al. Use of the McGill Pain Questionnaire in the assessment of cancer pain: replicability and consistency. Pain. 1980; 8: 377–387.

    Article  PubMed  CAS  Google Scholar 

  28. Wallenstein SL. Measurement of pain and analgesia in cancer patients. Cancer. 1984; 53: 2217–2384.

    Google Scholar 

  29. Silvestri GA, Mahler DA. Evaluation of dyspnea in the elderly patient. Clin Chest Med. 1993; 14 (3): 393–404.

    PubMed  CAS  Google Scholar 

  30. Coyle N, Adelhardt J, Foley KM, et al. Character of terminal illness in the advanced cancer patient: pain and other symptoms during the last four weeks of life. J Pain Symptom Manage. 1990; 5: 83–93.

    Article  PubMed  CAS  Google Scholar 

  31. Bonica JJ. Treatment in cancer pain. Current status and future needs. In: Fields H, et al., eds. Advances in Pain Research and Therapy. New York: Raven Press; 1985:589-616.

    Google Scholar 

  32. Foley KM: Pain syndromes in patients with cancer. In: Bonica JJ, Ventafridda V, eds. Advances in Pain Research and Therapy, vol 2. International Symposium on pain in Advanced Cancer. New York: Raven Press; 1979: 59–76.

    Google Scholar 

  33. Mogielnicki RP, Nelson WA, Dulac JA. A study of the dying process in elderly hospitalized males. J Cancer Education. 1990; 5 (2): 135–145.

    Article  CAS  Google Scholar 

  34. Reuben DB, Mor V. Dyspnea in terminally ill cancer patients. Chest. 1986; 89: 234–236.

    Article  PubMed  CAS  Google Scholar 

  35. Bruera E, deStoutz N, Velasco-Leiva A, et al. Effects of oxygen on dyspnoea in hypoxaemic terminal-cancer patients. Lancet. 1993; 342: 13–14.

    Article  PubMed  CAS  Google Scholar 

  36. Dean NC, Brown JK, Himmelman RB, et al. Oxygen may improve dyspnea and endurance in patients with chronic obstructive pulmonary disease and only mild hypoxemia. Am Rev Respir Dis. 1992; 146 (4): 941–945.

    PubMed  CAS  Google Scholar 

  37. Bruera E, MacEachern T, Ripamonti C, et al. Subcutaneous morphine for dyspnea in cancer patients. Ann Intern Med. 1993; 119: 906–907.

    PubMed  CAS  Google Scholar 

  38. Cohen MH, Anderson AJ, Krasnow SH, et al. Continuous intravenous morphine for severe dyspnea. South Med J. 1991; 84 (2): 229–234.

    Article  PubMed  CAS  Google Scholar 

  39. Saunders C. Principles of symptom control in terminal care. Med Clin North Am. 1982; 66: 1169–1183.

    PubMed  CAS  Google Scholar 

  40. Massie MJ, Holland JC. Depression and the cancer patient. J Clin Psychiatry. 1990; 51: 12–17.

    PubMed  Google Scholar 

  41. Evans DA, Funkenstein HH, Albert MS, et al. Prevalence of Alzheimer’s disease in a community population of older persons. Higher than previously reported. JAMA. 1989; 262: 2551–2556.

    Article  PubMed  CAS  Google Scholar 

  42. Kukull WA, Brenner DE, Speck CE, et al. Causes of death associated with Alzheimer disease: variation by level of cognitive impairment before death. J Am Geriatr Soc. 1994; 42: 723–726.

    PubMed  CAS  Google Scholar 

  43. Collins C, Ogle K. Patterns of predeath service use by dementia patients with a family caregiver. J Am Geriatr Soc. 1994; 42: 719–722.

    PubMed  CAS  Google Scholar 

  44. Volicer L. Need for hospice approach to treatment of patients with advanced progressive dementia. J Am Geriatr Soc. 1986; 34: 655–658.

    PubMed  CAS  Google Scholar 

  45. Enck RE. Alzheimer’s disease and hospice care. Am J Hosp Care. 1987; 4 (l): 19–20.

    Article  PubMed  CAS  Google Scholar 

  46. Volicer L, Collard A, Hurley A, et al. Impact of special care unit for patients with advanced Alzheimer’s disease on patients’ discomfort and costs. J Am Geriatr Soc. 1994; 42: 597–603.

    PubMed  CAS  Google Scholar 

  47. Hockley JM, Dunlop R, Davies RJ. Survey of distressing symptoms in dying patients and their families in hospital and the response to a symptom control team. Br Med J. 1988; 296: 1715–1717.

    Article  CAS  Google Scholar 

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Authors
  1. Sarah Goodlin
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  2. Joanne Lynn
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Editor information

Editors and Affiliations

  1. The Henry L. Schwartz Department of Geriatrics and Adult Development, The Mount Sinai Medical Center, 10029-6574, New York, NY, USA

    Christine K. Cassel M.D. (Professor and Chairman) & Diane E. Meier M.D. (Associate Professor) (Professor and Chairman) &  (Associate Professor)

  2. Center for Study of Aging and Geriatric Research Education and Clinical Center, Duke University Medical Center, 27710, Durham, NC, USA

    Harvey J. Cohen M.D. (Director) (Director)

  3. University of Washington Medical Center, 98195, Seattle, WA, USA

    Eric B. Larson M.D., M.P.H. (Medical Director) (Medical Director)

  4. Gerontology Division, Harvard Medical School, Brigham and Women’s Hospital, 02115, Boston, MA, USA

    Neil M. Resnick M.D. (Chief) (Chief)

  5. Geriatric Research Education and Clinical Center, Sepulveda VA Medical Center, 91343, Sepulveda, CA, USA

    Laurence Z. Rubenstein M.D., M.P.H. (Director) (Director)

  6. Department of Medicine, University of Chicago, 60637, Chicago, IL, USA

    Leif B. Sorensen M.D. (Professor and Vice Chairman) (Professor and Vice Chairman)

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© 1997 Springer Science+Business Media New York

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Goodlin, S., Lynn, J. (1997). Care Near the End of Life. In: Cassel, C.K., et al. Geriatric Medicine. Springer, New York, NY. https://doi.org/10.1007/978-1-4757-2705-0_58

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  • DOI: https://doi.org/10.1007/978-1-4757-2705-0_58

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4757-2707-4

  • Online ISBN: 978-1-4757-2705-0

  • eBook Packages: Springer Book Archive

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