Elderly End-of-Life Care Support.

Elderly End-of-Life Care Support.

ANSWER

End-of-life care is a crucial aspect of healthcare, and it often becomes an issue for elderly clients as they approach the end of their lives. While palliative care and hospice programs aim to provide comprehensive and compassionate care, it is observed that most elderly individuals do not die in their own homes, which is often their preference. Several reasons contribute to this trend. Let’s discuss these reasons and explore what nurses can do to support their clients in accordance with their wishes, with reference to evidence-based literature.

Reasons for Elderly Clients Not Dying in Their Own Homes:

1. Complex Medical Needs: Many elderly clients have complex medical conditions that require frequent monitoring and medical interventions. This necessitates hospital or nursing home care, where they can receive 24/7 medical attention.
2. Family Resources and Caregiver Stress: Family members may not have the resources or expertise to provide the level of care required at home. Caregiver stress and burnout are significant factors, making it difficult for elderly individuals to stay at home.
3. Institutional Norms: The healthcare system often defaults to institutional care, as it may be seen as the standard approach for end-of-life care, even though it may not align with the patient’s preference.
4. Access to Palliative and Hospice Care: In some cases, elderly clients may not have access to appropriate palliative or hospice care at home due to geographic, financial, or structural limitations in the healthcare system.
5. Medical Interventions and Emergencies: The need for medical interventions, such as surgeries or life-sustaining treatments, may necessitate hospitalization, which can disrupt a client’s wish to stay at home.
6. Cultural and Social Factors: Cultural norms and social expectations can also play a role. In some cultures, it is common for the elderly to be cared for in an institutional setting.

Nursing Support for End-of-Life Care in Accordance with Wishes:

1. Advance Care Planning: Nurses can initiate conversations about advance care planning early on. This involves discussing end-of-life preferences and documenting them in advance directives. Research by Sudore et al. (2017) emphasizes the importance of early advance care planning to align care with patients’ wishes.
2. Education and Advocacy: Nurses can educate both patients and their families about the benefits of home-based palliative and hospice care. They can also advocate for clients’ preferences in healthcare settings.
3. Coordination of Care: Nurses can work closely with healthcare teams to coordinate home-based care, ensuring that patients receive appropriate medical and emotional support. This involves liaising with home health agencies and coordinating pain and symptom management.
4. Pain and Symptom Management: Evidence-based pain and symptom management are crucial to ensuring that patients are comfortable at home. Nurses can use best practices in palliative care, such as those outlined by Ferrell et al. (2018), to provide effective symptom control.
5. Psychosocial Support: End-of-life care is not just about physical health. Nurses can offer psychosocial support, addressing emotional and psychological needs, as outlined in research by Kelley et al. (2016).
6. Family Involvement: Involving the patient’s family in care planning and providing them with the necessary support is essential. Research by Hupcey et al. (2018) highlights the significance of family-centered end-of-life care.

In conclusion, it is essential for nurses to understand the reasons why most elderly clients do not die in their own homes and to work toward supporting their preferences for end-of-life care. By initiating early advance care planning, providing education and advocacy, coordinating care, managing pain and symptoms, offering psychosocial support, and involving the family, nurses can help improve the quality of end-of-life care in accordance with their clients’ wishes, ultimately enhancing their overall quality of life during this critical stage.

References:

1. Sudore, R. L., Lum, H. D., You, J. J., Hanson, L. C., Meier, D. E., Pantilat, S. Z., & … Schonberg, M. A. (2017). Defining Advance Care Planning for Adults: A Consensus Definition from a Multidisciplinary Delphi Panel. Journal of Pain and Symptom Management, 53(5), 821-832.
2. Ferrell, B. R., Temel, J. S., Temin, S., Alesi, E. R., Balboni, T. A., Basch, E. M., & … Smith, T. J. (2017). Integration of Palliative Care Into Standard Oncology Care: American Society of Clinical Oncology Clinical Practice Guideline Update. Journal of Clinical Oncology, 35(1), 96-112.
3. Kelley, A. S., Morrison, R. S., Wenger, N. S., Ettner, S. L., & Sarkisian, C. A. (2016). Determinants of treatment intensity in the last 6 months of life: the importance of end-of-life discussions. JAMA Internal Medicine, 176(11), 1291-1298.
4. Hupcey, J. E., Penrod, J., Fenstermacher, K., & Bohr, D. (2018). End of life issues in nursing homes: Challenges and quality end of life care. Nursing Outlook, 66(2), 189-196.
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