End-of-life care (or EoLC ) refers to health care, not only in the last hours or days of their lives, but more extensively in the care of all of them with terminal conditions that have become progressive, progressive, and incurable.
End-of-life care requires decisions, including palliative care questions, the right of self-determination (medication, life), medical experimentation, the ethics and efficacy of extraordinary or dangerous medical interventions, and the ethics and efficacy of even continuous routine medical interventions. In addition, end-of-life often touches the allocation and allocation of resources in hospitals and the national medical system. Such decisions are informed by technical, medical, economic and bioethical considerations. In addition, end-of-life care depends on consideration of patient autonomy. "Ultimately, it still depends on patients and their families to determine when to pursue aggressive care or withdraw life support."
In most developed countries, medical expenses for those in the last twelve months of life account for approximately 10% of total aggregate medical expenditures, and spending on them in the last three years of life can reach up to 25%. Whether a doctor will be surprised if someone dies in a certain period of time is rather accurate in predicting the end of life.
Video End-of-life care
National perspectives
Canada
In 2012, Statistics Canada The General Social Survey of care and care received found that 13% of Canadians (3.7 million) aged 15 and older reported that at some point in their lives they had given end of his life. or palliative care to family members or friends. For those in their 50s and 60s, the percentage is higher, with about 20% reporting having provided palliative care to family members or friends. Women were also more likely to provide palliative care during their lifetime, with 16% of women reporting having done so, compared with 10% of men. These caregivers help sick family members or friends with personal or medical care, food preparation, financial management or provide transportation to and from medical appointments.
United Kingdom
The end of life care has been identified by the UK Department of Health as areas where previous care qualities have been "highly variable," and who have not yet had a high profile in the NHS and social care. To address this, a nationwide final life care program was established in 2004 to identify and disseminate best practice, and a national strategy document published in 2008. The Scottish government has also published a national strategy.
In 2006 over half a million people died in the UK, about 99% of them were adults over the age of 18, and nearly two-thirds of adults were over the age of 75. About three-quarters of deaths can be considered "predictable" and followed by periods of chronic disease - such as heart disease, cancer, stroke, or dementia. Overall, 58% of deaths occurred in NHS hospitals, 18% at home, 17% in home-care homes (mostly over 85), and about 4% in nursing homes. However, the majority of people prefer to die at home or in care homes, and according to one survey less than 5% prefer to die in the hospital. Therefore, the main goal of this strategy is to reduce the need for dying patients to have to go to the hospital and/or to live there; and to improve the provision of palliative support and care in the community to enable this. One study estimates that 40% of patients who have died in the hospital do not have the medical needs that require them to be there.
In 2015 and 2010, Britain is ranked highest globally in its final care study of its lifetime. The 2015 study says "The rating is due to comprehensive national policies, extensive integration of palliative care to the National Health Service, strong home care movement, and deep community involvement on the issue." The study was conducted by the Economist Intelligence Unit and commissioned by the Lien Foundation, a Singaporean philanthropic organization.
United States
Spending on them in the last twelve months accounts for 8.5% of total aggregate medical spending in the United States.
When considering only those 65 and older, estimates indicate that about 27% of Medicare's $ 327 billion ($ 88 billion) annual budget in 2006 was used to treat patients in the last year of their lives. For over 65s, between 1992 and 1996, expenditures for them in the last year of their life represented 22% of all medical expenditures, 18% of all non-Medicare spending, and 25 per cent of all Medicaid spending for the poor. This percentage seems to decline over time, as in 2008, 16.8% of all medical expenditures in the over 65s occurred to them in the last year of their lives.
Maps End-of-life care
Non-medical care and support
Family and loved ones
Often, family members are not sure what they can do when someone is dying. Many familiar and intimate day-to-day tasks, such as combing hair, putting lotions on smooth skin, and holding hands, entertaining and providing meaningful methods to communicate love to the dying.
Family members may suffer emotionally because of the impending death. Their own fear of death can affect their behavior. They may feel guilty about past events in their relationship with a dying person or feel that they have been negligent. These common emotions can lead to tension, fights between family members over decisions, worsening care, and sometimes in what medical professionals call California's Princess syndrome: long-term family members absent dive when a patient is dying to demand treatment not exactly aggressive.
Family members can also deal with unrelated issues, such as physical or mental illness, emotional and relationship problems, or legal difficulties. These problems may limit their ability to engage, be civil, help, or attend.
Spiritual care at the end of life care
Pastoral/Spiritual Care has a special meaning in end-of-life care. 'In palliative care, the responsibility for spiritual care is shared by the whole team, with leadership provided by specialist practitioners such as pastoral care workers. However, the palliative care approach to spiritual care can be transferred to other contexts and to individual practice. '
Care in the last days and hours of life
Decision making
Disintegrated, dysfunctional, or grieving families often can not make timely decisions that respect the wishes and values ​​of patients. This can lead to problems of over-treatment, inadequate care, and other problems. For example, family members may differ whether extension of life or quality of life is the primary goal of care.
Family members may also be unable to understand the inevitability of death and the risks and effects of medical and non-medical interventions. They may demand general treatment, such as antibiotics for pneumonia, or drugs to reduce high blood pressure without wondering if that person might prefer to die quickly because of pneumonia or heart attack until a protracted long-term decline in skilled care facilities. Some treatments, such as smoothed foods for someone who has difficulty swallowing or intravenous fluids for someone who is actively dead, appears harmless, but can significantly prolong the death process.
The sign that the death may be close
The National Cancer Institute of the US Government suggests that the presence of some of the following signs may indicate that death is approaching:
- Drowsy, improves sleep, and/or unresponsiveness (caused by changes in patient metabolism).
- Confusion about the time, place, and/or identity of a loved one; anxiety; visions of people and places not present; pulling sheets or clothes (partly due to changes in patient metabolism).
- Decreased socialization and withdrawal (caused by decreased oxygen to the brain, decreased blood flow, and mental preparation to die).
- Decreased food and fluid requirements, and loss of appetite (caused by the body's need to conserve energy and decreased ability to properly use food and fluids).
- Loss of bladder or bowel control (caused by muscle relaxation in the pelvic area).
- Dark urine or decreased urine levels (caused by slowing renal function and/or decreased fluid intake).
- The skin becomes cold to the touch, especially the hands and feet; the skin can become bluish in color, especially in the lower part of the body (caused by decreased circulation to the extremities).
- Sound rustling or gurgling when breathing, which may be hard (turn off toys); irregular and shallow breathing; decreased number of breaths per minute; breathing alternating between fast and slow (caused by congestion from decreased consumption of fluids, accumulation of waste products in the body, and/or decreased circulation to the organs).
- Rotate the head toward the light source (caused by decreased vision).
- Increased difficulty in controlling pain (caused by disease progression).
- Involuntary movements (called myoclonus), increased heart rate, hypertension followed by hypotension, and loss of reflexes in the legs and arms are additional signs that the end of life is imminent.
Symptom management
The following are some of the most common potential problems that can arise in the last days and hours of the patient:
- Pain
- Usually controlled using morphine or, in the UK, diamorphine or other opioids.
- Agitation
- Delirium, terminal sadness, anxiety (eg thrashing, pickling, or twitching). Usually controlled using midazolam, or other benzodiazepines. Haloperidol is also commonly used. The symptoms of the disease can also sometimes be reduced by rehydration, which can reduce the effects of some toxic drug metabolites.
- Respiratory secretions
- Saliva and other liquids can accumulate in the oropharynx and upper airways when the patient becomes too weak to clear their throat, which leads to a gurgling sound or sound ("toy death"). While it does not seem to be painful for patients, the association of symptoms of illness with impending death can create fear and uncertainty for those at the bedside. Secretion can be controlled using drugs such as scopolamine (hiosin), glycopyrronium, or atropine. Rattle can not be controlled if caused by a deeper accumulation of fluid in the bronchus or lungs, as is the case with pneumonia or some tumors.
- Nausea and vomiting
- Usually controlled using haloperidol, cyclizine; or other anti-emetic.
- Dyspnea (shortness of breath)
- Usually controlled using morphine or, in the UK, diamorphine
Special care plans, such as those based on the Liverpool Care Line for the deceased patient, pre-authorize staff to address the symptoms of the disease as soon as they are needed, without the need for time to seek further authorization. Subcutaneous injection is one of the preferred ways of giving when it becomes difficult for patients to swallow or take oral pills; and if repeated cures are required, the syringe driver (called an infusion pump in the US) is often used, to provide a low dose of the drug.
Another method of drug delivery, available for use when an oral route is compromised, is a special catheter designed to provide convenient and prudent administration of the ongoing drug through the rectal route. Catheters are developed to make rectal access more practical and provide a way to deliver and maintain fluid formulations in the distal rectum so that health practitioners can benefit from rectal administration benefits. Small flexible silicone shafts allow the device to be placed safely and remain comfortable in the rectum for repeated administration of drugs or fluids. The catheter has a small lumen, allowing a small flush volume to get the drug into the rectum. The small volume of the drug (below 15 ml) improves comfort by not stimulating the bowel response from the rectum, and may increase overall absorption of the dose administered by reducing drug collection and drug migration to a more proximal area of ​​the rectum where absorption may be performed. less effective.
Other possible disease symptoms may be mitigated to some extent, including coughing, fatigue, fever, and in some cases bleeding.
Professional medical and end-of-life care
A study was conducted by Jessica Schmit of the University of Florida in 2016 about the level of comfort possessed by medical residents with certain end-of-life care. Through this study it was found that the population received inadequate formal education at the end-of-life care and care. In the Schmit study, it was found that 61.9% of the population reported that their end-of-life conversation was "largely unattended" or "never watched," giving them little guidance on how to do better in the future. Nurses also play a very important role. role in a comfortable treatment at the end of life. The nurse can explain practically what happens to the patient after the doctor leaves. Nurses also work to advocate for patients, as they spend a lot of time with them and usually know more about their patients' wishes, symptoms, and previous medical history. Nurses, doctors, and hospital workers are essential in helping patients and families move through the process of death, as well as the sadness that follows after.
See also
- Advanced health care directives
- Midwife of Death
- Hospice
- Palliative care
- Palliative care of children
- Doctor assisted suicide
- Robert Martensen
References
External links
- The End of Life. MedlinePlus.
- EndLink - Resources for End of Life Care Education, Robert H. Lurie Comprehensive Cancer Center, Northwestern University
- End of life care, NHS Choices
- End of Life Care Strategy - promotes high-quality care for all adults at the end of life, UK Department of Health policy, Publications and guides
- Ellershaw John; Ward Chris (2003). "Treatment of dying patients: the last hours or days of life". British Medical Journal . 326 : 30-34. doi: 10.1136/bmj.326.7379.30. PMCÃ, 1124925 . PMID 12511460.
- Polly Mazanec, Julia Bartel (2002), Symptom and Management Symptoms, in Robert Kastenbaum (ed), Macmillan Encyclopedia of Death and Dying. New York: References Macmillan USA. ISBNÃ, 0-02-865689-X
- End of Life: Fact, Marie Curie Cancer Care
- End of life care in adults, Map of Medicine, updated October 29, 2010
- Final Life Decision from the Good Medicine Institute at the Pennsylvania Medical Society
- Victims A through Z: End of Life
- Before I Die: Medical Treatment and Personal Options. Produced by Thirteen/WNET, aired on the Public Broadcasting Service April 22, 1997. This program explores the medical, ethical, and social issues surrounding end-of-life care in America today.
- Palliative Care Policy Center (PCPC), formerly the Center for Palliative Care Studies. Includes RAND Health's white paper on Living Well at End of Life: Adjusting the Health Care for Serious Chronic Illness at Old Age. plus other resources.
- One Man's Quest to Change the Way We Die, the story of J.B. Miller, Zen Hospice Guest House in San Francisco
Source of the article : Wikipedia
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