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End of Life Care

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Ann Nolcher is an old woman aged 84 years who represent typical type of women who is sick of lung cancer. She believes that death is her only solution for her disease.  She is against invasive treatment when doctor suggests one. Finally she decides to be treated after a long discussion with her three children who are closely related to her. Her children live out of the state. Her husband had died some years back. She lived independently despite of her problems. She has problem with her eyes. There is wet muscular degeneration in the left eye with the sign of the same spreading on to the right eye. She experiences difficulty in swallowing, eating, and felt wearily and weak. She has been hospitalized in order to drain pleural effusion. She believes that computed tomography scans are just but short-term solution. She does not object dying of cancer but she is worried of living as a blind woman.

There are various misconceptions revolving around end of care which covers about deaths, dying and comfort of life.  She holds into a misconception that dying  when old is preferable than dying when young since she quotes that she is 84 years and she has excelled in life. She says that it would be different if she would be expecting to die while she is aged fifty or sixty years. She seems to see that death is the only result of disease or an illness. She is one out of many old people who believe this way which in most cases it is not true since death can occur at any age either to sick people or to healthy one.

Most deaths occur in hospitals. This is another misconception that many old people believe in. Statistics may have shown that 25% of deaths occur at home, 50% at hospital, and 20-25 occurs at nursing homes but this will entirely depends on how many deaths occurring at home are actually reported. A person born in 2000 is expected to have a long life span where by he/she is expected to survive for the next seventy seven years compared to a person born in 1919, who is expected to live for about 45 years. In the case of a person born in year 2000, many illnesses, that were quickly and inexorably fatal now follows a different course with alternating periods of exacerbation and remission.

In the event of improving nursing home care, it should be noted that the elderly are less damaged by cumulative loss. Cumulative losses compounds the effects of grief’s and the bereavement associated with the deaths. It has been shown that the elderly after losing many relatives who includes even their spouses are less likely to be affected by the loss of their loved ones at old age. Older people do not feel much pain but nurses have seen that that pain and discomfort are unavoidable aspects of aging. 

In the end of life wise decisions need to be made. Planning is essential if preferences for end-of-life care are to be honored, but Drought and Koenig point out that there is no clear evidence as to which approaches facilitates decision making. They note that what appears to be collaboration in the making of such decisions is often false: the ill patient tends to defer to physicians, and physicians try to spare the patient difficult decisions. Moreover, patients may feel differently about choices made in advance once they are dying. The results of several studies confirm that providers, particularly nurses, are vital to helping patients and families make end-of-life decisions. The support trial demonstrated that nurses often were the first to recognize that a patient was approaching death. Patients often expressed to them their concerns about decision making (do-not-resuscitate orders, for example). Yet physicians often did not know their patients’ preferences; only 46% of them in the SUPPORT trial knew when their patients preferred to forgo cardiopulmonary resuscitation.

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