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At peace : choosing a good death after a long life
\"The authoritative, informative, and practical follow up to BEING MORTAL, on end-of-life care for patients over the age of 65. Most people say they would like to die quietly at home. But overly aggressive medical advice, coupled with an unrealistic sense of invincibility, results in the majority of elderly patients misguidedly dying in institutions while undergoing painful procedures, instead of having the better and more peaceful death they desired. At Peace outlines specific active and passive steps that older patients and their health care proxies can take to insure loved ones pass their last days comfortably at home and/or in hospice, when further aggressive care is inappropriate. Through Dr. Harrington's own experience with his parents and patients, he describes the terminal patterns of the six most common chronic diseases; how to recognize a terminal diagnosis even when the doctor is not clear about it; how to have the hard conversation about end-of-life wishes; how to minimize painful treatments; when to seek hospice care; and how to deal with dementia and other special issues. Informed by more than thirty years of clinical practice, Dr. Harrington came to understand that the American health care system wasn't designed to treat the aging population with care and compassion. His work as a hospice trustee and later as a hospital trustee informed his passion for helping patients make appropriate end-of-life decisions\"-- Provided by publisher.
Book
Finishing our story : preparing for the end of life
\"Death is the destiny we all share, and this will not change. Yet the way we die, which had remained the same for many generations, has changed drastically in a relatively short time for those in developed countries with access to healthcare. For generations, if people were lucky enough to reach old age, not having died in infancy or childhood, in childbirth, in war, or by accident, they would take to bed, surrounded by loved ones who cared for them, and fade into death. Most likely, they would have seen their parents and grandparents die the same way, and so this manner of dying would be familiar: it was part of the natural cycle of life. Now less than 25 per cent of Americans die at home, having reached much older ages than people would have dreamed of in past generations, often after surviving many illnesses and even diseases that would have been terminal for their grandparents. We are fortunate to live (and die) today, supported by myriad scientific, medical, and technological advancements, however we also face new problems as a result of the new way in which we die. We can no longer anticipate a peaceful waning at home with family. We know our lives will likely end in hospitals likely after we have endured grueling treatments to prolong life. We have to decide what decisions we want our loved ones, or care-givers, to make when we cannot choose for ourselves. We have to think about whether in any circumstances we would seek physician-assisted death. We know we face other questions as well, but we may not even know where to start. In the face of these decisions, we can feel daunted and afraid. The best remedy is information and planning. In this book, Gregory Eastwood - a physician who has cared for dying patients, served as an ethics consultant, and taught end of life issues to medical and other health profession students - draws from his substantial experience with patients and families to provide the information that will help us think clearly about the choices and issues we will face at the end of our own lives, and when faced with the deaths of our loved ones. With sensitivity and profound insight, Eastwood guides us through all the important questions about death and dying in straightforward, clear language, enhanced by real-life stories. Throughout, he shows us how we can take ownership of the way we want to die, when we must die, and feel more in control as death approaches. \"-- Provided by publisher.
Book
UTILIZING VALID, RELIABLE, AND PRACTICAL MEASURES OF HEALTH STATUS IN PRIMARY GERIATRIC CARE: TRANSLATING RESEARCH INTO USUAL CARE WITH THE SENIOR’S HEALTH ASSESSMENT REPORT AND PLAN (SHARP™)
Abstract
Introduction
To better support evidenced-based care, we combined 9 valid, reliable, and clinically useful tests into a single health status and risk assessment tool, performed by a Team nurse, called the Seniors Health Assessment, Report and Plan (SHARP™). These tests include: CFS, EQ5D-5L, EQ-VAS, MoCA, GDS, Months of the Year Backwards, Gait Speed, Grip Strength, Water Swallow Test, and MNA-6. A published study, with 18 months of follow-up for a primary geriatric home-based practice demonstrated that these tests were stronger predictors of death, nursing home transfer (NHT), or hospital admission(HA) compared to any medical diagnosis, multiple comorbidities, or polypharmacy. Hazard Ratios for SHARP™ vs medical diagnoses were: Death (median HR 5.9 vs. 1.6), NHT (median HR 4.6 vs.1.4), and HA (median HR 6.0 vs. 1.6). The research presented here will provide several case-based studies to demonstrate how we have translated this research into “usual care” for a primary home-based interdisciplinary geriatric medical practice. Specifically, we will demonstrate how we: 1. share this data with patients and caregivers to motivate them for Team interventions, 2. share a summary report of an individual’s health with the hospital and other community care providers, 3. use these tests to guide and evaluate Team interventions for individual patients (e.g. changes in gait speed), 4. Track changes in health status and risk, and 5. use aggregated data at a program level for benchmarking, defining population needs, and for planning and evaluation.
Conclusions
Standardized testing is acceptable to patients, efficient, supports evidenced-based care, and is useful for program planning and evaluation.
Journal Article