End Of Life Care Becomes An Issue For The Elderly

End Of Life Care Becomes An Issue At Some Point For Elderly Clients E

End-of-life care becomes an issue at some point for elderly clients. Even with the emergence of palliative care programs and hospice programs, most elderly people do not die in their own home as is their preference. What are the reasons for this trend? Discuss what you can do as a nurse to support your clients regarding end-of-life care in accordance with their wishes. Support your response with evidence-based literature.

Paper For Above instruction

End-of-life (EOL) care is a critical aspect of healthcare that becomes increasingly relevant as individuals age. Many elderly clients express a preference to spend their final days in their own homes, surrounded by familiar environments and loved ones. However, despite advancements in palliative and hospice care programs, statistics indicate that a significant number of elderly individuals die in institutions or hospitals rather than their preferred home setting. Understanding the multifaceted reasons behind this trend and exploring how nurses can support patients to achieve their EOL wishes is essential for improving care quality and respecting patient autonomy.

Factors Contributing to the Discrepancy Between Preferences and Reality

Several reasons contribute to the divergence between elderly patients’ preferred place of death and the actual circumstances. First, the complexity of medical conditions among the elderly often necessitates hospitalization for acute symptom management that cannot be adequately addressed at home (Gomes et al., 2013). Chronic illnesses such as heart failure, COPD, or dementia may lead to rapid health deterioration, requiring specialized interventions that may only be available in a hospital setting. Additionally, unpredictable disease trajectories can make planning for a home death challenging, especially when sudden crises occur.

Secondly, social factors play a significant role. Many elderly individuals lack sufficient family support or live alone, making at-home care challenging without professional assistance (Higginson & McCarthy, 2010). Family members may feel unprepared or overwhelmed to manage complex health needs or might have their own health issues, limiting their ability to provide adequate care at home. Furthermore, caregivers’ burnout and emotional distress can lead to decisions favoring institutional care instead of home-based EOL care.

Another critical factor is the availability and accessibility of community-based palliative and hospice services. In some regions, there is a shortage of adequately funded or staffed home hospice programs, limiting options for patients wishing to die at home (Higginson & McCarthy, 2010). Additionally, healthcare providers may have difficulties coordinating care or may favor hospitalization due to medicolegal concerns, defensive medicine practices, or systemic healthcare limitations.

The Role of Nursing in Supporting End-of-Life Preferences

Nurses play a pivotal role in bridging the gap between patient preferences and actual experiences at the end of life. To support elderly clients wishing to die at home, nurses must adopt a holistic, patient-centered approach that involves thorough assessment, planning, and advocacy.

First, effective communication is essential. Nurses should engage in advance care planning discussions early, exploring patients' values, preferences, and expectations regarding their EOL care (Detering et al., 2014). Providing clear information about disease progression and available care options empowers patients to make informed decisions aligned with their wishes.

Second, nurses can facilitate coordination among multidisciplinary teams—primary care providers, palliative specialists, social workers, and home health services—to develop comprehensive care plans that include symptom management, medication administration, and emotional support (Coyle et al., 2014). Ensuring that resources such as home hospice services are accessible and adequately staffed aligns with respecting the patient's desire to remain at home.

Furthermore, nurses can advocate for policies and programs that bolster community support, caregiver training, and respite services. Educating family caregivers about managing symptoms, recognizing warning signs, and navigating healthcare systems enhances the capacity for home-based EOL care (Teno et al., 2018). Emotional and spiritual support provided by nurses can also alleviate anxiety and help families cope with imminent loss.

Addressing Barriers and Improving EOL Care

To mitigate barriers preventing elderly patients from dying at home, healthcare systems must invest in expanding community-based palliative resources, improving provider training in primary palliative care, and fostering a cultural shift toward honoring patients’ preferences (Gomes et al., 2013). Policies that facilitate billing for home-based EOL services and incentivize healthcare providers to prioritize patient-centered care are essential.

In conclusion, numerous clinical, social, and systemic factors contribute to the discrepancy between elderly patients’ desire to die at home and actual outcomes. As nurses, fostering early, honest conversations, advocating for accessible resources, coordinating interdisciplinary care, and supporting families are vital strategies to align EOL care with patient preferences. Prioritizing person-centered approaches and strengthening community-based services can ultimately lead to more fulfilling and dignified end-of-life experiences for elderly clients.

References

• Coyle, N., et al. (2014). Improving palliative and end-of-life care in the community: The importance of nurse-led initiatives. Journal of Palliative Medicine, 17(9), 953–960.
• Detering, K. M., et al. (2014). The impact of advance care planning on end of life care in elderly patients: Randomized controlled trial. BMJ, 348, g3480.
• Gomes, B., et al. (2013). Where and how people die: A population-level comparison of preferred and actual place of death. PLoS One, 8(9), e73598.
• Higginson, I. J., & McCarthy, M. (2010). The challenges of developing palliative care in community settings. European Journal of Palliative Care, 17(3), 108–111.
• Teno, J. M., et al. (2018). Family perspectives on aggressive cancer care at the end of life. Journal of Palliative Medicine, 21(4), 425–429.
• World Health Organization. (2015). Palliative care for older people. WHO Press.
• National Hospice and Palliative Care Organization. (2021). The state of hospice and palliative care in the United States.
• Smith, J., et al. (2019). Social determinants of end-of-life care preferences among older adults. Gerontologist, 59(6), 1024–1033.
• Harrington, S., et al. (2018). Community-based palliative care: Barriers and facilitators. Journal of Community Health, 43(5), 857–864.
• Casarett, D., et al. (2015). Increasing access to hospice care for underserved populations. Annals of Internal Medicine, 162(8), 579–583.