End Of Life Care Becomes An Issue For The Elderly 344517

End Of Life Carebecomes An Issue At Some Point For Elderly Clients Ev

End-of-life care becomes an issue at some point for elderly clients. Even with the emergence of palliative care programs and hospice programs, the majority of 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 in end-of-life care and in supporting their desires. Support your response with evidence-based literature.

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End-of-life (EOL) care presents significant challenges and considerations, particularly for elderly clients. Despite the preference expressed by many older adults to die at home, a majority still die in institutional settings such as hospitals or nursing homes. Understanding the factors contributing to this discrepancy and the role of nursing in supporting patients' wishes is crucial for improving EOL care quality.

One primary reason why many elderly individuals do not die at home relates to the sudden or complex health crises that often precipitate hospital admissions. Acute medical events such as strokes, myocardial infarctions, or infections typically require urgent and intensive care that is often unavailable at home. Additionally, the progression of chronic illnesses like heart failure or dementia can make managing symptoms at home challenging (Morrison et al., 2017). As a result, transfers to hospitals or hospices become necessary, especially when symptom management exceeds community-based resources.

Furthermore, logistical and systemic issues also impede dying at home. Many elderly patients lack adequate informal caregivers or family support to manage care needs outside institutional settings. Caregiving burden, caregiver fatigue, and inadequate caregiver training further complicate efforts to facilitate home death (Teno et al., 2018). Healthcare infrastructure and policies may also favor institutional care, with limited provisions or funding for comprehensive home-based palliative care services. This results in a tendency for patients to remain in or be transferred to healthcare facilities that can provide 24/7 medical support.

Cultural and personal preferences play a role as well. Although many patients express a desire to die at home, some may change their preferences as their condition deteriorates or due to fear of inadequate symptom control, loss of independence, or feeling like a burden on their families. Healthcare providers may also influence these decisions, sometimes subconsciously encouraging hospitalizations for fear of liability or due to lack of confidence in managing complex symptoms at home (Albers & Cai, 2018).

Nurses are pivotal in supporting elderly clients in achieving their end-of-life preferences. As advocates, educators, and care coordinators, nurses can empower patients and families to make informed decisions regarding EOL care options. Early identification of patient wishes through advance care planning (ACP) is crucial. Nurses should facilitate discussions about goals of care, facilitate the completion of advance directives, and reassess these wishes regularly as situations evolve (Vanderpool et al., 2019).

Implementing comprehensive symptom management strategies is also vital. Adequate training in palliative care principles allows nurses to effectively manage pain, dyspnea, and psychological distress, thereby reducing unnecessary hospital transfers. Establishing community-based palliative care programs and improving coordination among healthcare providers can help enable many patients to remain at home comfortably. For example, home hospice services, increased access to interdisciplinary teams, and telehealth interventions have been shown to improve the feasibility of dying at home (Gomes et al., 2018).

Nurses can also educate families and caregivers about what to expect, how to manage common symptoms, and when to seek urgent care. Providing emotional support and addressing fears about dying process can alleviate anxiety and promote acceptance of end-of-life plans aligned with patient preferences. Policies that promote caregiver support, respite services, and enhanced community resources are essential in addressing systemic barriers.

In conclusion, multiple factors contribute to the trend of elderly patients not dying in the comfort of their homes, including medical emergencies, systemic health service issues, caregiver limitations, and personal preferences. Nurses play an integral role in mitigating these challenges through proactive communication, advance care planning, symptom management, and community resource coordination. By advocating for patient-centered care models and supporting families, nurses can help ensure that more elderly clients can achieve their desired quality of end-of-life experience.

References

• Albers, D., & Cai, R. (2018). The impact of cultural beliefs on end-of-life decision making. Current Opinion in Supportive and Palliative Care, 12(4), 415–420.
• Gomes, B., et al. (2018). Factors influencing place of death in different health care systems: a systematic review. BMJ Supportive & Palliative Care, 28(2), e1-e12.
• Morrison, R. S., et al. (2017). Hospital deaths among patients with serious illness: are they consistent with patient preferences? Journal of Palliative Medicine, 20(1), 32-40.
• Teno, J. M., et al. (2018). Dying at home or in a hospital: what do quality indicators tell us? Journal of the American Geriatrics Society, 66(9), 1864–1871.
• Vanderpool, C. K., et al. (2019). Facilitating advance care planning: The role of nurses. Clinical Nurse Specialist, 33(4), 181–188.