End of Life Care

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As the number of geriatric patients increases due to improved medical science, the number of patients near the end of life at any given time also increases. Statistics indicate that around two-thirds of elderly decedents receive their final care in some kind of hospital or nursing home, not at home (Teno et al., 2004).  Part of the reason for the high number of institutional deaths is that there is an inadequate population of healthcare professionals to provide personal care to every elderly patient.  Not all elderly patients are able to afford hospice care, either, as there are numerous hospice organizations with hefty price tags.  A less obvious possibility, however, is that patients in institutions might more often benefit from physician-assisted suicide, rather than go home to die slowly and painfully (Meier, Morrison, & Cassel, 1997).  A patient that is ready to simply die is probably less likely to invest the money and effort in getting hospice care if there is a faster, less drawn out option.  While physician-assisted suicide is a morally ambiguous and much-debated subject, the reality of it exists and affects the statistics for patient deaths.

For those patients who are not seeking to simply end the pain quickly, existing palliative care is not sufficient to meet the needs of elderly patients in their last days.  Studies show that family members interviewed after the passing of an elderly relative were largely concerned or even dissatisfied with the quality of care their family member received.  Just under a quarter of interviewed family members believed the related patient did not receive appropriate care for pain and over fifty percent believed that inadequate emotional support was provided (Teno et al., 2004).  While the opinion of the patient would obviously be more relevant than that of the family, it has to be acknowledged that the sample group of decedent patients willing to respond to surveys is limited so this data must be considered.  Medical professionals acknowledge their lack of palliative care proficiency, though (Meier et al., 1997).  The general consensus is that greater focus on physical and emotional care for terminal patients should be made in training and that specialized training should exist for healthcare professionals that are likely to provide palliative or hospice care.


Meier, D. E., Morrison, S. R., & Cassel, C. (1997). Improving palliative care. Annals of Internal Medicine, 127(3), 225-230. Retrieved from http://jama.jamanetwork.com/article.aspx?articleid=197944#qundefined 

Teno, J. M., Clarridge, B. R., Casey, V., Welch, L. C., Wetle, T., Shield, R., … Mor, V. (2004). Family perspectives on end-of-life care at the last place of care. The Journal of the American Medical Association, 291(1), 88-93. Retrieved from http://jama.jamanetwork.com/article.aspx?articleid=197944#qundefined