Abstract
This summary provides clinicians with information about anticipating the end of life (EOL); the common symptoms patients experience as life ends, including in the final hours to days; and treatment or care considerations. Psychiatrists can help patients to navigate emotionally charged issues associated with EOL care, as well as to facilitate discussions among patients and other clinicians. As patients cope with progressively debilitating chronic illnesses, psychiatrists will be increasingly involved in diagnosing and treating common syndromes associated with the EOL such as delirium, anxiety disorders, and depressive disorders. They will also be consulted on difficult cases as patients, family members, and clinical staff struggle with other issues beyond psychiatric illness, per se.
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References
Christensen K, Dobilhammer G, Rau R, Vaupel J. Ageing populations: the challenges ahead. Lancet. 2009;374:1196–208.
Zhao J, Barclay S, Farquhar M, Kinmonth AL, Brayne C, Fleming J, et al. The “oldest old” in the last year of life: population-based findings from CC75C study participants aged at least 85 at death. J Am Geriatr Soc. 2010;58(1):1–11.
NIH Concesus Development Program, Office of Disease Prevention. National Institutes of Health State-of-the-Science Conference Statement on Improving End-of-Life Care December 6–8, 2004.
General Medical Council. End of life care: Guidance. https://www.gmc-uk.org/guidance/ethical_guidance/end_of_life_guidance.asp. Accessed 25 Nov 2017.
Winzelberg GS, Hanson LC, Tulsky JA. Beyond autonomy: diversifying end-of-life decision-making approaches to serve patients and families. J Am Geriatr Soc. 2005;53:1046–50.
Singer PA, Martin DK, Kelner M. Quality end-of-life care: patients’ perspectives. JAMA. 1999;281:163–8.
Drazen JM, Desai NR, Green P. Fighting on. N Engl J Med. 2009;360:444–5.
Singer PA, Robertson G, Roy DJ. Bioethics for clinicians: advance care planning. CMAJ. 1996;155:1689–92.
Wright AA, Zhang B, Ray A, et al. Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment. JAMA. 2008;300(14):1665–73.
Steinhauser KE, Clipp EC, McNeilly M, Christakis NA, McIntyre LM, Tulsky JA. In search of a good death: observations of patients, families and provides. Ann Intern Med. 2000;132:825–32.
Meier EA, Gallegos JV, Montross-Thomas LP, Depp CA, Irwin SA, Jeste DV. Defining a good death (successful dying): literature review and a call for research and public dialogue. Am J Geriatr Psychiatry. 2016;24(4):261–71.
Mack JW, Cronin A, Keating NL, et al. Associations between end-of-life discussion characteristics and care received near death: a prospective cohort study. J Clin Oncol. 2012;30(35):4387–95.
Brinkman-Stopllelenburg A, Rietjens JA, van der Heide A. The effects of advance care planning on end-of-life care: a systematic review. Palliat Med. 2014;28(8):1000–25.
Cartwright CM, Parker MH. Advance care planning and end of life decision making. Aust Fam Physician. 2004;33:815–9.
British Medical Association. End-of-life decisions. BMA. 2007. www.bma.org.uk
Emanuel LL, Barry MJ, Stoeckle JD, Ettelson LM, Emanuel EJ. Advance directives for medical care: a case for greater use. N Engl J Med. 1991;324:889–95.
Gillick MR. Advance care planning. N Engl J Med. 2004;350:7–8.
Detering KM, Hancock AD, Reade MC, Silvester W. The impact of advance care planning on end of life care in elderly patients: randomized controlled trial. BMJ. 2010;340:1–9.
Mignani V, Ingravallo F, Mariani E, Chattat R. Perspectives of older people living in long-term care facilities and their family members toward advance care planning discussions: a systematic review and thematic synthesis. Clin Interv Aging. 2017;12:475–84.
Senel G, Uysal N, Oguz G, et al. Delirium frequency and risk factors among patients with cancer in palliative care unit. Am J Hosp Palliat Care. 2017;34(3):282–6.
National Institutes of Health, National Institute on Aging. https://www.nia.nih.gov/health/what-are-palliative-care-and-hospice-care. Accessed 27 Nov 2017.
Krau SD The differences between palliative care and end of life care: more than semantics. Nursing Clin North Am. 2016;51(3):ix–x, doi: 101016/jcnur201607.002.
VITAS Health Care organization. Available at: http://www.vitas.com/resources/palliative-care/palliative-care-vs-hospice-care. Accessed 27 Nov 2017.
American Board of Hospice and Palliative Medicine. www.abhpm.org. Accessed 27 Nov 2017.
Periyakoil VS, Hallenbeck J. Identifying and managing preparatory grief and depression at the end of life. Am Fam Physician. 2002;65(5):883–90.
American Psychiatric Assocation. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Association; 2013. p. 789–90.
Strada EA. Grief, demoralization and depression: diagnostic challenges and treatment modalities. Prim Psych. 2009;16(5):49–55.
Kissane D. Demoralization: a life-preserving diagnosis to make for the severely medically ill. J Palliat Care. 2014;30(4):251–4.
Block SD. Assessing and managing depression in the terminally ill patient. Ann Intern Med. 2000;132(3):209–18.
Raynor L, Price A, Evans A, et al. Antidepressants for the treatment of depression in palliative care: systematic review and meta-analysis. Palliat Med. 2011;25(1):36–51.
Block SD. Psychological issues in end-of-life care. J Palliat Med. 2006;9(3):751–72.
Leung MW, Kaplan L, Bourgeois JA. Palliative care for geriatric psychiatric patients with life-limiting illness. In: Hategan A, Bourgeois JA, Hirsch CH, Giroux C, editors. Geriatric psychiatry: a case-based textbook. Berlin: Springer International Publishing. 2018, p. 671–690.
PDQ® Supportive and Palliative Care Editorial Board. PDQ Last Days of Life. Bethesda, MD: National Cancer Institute. Available at: https://www.cancer.gov/about-cancer/advanced-cancer/caregivers/planning/last-days-hp-pdq. Accessed 27 Nov 2017. [PMID: 26389307]. September 11, 2017.
Toscani F, Di Giulio P, Brunelli C, et al. How people die in hospital general wards: a descriptive study. J Pain Symptom Manag. 2005;30(1):33–40.
Thorns A, Sykes N. Opioid use in last week of life and implications for end-of-life decision-making. Lancet. 2000;356(9227):398–9.
Bercovitch M, Waller A, Adunsky A. High dose morphine use in the hospice setting. A database survey of patient characteristics and effect on life expectancy. Cancer. 1999;86(5):871–7.
Sykes N, Thorns A. The use of opioids and sedatives at the end of life. Lancet Oncol. 2003;4(5):312–8.
Bercovitch M, Adunsky A. Patterns of high-dose morphine use in a home-care hospice service: should we be afraid of it? Cancer. 2004;101(6):1473–7.
Kelly KG, Zisselman M, Cutillo-Schmitter T, et al. Severity and course of delirium in medically hospitalized nursing facility residents. Am J Geriatr Psychiatry. 2001;9(1):72–7.
Lawlor PG, Fainsinger RL, Bruera ED. Delirium at the end of life: critical issues in clinical practice and research. JAMA. 2000;284(19):2427–9.
Leonard M, Raju B, Conroy M, Donnelly S, et al. Reversibility of delirium in terminally ill patients and predictors of mortality. Palliat Med. 2008;22(7):848–54.
Solano JP, Gomes B, Higginson IJ. A comparison of symptom prevalence in far advanced cancer, AIDS, heart disease, chronic obstructive pulmonary disease and renal disease. J Pain Symptom Manag. 2006;31(1):58–69.
Ventafridda V, Ripamonti C, De Conno F, et al. Symptom prevalence and control during cancer patients’ last days of life. J Palliat Care. 1990;6(3):7–11.
Fainsinger RL, Waller A, Bercovici M, et al. A multicentre international study of sedation for uncontrolled symptoms in terminally ill patients. Palliat Med. 2000;4(4):257–65.
Lo B, Rubenfeld G. Palliative sedation in dying patients: “we turn to it when everything else hasn’t worked.”. JAMA. 2005;294(14):1810–6.
Morita T, Chinone Y, Ikenaga M, et al. Efficacy and safety of palliative sedation therapy: a multicenter, prospective, observational study conducted on specialized palliative care units in Japan. J Pain Symptom Manag. 2005;30(4):320–8.
Sykes N, Thorns A. Sedative use in the last week of life and the implications for end-of-life decision making. Arch Intern Med. 2003;163(3):341–4.
Vitetta L, Kenner D, Sali A. Sedation and analgesia-prescribing patterns in terminally ill patients at the end of life. Am J Hosp Palliat Care. 2005;22(6):465–73.
Kinzbrunner BM, Maluso-Bolton T, Schlecter B. Neurological symptoms at the end-of-life. In: Kinzbrunner BM, Policzer JS, editors. End-of-life care: a practical guide. 2nd ed. New York: McGraw Hill; 2011. p. 243–58.
Dong ST, Butow PN, Costa DS, et al. Symptom clusters in patients with advanced cancer: a systematic review of observational studies. J Pain Symptom Manag. 2014;48(3):411–50.
Lamont EB, Christakis NA. Prognostic disclosure to patients with cancer near the end of life. Ann Intern Med. 2001;134(12):1096–105.
Hui D, Kilgore K, Nguyen L, et al. The accuracy of probabilistic versus temporal clinician prediction of survival for patients with advanced cancer: a preliminary report. Oncologist. 2011;16(11):1642–8.
Hui D, dos Santos R, Chisholm G, et al. Bedside clinical signs associated with impending death in patients with advanced cancer: preliminary findings of a prospective, longitudinal cohort study. Cancer. 2015;121:960–7.
Moyer DD. Terminal delirium in geriatric patients with cancer at the end of life. Am J Hosp Palliat Med. 2011;28(1):44–51.
Mitchell SL, Teno JM, Jiely DK, et al. The clinical course of advanced dementia. N Engl J Med. 2009;361(16):1529–38.
Dufour AB, Shaffer ML, D’Agata EM, et al. Survival after suspected urinary tract infection in individuals with advanced dementia. J Am Geriatr Soc. 2015;63(12):2472–7.
Givens JL, Jones RN, Shaffer ML, et al. Survival and comfort after treatment of pneumonia in advanced dementia. Arch Intern Med. 2010;170(3):1102–7.
American Geriatrics Society Ethics Committee and Clinical Practice and Models of Care Committee. American Geriatrics Society feeding tubes in advanced dementia position statement. J Am Geriatr Soc. 2014;62(8):1590–3.
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Hategan, A., Bourgeois, J.A., Cheng, T., Young, J. (2018). End-of-Life Care. In: Geriatric Psychiatry Study Guide. Springer, Cham. https://doi.org/10.1007/978-3-319-77128-1_18
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DOI: https://doi.org/10.1007/978-3-319-77128-1_18
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