Skip to main content

End-of-Life Care

  • Chapter
  • First Online:
Book cover Geriatric Psychiatry Study Guide
  • 937 Accesses

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.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 69.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 89.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Christensen K, Dobilhammer G, Rau R, Vaupel J. Ageing populations: the challenges ahead. Lancet. 2009;374:1196–208.

    Article  PubMed Central  PubMed  Google Scholar 

  2. 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.

    Article  PubMed  Google Scholar 

  3. 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.

    Google Scholar 

  4. 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.

  5. 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.

    Article  PubMed  Google Scholar 

  6. Singer PA, Martin DK, Kelner M. Quality end-of-life care: patients’ perspectives. JAMA. 1999;281:163–8.

    Article  CAS  PubMed  Google Scholar 

  7. Drazen JM, Desai NR, Green P. Fighting on. N Engl J Med. 2009;360:444–5.

    Article  CAS  PubMed  Google Scholar 

  8. Singer PA, Robertson G, Roy DJ. Bioethics for clinicians: advance care planning. CMAJ. 1996;155:1689–92.

    PubMed Central  CAS  PubMed  Google Scholar 

  9. 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.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  10. 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.

    Article  CAS  PubMed  Google Scholar 

  11. 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.

    Article  PubMed Central  PubMed  Google Scholar 

  12. 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.

    Article  PubMed Central  PubMed  Google Scholar 

  13. 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.

    Article  Google Scholar 

  14. Cartwright CM, Parker MH. Advance care planning and end of life decision making. Aust Fam Physician. 2004;33:815–9.

    PubMed  Google Scholar 

  15. British Medical Association. End-of-life decisions. BMA. 2007. www.bma.org.uk

  16. 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.

    Article  CAS  PubMed  Google Scholar 

  17. Gillick MR. Advance care planning. N Engl J Med. 2004;350:7–8.

    Article  CAS  PubMed  Google Scholar 

  18. 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.

    Article  Google Scholar 

  19. 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.

    Article  PubMed Central  PubMed  Google Scholar 

  20. 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.

    Article  PubMed  Google Scholar 

  21. 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.

  22. 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.

  23. VITAS Health Care organization. Available at: http://www.vitas.com/resources/palliative-care/palliative-care-vs-hospice-care. Accessed 27 Nov 2017.

  24. American Board of Hospice and Palliative Medicine. www.abhpm.org. Accessed 27 Nov 2017.

  25. Periyakoil VS, Hallenbeck J. Identifying and managing preparatory grief and depression at the end of life. Am Fam Physician. 2002;65(5):883–90.

    PubMed  Google Scholar 

  26. American Psychiatric Assocation. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Association; 2013. p. 789–90.

    Book  Google Scholar 

  27. Strada EA. Grief, demoralization and depression: diagnostic challenges and treatment modalities. Prim Psych. 2009;16(5):49–55.

    Google Scholar 

  28. Kissane D. Demoralization: a life-preserving diagnosis to make for the severely medically ill. J Palliat Care. 2014;30(4):251–4.

    Google Scholar 

  29. Block SD. Assessing and managing depression in the terminally ill patient. Ann Intern Med. 2000;132(3):209–18.

    Article  CAS  PubMed  Google Scholar 

  30. 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.

    Article  Google Scholar 

  31. Block SD. Psychological issues in end-of-life care. J Palliat Med. 2006;9(3):751–72.

    Article  PubMed  Google Scholar 

  32. 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.

    Google Scholar 

  33. 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.

  34. 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.

    Article  Google Scholar 

  35. 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.

    Article  CAS  PubMed  Google Scholar 

  36. 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.

    Article  CAS  PubMed  Google Scholar 

  37. Sykes N, Thorns A. The use of opioids and sedatives at the end of life. Lancet Oncol. 2003;4(5):312–8.

    Article  PubMed  Google Scholar 

  38. 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.

    Article  PubMed  Google Scholar 

  39. 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.

    Article  CAS  PubMed  Google Scholar 

  40. 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.

    Article  CAS  PubMed  Google Scholar 

  41. 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.

    Article  CAS  PubMed  Google Scholar 

  42. 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.

    Article  Google Scholar 

  43. 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.

    CAS  PubMed  Google Scholar 

  44. 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.

    Article  Google Scholar 

  45. 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.

    Article  CAS  PubMed  Google Scholar 

  46. 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.

    Article  Google Scholar 

  47. 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.

    Article  PubMed  Google Scholar 

  48. 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.

    Article  PubMed  Google Scholar 

  49. 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.

    Google Scholar 

  50. 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.

    Article  Google Scholar 

  51. Lamont EB, Christakis NA. Prognostic disclosure to patients with cancer near the end of life. Ann Intern Med. 2001;134(12):1096–105.

    Article  CAS  PubMed  Google Scholar 

  52. 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.

    Article  PubMed Central  PubMed  Google Scholar 

  53. 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.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  54. Moyer DD. Terminal delirium in geriatric patients with cancer at the end of life. Am J Hosp Palliat Med. 2011;28(1):44–51.

    Article  Google Scholar 

  55. Mitchell SL, Teno JM, Jiely DK, et al. The clinical course of advanced dementia. N Engl J Med. 2009;361(16):1529–38.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  56. 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.

    Article  PubMed Central  PubMed  Google Scholar 

  57. 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.

    PubMed Central  PubMed  Google Scholar 

  58. 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.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

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

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-77128-1_18

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-77127-4

  • Online ISBN: 978-3-319-77128-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics