February 21st, 2013 at 10:00 am
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Respecting elders’ wishes to die at home

by Dorian Martin

Many people say they want to die at home. Furthermore, some elders who face critical health issues such as cancer or heart disease do not want any extra medical interventions to prolong their lives. Instead, they want to focus on the quality, instead of the quantity, of their remaining days. So are these wishes coming true?

Research confirms that more elders in the United States are dying at home. However, more elders are being admitted to the hospital repeatedly during the last months of their lives, and almost one-third spend time in an intensive care unit during the last month they are alive.

Greater number of cancer patients with at-home deaths

A study led by Joan Teno of Brown Medical School reviewed data for more than 800,000 individuals with these characteristics:

  1. Fee-for-service Medicare beneficiaries
  2. Minimum age of 66 years (although actual average age was calculated as 82)
  3. Diagnosed with cancer, chronic obstructive pulmonary disease (COPD) or dementia
  4. Deceased during one of three specific years: 2000, 2005 or 2009

The Brown University researchers found changes from 2000 to 2009:

  • Fewer deaths in acute care hospitals (decline from 33 percent to 25 percent)
  • More deaths at home (rising from approximately 30 percent to 33 percent)

However, there was a marked difference in the specific health condition of those who were able to die at home. Out of the seniors studied, 43 percent of those with cancer died at home in 2009, compared to 28 percent who had COPD and 23 percent of elders who had dementia.

Timing of hospice care

The Brown study also found that elders increasingly are using hospice care — from 22 percent in 2000 up to 42 percent in 2009. Approximately 60 percent of elders with cancer and 48 percent of elders with dementia were in hospice care when they died.

However, many of these elders moved to hospice care right before they died, following hospital stays. The researchers found that short stays in hospice — only three days or less — increased from 22 percent in 2000 to 28 percent in 2009. Of those elders who received these short hospice referrals, 40 percent had been in an intensive care unit immediately before entering hospice. The study pointed out that health care transitions in the last three days of life could be burdensome.

I’ve written before on the importance of educating seniors about their options, for examples, with videos about end-of-life care choices. In another blog post, I talked about the potential of palliative care to enhance the quality of life for patients with conditions such as Alzheimer’s disease and COPD.

Start the conversation now

A 2012 WBUR interview, Talking About How You Want To Die Before It’s Too Late, reports that about 70 percent of Americans wish to die at home. However, 56 percent of individuals have not told others about their end-of-life wishes, according to The Conversation Project, which encourages communication on this subject.

The Brown Medical School study underscores why family members and caregivers need to clarify with elders and their doctors what the elder wants in the final months of life. This conversation should happen well before there is a health crisis and preferably before the elder is in the final stage of life. Be sure to cover where the elder would like to die, what types of life-extending measures he or she wishes, and where the completed legal paperwork — such as the durable power of attorney for health care choices — is located.

Death is a given for everyone. However hard it may be, it’s really important for family members, caregivers and medical personnel to hear, respect and follow an elder’s wishes about how and where he or she dies.

Posted in Caregiving, Death | 1 Comment »
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One Response to “Respecting elders’ wishes to die at home”

  1. Terri Benincasa

    Having just lost my mother (lost Daddy in 2009), a thought on how Boomers handle the loss of our parents vs. how our parents handled that loss….

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