Saturday, May 29, 2010
Predicting Death of the Terminally Ill: End-of-Life Care (Research and Video 2:55 mins.)
Consider that almost half of the people over 85 years old die annually in nursing homes across America. Even when they don’t share what they think, family members, friends, and the nursing home staff often develop their own individual perspectives about when terminally ill patients will actually die. Unfortunately, because it is not always easy to predict how close to death someone is, inaccurate guesses are made that may deny end-of –life care to those who might benefit from it. Although the predicted time of death for hospice patients is within six months, I have had hospice patients ranging from dying immediately after being assigned to hospice to those staying in hospice for years.
What do people consider when they set out to predict death? A research study that included 45 residents was set up to create a framework for organizing social interactions related to end-of-life care and to characterize the social construction of dying in two nursing homes. The resulting framework included five categories related to the possibility of death:
1) Dying allowed
2) Dying contested
3) Mixed message dying
4) Not dying
5) Not enough information
Based on predictions, over half the resident cases were classified as mixed message dying or not enough information. This indicates the ambiguity regarding residents’ care plan goals found in the two nursing homes in the study. These results imply the importance of residents, family, staff, and physicians working together to determine the dying status of residents as it relates to social interactions and healthcare the resident receives. Shared conversations about goals of care, and how these goals will be reached are important in determining the quality of care residents receive. You can read more about this research study from the “Gerontologist.”
While on the subject of predicting death, many of you probably remember reading in the news two years ago about a cat named Oscar that predicted deaths of nursing home residents. Oscar has even received a hospice award. In this video titled “Cat Is Harbinger Of Death (CBS News),” Oscar’s death predictions are discussed.
Frances Shani Parker, Author