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Only 10
percent of Americans will die suddenly. The remainder of
us (90 percent) will decline slowly, growing weaker
until we die. Because this process is so gradual, we
often don’t recognize that a loved one is approaching
the final weeks of life. This may be why most Americans,
around 80 percent, die in institutions, despite the fact
that most Americans polled (85 percent) voice that they
want to die at home. Perhaps the reason could be that we
simply do not see it coming.
It is only
natural that we would want to deny how seriously ill our loved
one is. Denial protects us from the painful reality that we may
soon lose someone precious to us. While denial can help us to
cope, it also may interfere with making a plan that will
guarantee that your loved one’s final months are spent in the
place they choose, surrounded by friends and family.
Well-thought-out
preparation, on the other hand, will allow us to choose where
death will occur, participate more fully in our loved one’s
care, make better decisions and achieve a measure of control
over the coming months. We will feel peaceful despite living
with uncertainty. In the future, after our loved one has died,
we will reflect back on these final months, and be left with the
deep comfort that comes from knowing that we did our best for
someone we love at a very difficult time.
So what are the
signs that an elderly person may be approaching the final months
of life? There are many indicators, but in this article, we will
discuss three common signs: weight loss, progressive weakness
and infections.
There is a great
deal of research that shows that
weight loss by itself is a powerful indicator that an
elderly person is approaching the final months of life. Just
five percent to 10 percent loss of weight in six months can be
significant. If a person is in a nursing home, it has been shown
that as little as 10 percent loss of weight in six months will
carry 85 percent mortality in the next six months. Weight loss
is so significant that it can be an indicator for hospice care.
It is commonly understood that elderly people approaching the
final months of life naturally stop wanting food and fluids.
Another
indicator is increasing dependency.
Loss of weight leads to loss of muscle which leads to
progressive weakness. This may start with having difficulty
getting up from the chair. It progresses from needing assistance
to transfer to being chair bound to eventually being mostly bed
bound. This immobility also puts an elderly person at risk for
skin breakdown and pneumonia.
A third
indicator is propensity for
developing infections. It is well known that there is a
progressive decline in the power of the immune system with
aging. Before the introduction of antibiotics in the 1940’s,
many elderly people died from pneumonia.
Pneumonia was called “the old man’s friend” as it
promised a swift death.
We may think of pneumonia as being curable, but many
elderly people are at risk to contract pneumonia and at risk to
die from pneumonia. If a person is older than 75, they have a
six times greater chance of getting pneumonia than if they were
60 years old. This is because the lung has lost its elasticity.
In addition, changes in the brain and nervous system affect
their ability to cough up secretions, which is essential to
overcoming pneumonia. Some elderly people have difficulty with
swallowing and may cough while eating, inhaling liquid into
their lungs. This is called aspiration, and can cause them to
get pneumonia repeatedly.
Some elderly people also develop infections of the
urinary tract, which can be treated, but which further weaken
the body.
Identifying
early that your loved one is declining has many advantages. You
can tell your health care provider how you want those final
months to be, so he or she can support you in your plan.
Services can be put in place at home or in a facility so that if
a crisis arises, it can be managed without going to a hospital.
If you are able to get hospice care in place, oxygen and
medications for comfort will be on hand should a medical crisis
arise. Nurses will do routine in-home assessments and advise you
as to what you can expect. You and your family will be better
prepared.
If you suspect
your elderly loved one is declining, you can ask for a “hospice
consult.” and a nurse will come to your home and advise you and
your healthcare provider about eligibility. In-home support and
availability of comfort
measures is the key to successful care at the end of
life.
Betsy Murphy has worked in hospice care for 23 years. Trained as a Family Nurse Practitioner and certified as a Hospice and Palliative Care Nurse, she has recently published the booklet, “Guide to Caregiving in the Final Months of Life” to assist families facing end of life care of a loved one. You can read more about her at www.GuidetoCaregiving.com.
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