Discussing End-of-Life Care With Older Patients: What Are You Waiting For?

Mary Anne Huggins, MD, CCFP, DABHPC; Laura Brooks, BScN, MScN, ACNP

Disclosures

Geriatrics and Aging. 2007;10(7):461-464. 

In This Article

Abstract and Introduction

Discussing end-of-life care with older patients is very important, as it ensures their preferences are known and they retain control over their care decisions even when they may no longer be actively involved in them. Unfortunately, these discussions do not always occur, and when they do occur, they are not always done well. There are patient and physician barriers to advanced care planning. Physicians may lack the skills necessary to accomplish the task of making decisions for future care. In this article we discuss advanced care planning, its importance as well as related challenges and barriers. We then outline a practical approach to advanced care planning for older adults.

Most older adults are relatively cognizant of their mortality. Death may already surround them: their friends and siblings may be dying or have died. Older people usually have experience with death, even though they may not talk about it. They have probably thought about their own death, about the process of dying and have ideas about what they want and what they do not want, and these are issues that physicians and their patients should be discussing at various times in the doctor-patient relationship.[1,2] This should be especially true for the care of older patients as death becomes more foreseeable; however, this does not always happen.[3,4,5]

Discussing and planning for the end of life can be a challenge. In this review we will define advanced care planning (ACP), discuss the importance and challenges of ACP, including barriers to planning, and outline a practical approach to ACP.

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