Old Age and Care near the End of Life

摘要: We have transformed our view of death: Rather than an accepted part life's experience, it is now seen as unfamiliar and much feared event. Popular images death dying are a jumble gun violence, young middle-aged adults on television fighting for life with the help tubes, intensive care units modern machinery, nineteenth century feverish mothers or children attended at home by their grieving families helpless physicians. In reality, these media visions bear little relationship to actual human experience in United States. society, overwhelming majority people who die elderly. They typically slowly chronic diseases, over long periods time, multiple coexisting problems, progressive dependency others, heavy needs met mostly family members. spend final months years but, most parts country, actually hospital nursing surrounded strangers. Many deaths become protracted negotiated processes, healthcare providers members making difficult, often wrenching, decisions about use discontinuation such life-prolonging technologies feeding ventilators, intravenous fluids. There abundant evidence that quality during process poor, characterized inadequately treated physical distress, fragmented systems, poor absent communcation between doctors patients families, enormous strains caregiver support systems. DEMOGRAPHY OF DYING AND DEATH IN THE UNITED STATES The median age States 77 years, associated steady linear decline age-adjusted rates since i94o. While 1900 expectancy birth was less so girl born today may expect live 79 boy 73. Those us reaching 75 can another ten (men) twelve (women) average. This dramatic unprecedented increase (equivalent occurring Stone Age year I9oo) due primarily decreases maternal infant mortality, resulting from improved sanitation nutrition effective control infectious diseases. result changes demography has been growth number health elderly, 2030, zo percent States' population will be 65, compared fewer 5 turn century. largely attributable leading causes heart disease, cancer, stroke. Advances treatment atherosclerotic vascular disease cancer turned previously rapidly fatal diseases into illnesses which many before death. parallel, occurred early twentieth occur institutions (57 hospitals 17 homes). reasons this shift location complex, but they related Medicare reimbursement hospital-based care, subsequent rise availability beds burdens chronicity functional accompanying life-threatening older patient, higher likelihood hospital, estimated 58 85 spending least some time last (National Center Health Statistics, I992). These statistics, however, hide fact person's still spent members, hospitalization placement only near very end life. …