A Guide to End-of-Life Care for Seniors

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Canada’s rapidly aging population has sparked a substantial increase in the number of health care and social service professionals involved in seniors’ health care.

While many of these professionals are specializing in geriatric and palliative care, the field of end-of-life care – which combines elements of both geriatric and palliative care to address seniors’ end-of-life needs – remains relatively neglected, says Dr. Rory Fisher, Director of the University of Toronto’s Interdepartmental Division of Geriatrics.

“Lack of information and guidance on end-of-life care is making the task of providing care for seniors who are facing life-threatening conditions, or who are at or near the end of their lives, all the more difficult for health care and social service professionals and for seniors and their families,” says Dr. Fisher.

With a view to addressing this information gap, Dr. Fisher teamed up with Dr. Margaret Ross of the University of Ottawa Faculty of Health Sciences, School of Nursing and Dr. Michael MacLean, Dean of Social Work at the University of Regina and Director of the consulting company, Age Wise Inc. to produce an innovative new manual entitled A Guide to End-of-Life Care for Seniors.  The guide is MAINLY intended for a audience of health professionals, but it contains a wealth of information that will be useful to anyone approaching this transition or caring for someone who might be.

The guide, funded by Health Canada, presents national guidelines and best practices for end-of-life care. It also provides information to health care and social service providers, seniors, family caregivers and the general public on issues related to living and dying well, maintaining comfort for seniors and how to care for the family caregiver.

The guide was published in April, 2000, 18,000 English-language copies and 5,000 French-language copies of the guide have been distributed to health care and social service professionals across Canada.

In addition to offering professionals end-of-life care information, Dr. Fisher notes that the guide addresses ethical issues surrounding end-of-life care. “Our goal is to respond not just the physical needs of care recipients but their spiritual and cultural needs,” emphasizes Dr. Fisher. “This whole-person approach is designed to ensure that we deliver competent, comprehensive and compassionate end-of-life care to Canadian seniors.”

For Dr. Rory Fisher of the University Toronto, one of the chief contributions of A Guide to End-of-Life Care for Seniors is the new perspective it brings to the management of dying elderly patients.

“In the health care profession we have traditionally not been very good at looking after dying patients,” notes Dr. Fisher, Co-Chair of the National Advisory Committee responsible for the development of the guide. “This is because our focus has been confined to disease prevention and cure. When we can’t keep people alive, we see it as a failure.”

Dr. Fisher says A Guide to End-of-Life Care for Seniors responds to a need for an approach to end-of-life care that recognizes the inevitability of death in later life from a variety of diseases – including those of a chronic and progressive nature, such as Alzheimer’s disease. “As our population ages, this approach is becoming increasingly important and should be a priority for everyone in our health system,” emphasizes Dr. Fisher.

He explains that end-of-life care brings together advances in both palliative and geriatric care to help health and social service professionals focus on the broader issues of management of dying patients, whether they are in their homes, in long-term care facilities or in acute care hospitals.

“The benefit of this approach is that it focuses on autonomy and self-determination among seniors and their families,” notes Dr. Fisher. “Our experience tells us that seniors have a heightened awareness that death is drawing near. At this stage, they are more concerned with quality rather than quantity of life. Physical autonomy and self-determination in decision-making are crucial to their ability to maintain their quality of life right to the end of their days.”

End-of-Life Care – A Definition

End-of-life care is an active and compassionate approach to care for older people in the last stages of their lives. It offers treatment, comfort and support to those living with progressive or chronic life-threatening conditions. End-of-life care is sensitive to personal, cultural and spiritual beliefs and practices. It also encompasses support for families and friends up to and including the period of bereavement.

End-of-Life Care: Myth and Reality

Myth: Seniors die of old age

Reality: Aging itself does not cause symptoms, let alone death. Seniors die of many different illnesses, such as heart disease, cancer, respiratory diseases and strokes.

Myth: Seniors are completely prepared for death

Reality: A senior’s indecision, ambivalence, or denial can prevent proper decision making in preparation for death. Health and social service providers and families can help older people choose the type of care they wish to receive if they become terminally ill.

Myth: There is nothing that can be done for seniors who are dying

Reality: There are many things that can be done. Seniors should be informed about their rights and assisted in making end-of-life decisions before a crisis emerges. Many seniors want the opportunity to decide and/or share decisions with their families or caregivers.

To view or print A Guide to End of Life Care for Seniors, click here