you notice that a patient delays
Center for Community Research and Services
seeking treatment or offers
University of Delaware
improbable explanations for
297 Graham Hall
Newark, DE 19716
injuries, for example, you may
1-302-831-3525
want to bring up your concerns.
www.ncea.aoa.gov
The laws in most States require
This consortium of organizations provides
helping professionals, such as
information about and conducts research
doctors and nurses, to report
on elder abuse.
suspected abuse or neglect.
Older people caught in an abusive situation are not likely to say what is happening to them for fear of reprisal or because of diminished cognitive abilities. If you suspect abuse, ask about it in a constructive, compassionate tone. If the patient lives with a family caregiver, you might start by saying that caregiver responsibilities can cause a lot of stress. Stress sometimes may cause caregivers to lose their temper. You can assist by recommending a support group or alternative arrangements (such as respite care). Give the patient opportunities to bring up this concern, but if necessary, raise the issue yourself.
talking about sensitive subjects 27
End-of-Life Care
Most older people have thought about the prospect of their own death and are willing to discuss their wishes regarding end-of-life care. You can help ease some of the discomfort simply by being willing to talk about dying and by being open to discussions about these important issues and concerns. It may be helpful to do this early in your relationship with the patient when discussing medical and family history. Stay alert to cues that the patient may want to talk about this subject again. Encourage the patient to discuss end-of-life decisions early with family members and to consider a living will.
For more information on end-of-life care, contact:
Education in Palliative and End-of-life Care (EPEC) Northwestern University, Feinberg School of Medicine 750 North Lake Shore Drive, Suite 601
Chicago, IL 60611
1-312-503-3087
www.epec.net
EPEC provides physicians the basic knowledge and skills needed to care for dying patients.
National Hospice and Palliative Care Organization 1731 King Street, Suite 100
Alexandria, VA 22314
1-800-658-8898 (toll-free)
1-877-658-8896 (toll-free, multilingual helpline)
www.nhpco.org
NHPCO links to care organizations and the consumer website, www.caringinfo.org.
Of course, it is not always easy to determine who is close to death; even experienced clinicians fi nd that prognostication can be diffi cult. Even if you have already talked with your patient about end-of-life concerns, it still can be hard to know the right time to re-introduce this issue. Some clinicians fi nd it helpful to ask themselves, “Would I be surprised if Mr. Flowers were to die this year?” If the answer is “no,” then it makes sense to start working with the patient and family to address end-of-life concerns, pain and 28
talking about sensitive subjects
symptom management, home health, and hospice care. You can offer to help patients review their advance directives. Include these updates in your medical records to ensure that patients receive the care they want.