Managing pain and other end-of-life issues
As people age, they may become more accepting of death. But they continue to fear the things associated with it. In a study addressing end-of-life issues published in the
Journal of the American Medical Association (November 2000), participants stated that the most important issues that concerned them were pain management, mental awareness, preparation for death, and a sense of completion.
Managing pain
Making end-of-life decisions in advance
Helpful resources
Managing pain
While all of these issues cause concern, pain perhaps is the most feared of all. Pain increases stress, interferes with sleep, and causes psychological problems such as depression, affecting a patient's overall quality of life.
"Pain management is a right that every patient is entitled to, whether it's at the end of life, or at the beginning," states
Jeffry Komins, MD, vice president of medical affairs and clinical outcomes at Virtua Memorial Hospital. "At Virtua, our goal is to assess every individual's pain and to keep each person as comfortable as possible, regardless of age. Since every patient's pain level is different, we use pain scales that allow patients to objectively rate their pain between zero and 10. We also ask them at what rating they would be more comfortable so we can help them reach that goal."
Making end-of-life decisions in advance
While in good health, some people find comfort in planning their end-of-life care with advance directives. Advance directives, or living wills, are legal documents which state how people want to be treated in the event they become unable to make healthcare decisions on their own because of terminal illness or catastrophic injury.
"One of the greatest benefits of preparing an advance directive early, is that it clarifies what kind of end-of-life care a person wants to receive," states
David Greenspan, MD, Virtua psychiatrist. "In the document, people can identify the type of medical, spiritual and emotional care that would help them maintain their quality of life."
While choices concerning life and death are personal ones, these decisions also affect the people who are close to the individual. For this reason, "It's often helpful for people to discuss their wishes with their family, friends, spiritual advisors, and physicians," states Dr. Greenspan. "A doctor can answer questions about the medical procedures used to treat terminal illness and manage pain. This allows individuals to determine their end-of-life experience on their own terms." An advanced directive also provides guidance to family, physician and caregivers — even if the individual can no longer communicate wishes effectively.
Helpful resources
* Dying Well: A Prospect for Growth at the End of Life by Ira Byock, MD
* Peaceful Dying by Daniel R. Tobin, MD
* Handbook for Mortals by Joanne Lynn & Joan Harrold
* On our own terms: Moyers on dying (
(http://www.thirteen.org/onourownterms)
* U.S. Living Will Registry (
http://www.uslivingwillregistry.com)
* American Bar Association (
http://www.abanet.org/aging/publications/docs/consumer_tool_kit_bk.pdf)