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Question 1

Home Care

(end of life care)

Answer 1

Person is in a familiar setting
—–In the company of family and friends

Often a 24hr/d job
—-Family members are often not able to provide this level of care
—–Home care assistance can be obtained but is often quite expensive
—–Not covered by public or private insurance
—–Institutional care may be necessary

55% of deaths still occur in hospital

Question 2

Hospital-Based Palliative Care

Answer 2

Collaborative, team-based approach designed to relieve the suffering of serious or life-threatening diseases

Goal is to improve the quality of life in the waning days of a person’s life

Focus is on the controlling pain and caring for the physical, psychological, spiritual and existential needs of the patient

Question 3

Hospice Palliative Care

Answer 3

Designed for persons wishing to die at home in their residential care facility or more peaceful hospital environment

Well known form of palliative care in Canada

Similar to hospital-based care, the move is from a curative model to accept there is no cure and reducing the aggressiveness of any further treatment

Allows the patient to determine where and when they die

—-Remote Indigenous communities often must move their loved ones away from the community

——Access to song, prayer and smudging can support the individual and family through the dying process

Question 4

Difficult Decisions at the end of Life

Answer 4

Medical interventions may cause more suffering than necessary
——The question becomes whether the treatment is worse than the illness
——Keeping patients alive at all costs is being questioned

Should a patient be kept alive only by artificial support?
——-These questions are ethically challenging and painful for all faced with them
——The question is important to answer nevertheless

Question 5

Withholding or Withdrawing Treatment

Answer 5

The right to refuse treatment is established in medical practice and the law
——-The choice to forgo life-sustaining treatments involves refusing treatments that would be expected to extend life
——–This right is constitutionally protected

Having a clear advanced directive written when the patient was competent to make health care decisions is very helpful

Question 6

Medical Assistance in Dying (MAID)

Answer 6

Known as physician-assisted death
——Physician provides or administers lethal drugs with the plans that the patient intends to end their life
——–Done at the patient’s request

1.Persons must be 18 years of age and mentally competent

2. Eligible for health care services in province or territory
3. Living with a grievous and irremediable medical condition
4. Voluntarily request medical assistance in dying
5. Provide informed consent

Do not need to have a terminal illness to qualify for MAID

2023 will see Canada as one of a few countries to allow adults with mental illness as the only underlying condition to access MAID

Question 7

middle knowledge

Answer 7

A state of knowing when
a person both acknowledges
the reality of a threatening
situation and maintains hope
for a positive outcome.

Reflect a coping strength sustaining the will to live despite a bleak prognosis

Question 8

Living with an illness that is life threatening and incurable can be described as a living-dying experience

Answer 8

From the diagnosis to treatment to the final days, a delicate balance must be maintained

Honesty to face reality as it is:
1. Hope for a positive outcome
2. If incurable – the hope for more time
3. As time runs out – changes to a pain free or “good” death

Question 9

Kübler-Ross suggested five psychological stages to imminent death

(tasks of coping)

Answer 9

denial, anger, bargaining, depression,
and acceptance.

DABDA

individuals go back and forth among
the stages during an illness, and different stages can occur simultaneously

Question 10

Corr and colleagues distinguish 4 primary dimensions:

(tasks of coping)

Answer 10

1. Physical: Satisfying bodily needs and
   minimizing physical distress.
2. Psychological: Maximizing a sense of security, self-worth, autonomy, and
   richness in living.
3. Social: Sustaining significant relationships and addressing the social
   implications of dying.
4. Spiritual: Identifying, developing, or
   reaffirming sources of meaning and
   fostering hope.

Question 11

The Tasks of Coping

Answer 11

Some may respond with a fighting spirit and see the illness as a challenge
——Take active part in their treatment

Others may withdraw and find peace in letting go
——The world becomes smaller and more intimate – ease into a peaceful place

Question 12

life expectancy

Answer 12

The average
length of time a
person is expected
to live.

Question 13

sarcopenia

Answer 13

loss of muscle mass

Question 14

osteoporosis

Answer 14

bones become dangerously thin and fragile, making them very easy to break, even with a relatively minor
injury.

Fractures are the most serious consequence of osteoporosis

• Bone decay

Question 15

arthritis

Answer 15

joint degeneration

Inflammation and
swelling of a joint
or joints, usually
causing pain and
stiffness.

Question 16

People who take charge of their health during their youth have greater control over the physical and mental aspects of aging.

Question 17

Exercise and a healthy diet throughout life enhance physical and psychological health.

Question 18

Regular physical examinations and participating in recommended health screening can help us live a longer, healthier life.

Question 19

Stress increases wear and tear on the body;

Answer 19

getting enough sleep, nurturing social connections, and practising relaxation and mindfulness can help reduce stress and increase vitality and happiness.

Question 20

Retirement can be one of the most fulfilling and enjoyable times of life. Adjusting to new roles, participating in a variety of activities, having enough money to live comfortably, and having a sense of purpose in life are all important factors in successful retirement.

Question 21

Successful aging involves anticipating and accommodating physical changes and limitations.

Question 22

Occasional slight confusion and forgetfulness can be a normal part of aging; however, more severe symptoms could be signs of a neurodegenerative disease, such as Alzheimer’s disease, and should prompt a medical evaluation.

Question 23

Family and community resources can help older adults stay active and independent.

Question 24

Dying and death are more than biological events; they have social and spiritual dimensions.

Question 25

A mature understanding of death can include ideas about the survival of the human personality or soul after death. Problems arise when avoidance or denial of death fosters the notion that it happens only to others.

Question 26

Palliative care is a team-based approach to treatment that aims to prevent and relieve suffering in patients with serious or life-threatening illness.

Question 27

Coping with dying involves physical, psychological, social, and spiritual dimensions.

Question 28

The gift of listening and loving touch can be especially important to someone who is dying.