Exam #2: Palliative Medicine Flashcards
Why is palliative medicine important in geriatrics?
- Majority of deaths occur in older adults
- Seriously ill spend most of their time at home; but death occurs mostly in the hospital or nursing home
Why is the quality of life poor in the dying process?
- Inadequate treatment
- Fragmented care
- Strains on family
- Poor support system
What are the four disease trajectories? What types of illnesses are these trajectories associated with?
1) Healthy–> Dead–trauma
2) Steady decline w/ short terminal phase–cancer
3) Slow decline, periodic crises, sudden death–lung failure or heart failure
4) Prolonged dwindling–general frailty & dementia
Can palliative care and acute care occur at the same time?
Yes–these can occur simultaneously
What is the “three-legged stool” of medicine?
1) Diagnosis
2) Therapeutics
3) Prognostics*
**Most aren’t very good at prognostics
What are the three main goals/ pathways in end of life care? Review slide 9 from ppt–test questions.
1) Life-prolonging care
2) Limited medical care
3) Comfort care
What is the difference between palliative medicine and hospice?
Palliative medicine=
- Specialty
- Applicable along any stage of disease process & in any patient population
- Acute care concurrent
- Variable payment source
Hospice=
- Philosophy of care
- Medicare hospice benefit= applied to patients presumed to have
Is hospice a place to die?
No–it is electing a “philosophy of care”
Do you need to sign a DNR to go into hospice?
No
Do you need to transfer care to a hospice physician to receive hospice care?
No
Do many patients in hospice starve to death?
No–body stops sending blood to the gut; body shuts down but the patient is not “starving”
If you take two patients with equal severity of illness, will the one in hospice or not survive longer?
Hospice
How is payment made for medicine in hospice care?
Hospice pays for the medications relating to the terminal illness NOT all meds
Is a good death free from pain and suffering?
No–death is associated with loss & loss always leads to suffering
Does good pain management always include measurable aspects of the patient’s pain?
Yes
