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Geriatrics > Overview of end of life care > Flashcards

Overview of end of life care Flashcards

1
Q

Why is the quality of life during the dying process poor?

A

Inadequate treatment of distress, fragmented care, strains on family etc

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2
Q

Deaths in the us occur most often in the elderly, and are marked by what characteristics? (2)

A
  1. Slow

2. Increased dependency

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3
Q

What are the three trajectories of illness?

A

Fall off a cliff
Slow decline with periodic crises
Prolonged dwindle

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4
Q

True or false: acute care and palliative care can occur simultaneously

A

True

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5
Q

What are the “three legs of the medicine stool”?

A

Diagnosis
Prognosis
Theraputics

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6
Q

What is the goal of life prolonging care? Palliative care?

A

Life prolonging = lengthen life at any cost

Palliative = no bad symptoms

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7
Q

Which is a board certified sub specialty–hospice care or palliative medicine?

A

Palliative medicine

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8
Q

What is the payment source of hospice?

A

Medicare

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9
Q

Where is the locus of care for hospice and palliative med?

A

Hospice - where home is

Palliative med = anywhere

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10
Q

True or false: there are more inclusive services in palliative medicine compared to hospice?

A

False–other way around

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11
Q

What is the difference in time frame for palliative vs hospice care?

A 
Palliative = all stages of disease trajectory
Hospice = less than 6 months
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12
Q

True or false: hospice is a place to die

A

False-where they can live well

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13
Q

True or false: a pt has to have a DNR in order to be accepted into hospice

A

False

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14
Q

True or false: many pts who enroll in hospice actually starve to death

A

False

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15
Q

How much longer do patient who get transferred to hospice live compared to those who do not?

A

29 days longer

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16
Q

True or false: one of the benefits of transferring a pt to hospice is knowing that the hospice will pay for all of the pts meds

A

True, but only for the meds that are involved in hospice placement

17
Q

True or false: in order to be transferred into hospice, pts must transfer their care to the hospice physician

A

False

18
Q

True or false: a good death is free from pain and suffering

A

False

19
Q

True or false: In order to refer a pt to hospice, the attending physician must certify that the patient will die in the next six months

A

False

20
Q

True or false: Good pain management alway includes measurable aspects of the patient’s pain

A

True

21
Q

True or false: Hospice has bereavement support for 13 months following a pts death

A

True

22
Q

True or false: the majority of hospice pts receive care at an in patient facility

A

False–often at home

23
Q

What are the four usual obstacles to hospice?

A
  1. limited access
  2. Lack of family support
  3. LATE REFERRAL
  4. Difficulties in determining prognosis
24
Q

What is the most common obstacle to hospice care?

A

Late referral

25
Q

How accurate are physicians’ prognoses?

A

3-5 times longer than what it actually is

26
Q

What is the goal of palliative medicine?

A

Improve QOL of pts and family with serious illness

27
Q

When is palliative medicine appropriate?

A

At any age or stage of a serious illness

28
Q

What is the rationale for palliative medicine?

A

Relieves family burden

29
Q

What are the three key palliative care services?

A
  1. Establish goals
  2. Treat symptoms
  3. Psychosocial support
30
Q

What are the two main barriers to palliative care?

A

Awareness of service

Tendency of clinicians to equate palliative care = end of life

31
Q

What are the four major concerns of drs in palliative care?

A
  1. Introducing palliative care will interfere with treatment
  2. Inadequate resources
  3. Reimbursement
  4. Shortage of palliative care drs.
32
Q

Why is it important to offer palliative services?

A

You are the gatekeeper (and the keymaster!)

33
Q

If a doctor knows a patient better, are they more likely to overestimate or underestimate the amount of time they have left

A

Overestimate, even more than usual

Geriatrics (30 decks)

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