PH+116+Aging+Dying+4-19-10 - PH 116: Aging, Dying, and...

Info iconThis preview shows pages 1–10. Sign up to view the full content.

View Full Document Right Arrow Icon
PH 116: Aging, Dying, and Death Donna Foliart, MD, Medical Director Palliative Care Service, John Muir Health April 19, 2010
Background image of page 1

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon
Objectives Present 3 representative cases Review cultural changes in dying Describe options for end of life support Detail the Hospice Medicare Benefit Present pros and cons of hospice Discuss palliative care Summarize outcome of representative cases
Background image of page 2
Case One: End of life issues in ICU 78 year old man with recently diagnosed cancer, metastatic to bone and liver Still contemplating whether he wanted to proceed with “palliative” chemotherapy Stringing Xmas lights, fell from ladder, found hours later, hypothermic, and air-lifted to John Muir Quadriplegic due to spinal injury and on a ventilator in ICU when Palliative Care consult requested
Background image of page 3

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon
Case 2: End of life dementia 91 year old woman with advanced dementia (bedbound, non-verbal, feeding tube directly in stomach) admitted from nursing home for the 12 th time within one year to John Muir. Had 7 previous admissions over year for recurrent aspiration pneumonia and 3 ED visits to replace the feeding tube she had pulled out Youngest daughter insists mother should be full code. Palliative care consult sought
Background image of page 4
Case 3: Multiple chronic diseases 96 year old woman, living in senior assisted living setting, with history of heart attack, congestive heart failure, and emphysema. Hospitalized due to bronchitis, anemia noted, work- up revealed new colon cancer. Surgeon recommends surgical resection, as cancer may lead to bowel obstruction over next several years. Hospitalist requests palliative care consult
Background image of page 5

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon
Dying in America: early 1900s 1900: life expectancy = 50 years, with high infant, child, and maternal mortality and occupational injuries for men 1900: leading causes of death were tuberculosis and other infections 1900: death tended to be quick, occurred in home, focus was on comfort care with family providing care
Background image of page 6
Dying in America: 1950s Introduction of antibiotics, improved surgical techniques and public health/ safety led to a decrease in infant, child, and maternal mortality 50% of deaths now occurred in hospital, family kept in waiting room The increase in medical technology led to changing expectations: focus on cure, not comfort. Medical specialties begin to “divide up” care by organ system, often with poor communication between MDs
Background image of page 7

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon
Dying in America: 1990-2007 In 1990: 75% die in an institutional setting 60% in hospital 15% in skilled nursing facility 20% at home (most with hospice) 5% other In 2007: 75 % die in an institutional setting 50% in hospital 25% in skilled nursing facility (some with hospice) 20% at home (most with hospice) 5% other
Background image of page 8
Advances in Medical Care We now “cure” some previously fatal diseases, such as infections Childhood leukemia, previously rapidly fatal, now has a ~85% cure rate
Background image of page 9

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon
Image of page 10
This is the end of the preview. Sign up to access the rest of the document.

This note was uploaded on 05/06/2010 for the course PUBLIC HEA 116 taught by Professor Potts during the Spring '09 term at University of California, Berkeley.

Page1 / 35

PH+116+Aging+Dying+4-19-10 - PH 116: Aging, Dying, and...

This preview shows document pages 1 - 10. Sign up to view the full document.

View Full Document Right Arrow Icon
Ask a homework question - tutors are online