Chapter 15: End-of-Life Care

End-of-Life Care on End-of-Life Care in geriatric nursing explores the profound modern shift in addressing death, noting that it now overwhelmingly occurs among older adults with chronic, debilitating conditions. Reflecting the emphasis on individual rights in Western culture, modern end-of-life care prioritizes patient autonomy and informed decision-making, moving away from a purely medical focus to a holistic, patient-centered approach. Crucial to this process is pre-crisis planning via advance directives and Physician Orders for Life-Sustaining Treatment (POLST), allowing individuals to articulate their wishes for or against aggressive interventions. The goal is to facilitate a "good death"—one characterized by comfort, dignity, peace, and control over symptoms and surroundings. Specialized care philosophies like hospice and palliative care support this goal by reducing suffering and optimizing quality of life rather than attempting to cure disease. Effective nursing care requires sensitivity to diverse cultural and spiritual beliefs which heavily influence communication about death, the decision-making structure (individual vs. family), acceptance of interventions, and the interpretation of pain. Key physiological assessments focus on managing distressing symptoms, with pain relief being a top priority, often utilizing both pharmacologic and nonpharmacologic interventions to maintain alertness. Other common changes needing skilled intervention include dyspnea, Cheyne-Stokes respirations, gastrointestinal issues (anorexia, cachexia, constipation), and cognitive changes like delirium. Nurses play a vital role in providing therapeutic communication, emotional support, and facilitating postmortem care while supporting loved ones through the unpredictable emotional journey of bereavement, often framed by Kübler-Ross’s recognized stages: Denial, Anger, Bargaining, Depression, and Acceptance.