Tag: Imminent Death

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Researchers Identify 8 Signs of Impending Death

Findings could help families prepare and aid in end-of-life care choices

By Alan Mozes

Researchers say they have identified eight specific physical signs that strongly indicate that someone with advanced cancer is entering the last days of life.

The investigators focused on telltale signs that a patient has, at most, just three days to live. The hope is that this information will help family members and other caregivers better handle an impending death, as well as be more prepared for choices that may have to be made during end-of-life care.

“I think the bottom line is that our study identified several classical signs that can be observed by the bedside by doctors, nurses and even family caregivers, which may help them to determine with confidence that the patient has entered the final days of life,” said study lead author Dr. David Hui. He is an assistant professor in the department of palliative care and rehabilitation medicine at the University of Texas MD Anderson Cancer Center in Houston.

He also said that “we believe these signs may apply to both cancer and even non-cancer patients, because these signs occur as part of the natural process of dying.”

Hui and his colleagues reported their findings in the Feb. 9 online edition of Cancer.

To compile their list, the researchers monitored physical changes that occurred just prior to death among more than 350 advanced-stage cancer patients. They were being treated at one of two cancer centers: one in the United States and one in Brazil. All of the patients were in an acute palliative (end-of-life) care unit.

Physical changes were noted twice daily, according to the study.

During the study time frame, more than half (57 percent) of the patients died. And in the end, the authors settled on eight indicators that seemed to most accurately predict imminent death.

Those included: an inability to close the eyelids; diminishing ability to react to visual stimulation; a reduced ability to react to sounds and words; facial drooping; non-reactive pupils; hyperextension of the neck (this causes the head to tilt further back when lying down); vocal cord grunting; and bleeding in the upper digestive tract.

“It is important to point out that only a small proportion of patients may have each of the signs before death,” said Hui, “although a majority would have at least one of the signs in the last three days of life. The presence of these signs strongly suggests that death will occur in the next three days. However, absence of these signs does not suggest that death will not occur.”

Some signs seemed to be more common than others, with some occurring among just 5 percent of the patients while others were seen among nearly 80 percent during the last three days of life, according to the study.

Hui also cautioned that there will always be exceptions to the rule, and his team’s list will not cover all situations. Exceptions, he said, would include cases of sudden death or when intensive care unit patients are breathing by means of mechanical ventilation.

Dr. R. Sean Morrison is director of the Lilian and Benjamin Hertzberg Palliative Care Institute at the Mount Sinai Icahn School of Medicine in New York City. He said that, while doctors are already very familiar with signs of impending death, the list could be very helpful for families struggling to come to grips with a disorienting set of circumstances.

“Within the palliative care community, this is very well understood,” Morrison noted. “And this is certainly not just about cancer. This would apply to anyone dying of heart disease, lung disease or even dementia, because the symptoms that are identified in this cancer population are almost universal for anyone approaching the end of life.

“But from a clinical perspective as physicians, I don’t think this list will prove terribly helpful,” he added. “Because what we’re talking about here is really people hours from death who really can’t respond or are not interactive or are essentially in a coma approaching death. So I would hope and expect that by this point a discussion of patient goals and family needs would have already taken place, long before, along with any decisions about blood tests and treatments.”

Still, Morrison said the list could be “helpful for the family, and for helping us guide families. Because one of the things that families wrestle with is how long do I have with my loved one? And we’re not always that good at predicting that. So this may help give families a time frame for knowing how long the vigil is going to be.”

Complete Article ↪HERE↩!

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Preparing Yourself or a Loved One to Die at Home

by Ray Burow

Death is not a fun topic, but failing to talk about end-of-life plans results in a lack of preparation and exacerbates emotional strain when a loved one passes away at home.

If your loved one opts to live out their final days in their house, or if you care for an elderly spouse or parent who’s in the advanced stages of Alzheimer’s disease, they could die at home. Are you prepared? What are your loved one’s end-of-life wishes? Would they choose to pass away at home? Is hospice care an option, or is a hospital setting a better choice for your circumstances? Medicare often pays for hospice care.

Why some people prefer to die at home

Passing away at home is often preferred by critically ill or older individuals. According to the Stanford School of Medicine, studies indicate that 80% of Americans would choose to pass from this life surrounded by what’s familiar to them, preferably at home. However, many don’t get their wish. Only 20% of Americans die at home, while 60% die in acute care hospitals and 20% die in nursing homes.

People prefer to die at home for various reasons, but perhaps control is a primary contributor. The family can manage who comes and goes, providing an opportunity to gather, reminisce, and properly say goodbye. Caregivers administer palliative care in a comfortable, familiar environment rather than one that is foreign and starkly sterile.

Hospice care will assist with pain management, and no heroic actions are taken to resuscitate the patient, who is allowed to slip away. Depending on the laws in your state, you may be able to keep the body at the house for a period of time, and some families may choose to have the funeral at home, too.

How to prepare for a death at home

Preparing to die at home is a process that must occur before the person’s final days. If you or a loved one has been diagnosed with dementia, it is essential to decide in the early days of the condition, while the decision is still yours to make. Caregivers and loved ones, acting as surrogates, can carry out your wishes, but only when they know what they are.

Advance directive

An advance health directive is crucial to securing end-of-life wishes. It’s a legal document containing the patient’s desires. If the patient is incapacitated, the document expresses their values regarding end-of-life processes. These include whether first responders and healthcare professionals will administer CPR, if the patient will donate organs, and what comfort measures will be in place during the dying process.

When a person dies at home unexpectedly and without an advance directive, first responders typically can’t pronounce them dead, as required by law. Paramedics transport the remains to the nearest hospital emergency room, where a doctor will pronounce them. If hospice is in place, the hospice nurse can pronounce the person’s death at home, and the family arranges for a funeral home to remove the remains.

Without hospice, a living will, or an advance directive, the family must call emergency services when their loved one dies at home. Paramedics, possibly firefighters, and police officers will arrive at your home, but only a doctor or coroner can pronounce death.

Understand that without the proper documents in hand, paramedics have to follow protocol and will often begin administering emergency procedures and transport your loved one to a hospital where a doctor with authority to pronounce can do so. There are exceptions to this rule depending on where you live, and in some cases, paramedics are permitted to pronounce.

Following death

Some states require an autopsy when a person dies at home. If the deceased was advanced in age, an autopsy might not be necessary. In either case, you must make arrangements for transportation to a funeral home or crematorium. Don’t be shy to ask about cost. Funeral homes are required by law to provide that information when requested.

There is much more to preparing for death at home than what we can briefly discuss in this column, including the emotional and spiritual aspects and mourning through the grieving process. Mourning is necessary and healthy, and it’s futile to try and skip it. Grief will rise to meet you in unexpected places and at random times. A grief counselor, pastor, trusted friend, or family member can help you through the mourning process. You don’t need to mourn alone.

Complete Article ↪HERE↩!

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Death, Dying and Suffering

— The Need for Medical Education Reform

by and

As she closed the door behind her, the palliative care geriatrician whom I (Meghan) was shadowing turned and said, “Remember, there are no difficult patients – just difficult situations.” We walked to our next patient, Mrs. C, who was suffering from congestive heart failure. All cures had been exhausted and she was tired of being at the hospital but was scared to enter hospice care. The doctor clasped hands with Mrs. C and explained that starting hospice did not mean giving up — it meant living life on her own terms in the time that was left. After these discussions, Mrs. C appeared more at ease and decided to pursue hospice care at her home.

During this and other palliative care consults, I saw how terminal illness could raise tough questions with patients, families and their providers. However, I also saw that working through these discussions could minimize suffering, give patients a sense of hope and allow them to make the most of their time remaining. Unfortunately, most medical students and doctors report feeling ill-equipped to have conversations about end-of-life care with patients. In this article, we will examine a provider’s role in validating the illness experience and describe how formal medical training on death, dying and suffering can equip physicians to provide better patient care.

According to medical humanist and physician, Eric Cassel, suffering can be defined as a state of distress that occurs when a person’s “intactness … as a complex social and psychological entity” is threatened. Suffering can occur when pain is uncontrollable, chronic or when its source is unknown. Patients may suffer and feel helpless when experiencing such pain due to a lack of perceived control or knowledge of how to relieve it. However, physical pain is just one aspect; there are also psychological, existential and social dimensions that can exacerbate suffering. I (Leonard) lived through this complex experience of suffering secondary to a debilitating illness when I was 19. I had an unusual Clostridioides difficile (C. diff) infection lasting several weeks which was so severe that it caused me to lose 15 pounds. During this period, I felt the uncertainty, vulnerability and alienation associated with being sick. Because it was so rare for a healthy, immunocompetent individual like myself to contract C. diff, it took a week and a half before my doctors were able to diagnose the medical origin of my suffering. To make matters worse, I felt that the doctors cared more about my atypical case of C. diff than about me as a human. Being solely viewed as an “interesting presentation of disease” invalidated my experience and caused me to suffer beyond the pathogenesis of the bacterial infection.

Physicians must work with their patients to identify the underlying and often complex sources of distress. Once a culprit has been identified, a physician can help the patient manage the aspects of distress which they can control, reframe their perceptions and interpretations of the aspects that they can’t control, and ultimately, reassure them that the distress will eventually end. In essence, physicians can empower patients to take control over their distress, thus reducing their suffering.

Regardless of their chosen medical specialty, physicians will inevitably confront death, dying and suffering during their education, training and career. However, due to the curricular gaps in our current medical education system, future physicians are underprepared to hold such conversations with their patients. Indeed, one survey of medical students at two prominent medical schools reported that students received “little or no explicit educational attention to the suffering of patients and their families” or for the clinical management of suffering. Instead, the students learned these clinical skills primarily by ad hoc observation of role models. While ad hoc observation can be a powerful learning method, it could be much more effective when used in tandem with more formal instruction. Not only does this unpreparedness result in suboptimal care, but it may even harm patients, who can suffer more from not feeling heard, validated or supported when discussing their illness with providers.

Medical school curricula should be formalized to teach students how to face suffering and death in clinical practice. We advocate for a longitudinal educational approach: first, incorporating curricula on suffering and death in didactic pre-clinical education will afford students the opportunity to learn foundational concepts, such as how to address suffering and openly discuss death, in a safe space. Secondly, to maximize student learning in the pre-clinical years, lived experience panels and group discussions following the panels may also prove useful; composed of people who have direct, firsthand experience with a particular topic, lived experience panels offer a personal lens through which to view the issue. For suffering and death education, lived experience panels may include patients with terminal illnesses (and their families), palliative care specialists and people living with chronic diseases.

At the University of Texas Medical Branch, we attended such panels during one of our first-year medical courses and found them to be profoundly insightful. These panels deepened our understanding of what patients and families had experienced and demonstrated how providers could better acknowledge and support patients’ needs. Early exposure to formalized curricula on suffering and death through lived experience panels will encourage budding physicians to inquire about their patients’ values throughout all stages of their lives.

Patients deserve to live their lives with dignity. From our experiences, we understand that suffering may interfere with this and cause patients to lose hope. Medical education must address death and suffering early so that such conversations are normalized amongst medical students by the time that they reach the clinical years. By incorporating more instruction on how to acknowledge distress and suffering in medical school curriculum and by learning directly from patients and families, future physicians will be able to work with patients to find the best balance between quantity and quality of life.

Complete Article ↪HERE↩!

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First ever recording of moment someone dies reveals what our last thoughts may be

Does your life really flash before your eyes when you die?

By

What happens when we die?

Scientists may finally be in a position to answer that question after they recorded the brain waves of a patient as her life ended.

Crucially, they didn’t set out to capture this data – instead it ocurred by happenstance.

Researchers in the United States were running an electroencephalogram (EEG) on an 87-year-old man who suffered from epilepsy.

An EEG measures the electrical activity of your brain and, in this case, was being used to detect the onset of seizures.

However, during the treatment, the patient had a heart attack and died.

As such, the scientists were able to record 15 minutes of brain activity around his death. And what they found was extremely interesting.

Focusing on the 30 seconds either side of the moment the patient’s heart stopped beating, they detected an increase in brain waves known as gamma oscillations.

These waves are also involved in activities such as meditation, memory retrieval and dreaming.

We can’t say for sure whether dying people really do see their life flash before their eyes, but this particualar study seems to support the idea.

And the scientists say the brain is capable of co-ordinated activity for a short period even after the blood stops flowing through it.

‘Through generating oscillations involved in memory retrieval, the brain may be playing a last recall of important life events just before we die, similar to the ones reported in near-death experiences,’ said Dr. Ajmal Zemmar, lead author of the study, which was published in the journal Frontiers in Ageing Neuroscience.

‘These findings challenge our understanding of when exactly life ends and generate important subsequent questions, such as those related to the timing of organ donation.’

In the study, the researchers point out that similar changes in brainwaves have been detected in rats at the time of death.

However, this is the first time it’s been seen in a human.

Dr. Zemmar and his team say that further research needs to be done before drawing any definite conclusions.

This study arises from data relating to just a single case study. And the patient’s brain had already been injured and was showing unusual activity related to epilepsy.

It’s not clear if the same results would occur in a different person’s brain at the time of death.

‘Something we may learn from this research is: although our loved ones have their eyes closed and are ready to leave us to rest, their brains may be replaying some of the nicest moments they experienced in their lives,’ Dr. Zemmar said.

Complete Article ↪HERE↩!

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My dad’s final days

By Ken Dychtwald, Ph.D.

I grew up in the 1950s and ’60s in a mostly blue-collar community in Newark, New Jersey. My father, Seymour, was a fiercely hardworking guy who wanted to be successful. For him, work wasn’t about “finding his bliss,” it was about being a responsible husband and father. His dad had skipped out on him, his siblings and mother for almost 10 years during the Depression. In contrast, my dad was a reliable family man and wanted our family to live the American dream.

Ultimately, Dad rose from selling clothing and home furnishings out of the back of his truck to owning and operating a successful chain of women’s clothing stores. In their mid-60s, my folks retired and relocated to Florida.

Throughout my life, Dad and I had a loving but feisty relationship. He was very opinionated (I guess I am, too) and was skeptical of many of my lifestyle and career moves—from moving to California, from studying physics to the field of psychology and then to gerontology. But he had great love for my family and he eventually developed a deep respect for what I made of myself.

In the 1990s, my father started to lose his vision and with it, control over much of his life. Sadly, Alzheimer’s was also chiseling away at my mother’s mind. Dad loved Mom so much that he railed against the dissolution of her memory and her mind. He got depressed and angry.

“If I die before Mom, she’ll struggle terribly, and if she dies before me, I’ll go crazy. Just as we’ve lived together, we want to die together,” he said. That was quite a lot for me to digest.

One night, he asked me, “If I take my own life and Mom’s, would that be brave or cowardly?”

I said, “I don’t know, Dad. If I was in your situation, I can’t imagine what I’d think or do.”

So, for almost a year, every night I’d go to sleep not knowing if my parents would be alive in the morning.

In 2013, my brother Alan called me in a state of distress to report that our dad’s blood sugar was going haywire. And to make things worse, he’d lost his balance and fallen on his face, giving himself a big gash on his forehead. Alan was already on his way to Florida. I packed my bags and headed east.

Dad’s doctor admitted him to intensive care. He had internal bleeding and had suffered a heart attack. When he realized that his boys were there for him, he called out to us: “What’s going on? Get me out of here!”

Dad settled down a bit, and Alan and I went to see our mom. Later that night, the phone rang. It was Dad pleading with us to rescue him. 

We shot back to the hospital and went into our anguished father’s room. His arms, chest, face and hair were covered with blood because he kept pulling out his IV lines. In the morning, after a torturous night for both my dad and brother, and a sad night for me and for my confused mother, I returned to the hospital. Alan and I asked: “Dad, what do you want?”

“I’m scared,” he said, “but I know this: I’ve lived my whole life on my own two feet, and I’m not going out on my hands and knees. Please help me bring this to an end.”

Shortly after, Alan and I met with Dad’s physician. He was a kind and decent man who asked us if we wanted our dad to remain in intensive care or if we preferred to shift him to hospice car
Were we going to battle to keep Dad alive for a few more days, albeit in a ghastly, ghoulish fashion? Or were we prepared to make him comfortable and allow him to die a good death? 

What would he want us to do?

We had Dad transferred to the hospice floor, where the nurses and aides removed all the wires and tubes, lovingly sponged all of the blood off him and even gave him a shave and combed his hair. They asked him what his favorite music was and then put on Frank Sinatra.

Next, they began a low dose of morphine to ease his anxiety. My wife and kids all dropped what they were doing to fly to Florida and be with him.

As I contemplated the end of my father’s life, I reflected that even though we had often butted heads, there was not one instance in my entire life when he wasn’t there for me when I truly needed him.

I wanted to show Dad proper respect and kindness, but not knowing how I should handle the situation with my dad nearing his death, I called one of my closest friends, Stuart Pellman, who had already dealt with the death of both of his parents.

He wisely told me, “Get one-on-one time with your dad. Even if he’s unconscious, tell him you love him, ask him to forgive you for anything you may have ever done to trouble him. Tell him you forgive him for anything he might have ever done to upset you, and then tell him you’ll always remember him.”

And that’s what I did.

Dad and I held each other for a long while, and then I left the room and allowed my brother some privacy to do the same.

Later that night, after the other members of my family had gone home, I joined my dad for a very intense and private conversation.

I said, “Dad, you’ve never asked me what I think happens when a person dies.”

“I’d like to know what you think about that, Kenny,” he responded. “Because I’ve begun to see my brothers and sister and they’re reaching out to me.”

My dad had no religious beliefs, but I had some. So I said, “Dad, I don’t know this for sure, but I believe when a person passes, there is another plane that presents itself. In that place are all the people you have known and loved.”

As I began to describe this, he started to cry. Then he turned toward me and told me he was ready.

I asked him if I could record the rest of our exchange on my phone so I could always have it to watch when I missed him. He said okay, and this is what transpired:

Ken: “Dad, you know that what’s going to be next is going to be beautiful and your vision’s going to be back and you’re going to be a young man again.”

Dad: “I’m ready for that, Kenny.”

Ken: “And you know we all love you, and you’ve always loved us.”

Dad: “I know it, Kenny.”

Ken: “So, what you’ll need to do is let go and not worry about anything because everything is going to be looked after. All we need is for you to be relaxed and calm and just drift off into the white light. Can you do that, Dad?”

Dad: “Absolutely.”

Ken: “I love you, Pops.”

Dad: “I love you, Kenny.”

My father died peacefully that night. With help from all of us, he went out on his own two feet.

Ultimately, even with all his frustration and anger, my dad died a good death. At the end, his pain was minimal. His mind was calm. He found a way to think about leaving his body as not being frightening. And although he had been blind for years, at the very end, he began to describe beautiful waterfalls, flowers, birds and castles.

When my time comes, I hope that my wife Maddy will kiss me goodbye and at least one of my kids—maybe even both—will be there to lovingly guide me out of my body.

Complete Article ↪HERE↩!

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Yellowknife teacher’s final lesson

— How to live a good death

Maureen Tonge at a Kundalini Yoga Retreat in October 2019 on the Greek island of Karpathos.

Maureen Tonge’s death from cancer at age 52 offers friends and family a window on how to live and die well

By Joanne Stassen

Maureen Tonge’s living room looks out over the houseboats on Yellowknife Bay. She’s sitting in a comfy chair by the window, wrapped in a cozy blanket.

“I’m in the end stages of my life,” she says matter-of-factly. “Yep. I’m dying.”

It’s Sept. 16. Three weeks from now, Maureen will die at home, with her husband Robert Charpentier, her sisters and her parents, by her side.

The way she wanted it.

But on this day, with the warm autumn sun lighting up her face, she wants to talk about dying, while she still has the strength and memory.

Tonge has taught at École Sir John Franklin High School in Yellowknife since 1992.

In the last decade she’s shared her Kundalini Yoga practice with people in the North and around the world.

Her family and friends say she’s taught them how to live a good life, and now, to die a good death.

‘I would prove them differently’

Tonge was diagnosed with glioblastoma multiforme in February 2019.

Doctors gave her four months and said she wasn’t likely to see the end of 2019.

Those giving the prognosis had no idea who I was … so I would prove them differently.
– Maureen Tonge

But Tonge wasn’t giving up that easily.

“I indicated to everyone who would listen that I was not my diagnosis nor my prognosis,” she told CBC North Trail’s End host Lawrence Nayally at the end of 2019.

Tonge went through chemotherapy, but also followed her own less conventional path, working with a naturopath, and with other healers. At diagnosis, the tumour was bigger than a golf ball, but a bit smaller than an egg. Ten months later it was more like a quarter of a marshmallow.

“Those giving the prognosis had no idea who I was,” she said.  “So I would prove them differently.”

Welcoming death

By June this year Tonge begins to feel pressure between her eyes, jitters and dizziness. A scan shows the tumour has grown aggressively.

By mid-September trips to the bathroom require a supportive arm. She has trouble keeping track of conversations.

“I’m pretty low functioning now,” she says. “It has been a bit of a struggle to wrap my head around the fact that has changed so dramatically.”

But the transition from fighting death, to accepting it, has become easier.

“It’s not been a struggle to wrap my head around the fact that I am dying. Dying is an inevitable part of living. I’m welcoming it.”

Teaching about life, and death

Maureen’s sister-in-law, Kathleen Charpentier has been helping with Maureen’s care and says hearing that gives her a lot of comfort.

“We live in a culture that is death-phobic and grief illiterate,” she says. “We often make the demand of dying people to live, and I think that’s a very hard demand.”

Eleven days before her death, Maureen’s condo is quiet, but there is still laughter, and a fridge full of food from friends. Hundreds of people have been posting on Maureen’s Facebook, sending messages of love and appreciation.

Maureen’s twin, Kirsten Tonge, has come from British Columbia, and soon her parents and two other sisters will be there, thanks to a special exemption from the territory’s chief public health officer.

Kirsten describes their relationship as “halves of the same whole” and remembers cuddling up with Maureen on the gurney, when they got the news that the tumours were growing again.

Their bond goes back to the womb, but Kirsten says she’s not sure she will ever understand the grace and gratitude her twin shows in the face of death.

“Earlier this month she said to me ‘I’m healing you know … it’s not the end.'”

Kirsten believes Maureen was talking about spiritual and emotional healing of trauma from her childhood.

“You know she had some deep wounds to her spirit, and emotionally. And she’s been able to truly dig deep and use the resources she’s built, and heal herself with the love and support of so many people.”

Former student Cailey Mercredi is there to give Maureen a massage.

“She’s taught me papier mâché mask-making and then Kundalini yoga,” Mercredi said. “To say she’s taught me about love would be an understatement.”

She added that being part of Tonge’s journey toward death will stay with her forever.

“Vulnerability and the trust there, is what brings us closer as human beings. This is how we make connections and how we build community.”

It’s just hard. Knowing I’m saying good-bye, and a part of me feeling entirely ready. And another part of me, not.
– Maureen Tonge

Tonge says she can’t say how she got to a place of peace about her death, but that it has been a process, something she’s been building toward through her life.Having people around her has been essential.

“I’m so grateful that I have family here but also friends that are like family. Connections have always been really important to me.”

For her sister-in-law Kathleen, sharing in Tonge’s last days is a gift.

“I think when you share your death, you are teaching others,” Charpentier says. “I think it’s important. Because we’re all going to be there someday.”

‘There is zero fear’

Tonge says she doesn’t know what happens after death, but she’s not afraid.

“Absolutely not,” she said. “There is zero fear. I know that we are composed of energy. And I don’t believe energy can be created or destroyed.”

She does feel sadness and it wells to the surface when she thinks about the ones she’s leaving behind.

“It’s just hard,” she says, between tears. “Knowing I’m saying good-bye, and a part of me feeling entirely ready. And another part of me, not.”

Two things bring Tonge comfort: Having no regrets, and the hope she has for her family and friends. It’s an echo of what her students of art and yoga have always heard from her: “I just hope that they are able to tap into their richest opportunities, and take full advantage of that.”

Kirsten Tonge says losing her twin will be the “the most difficult loss.”

“She has taught me that this time is only one of many … it’s not the final chapter,” she said.

“She may be gone in the physical sense … but I know without a doubt that her love will always be with me, and my love will always be with her.”

Complete Article ↪HERE↩!

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Social Isolation a Threat to Hospice Patients During COVID-19

By Holly Vossel

The threat of COVID-19 has forced many providers to keep high-risk seriously and terminally ill patients isolated to limit the virus’s exposure and spread. As families become disconnected from loved ones approaching the end of life, hospice providers have sought new ways to offer mental health support during the pandemic.

Social isolation during the coronavirus emergency has substantially impacted the hospice population, as well as seniors in general. Research has identified significant links between social isolation and increased risk of early mortality among older and seriously ill patients.

According to a recent report from health insurance marketplace company GoHealth, the pandemic has been driving a mental health decline among isolated aging populations as they practice social distancing from family and friends. In a nationwide study of 1,000 Medicare beneficiaries, 25% percent reported a decline in their mental wellness since the pandemic’s onset, and more than 90% felt lonelier now than before it began.

“Social isolation from friends, families and even their hospice providers visits, has impacted the mental health of hospice patients,” said Shelley Cartwright, executive director of Illinois-based Apex Hospice and Palliative Care. “Social isolation contributes to a decline in mental health. Depression, anxiety, and delirium in those who are terminally ill are frequent and currently most likely under-diagnosed as hospice frontline personnel are not being allowed to make in-person visits as frequently as they normally would as patients, families, hospitals and skilled nursing facilities are in COVID-19 precautions.”

Hospices have struggled to find a balance between technology and the human touch while offering telehealth visits and online virtual support. With families often connected only virtually in the last moments of life, disenfranchised grief has added to concerns of ramping up mental health support.

“Dying is inherently lonely and isolating and made worse when people are actually removed from their loved ones,” said Christopher Kerr, CEO and chief medical officer of Hospice & Palliative Care Buffalo in New York. “It’s ultimately a closing of a life, not just a medical phenomena, and that life is defined by relationships. The pandemic has taken a difficult situation and made it multiple times worse. It’s in moments of crisis and need that we need to connect ourselves to those people that give our life meaning. The opposite happened that when we most needed to be reconnected to those we love, we were removed.”

The sweeping effects of isolation has drawn heightened focus from hospice providers on the need for greater communication and deeper integration of psychiatric care. Research from 2018 projected that the number of seniors with mental health conditions will triple over the next three decades. An estimated 5 to 8 million aging Americans currently suffer from mental illness. Providers have been working on improving hospice access for these patients.

With facilities and hospitals limiting interactions, social isolation has exacerbated mental health concerns as hospices face barriers to reaching patients during the pandemic. One strategy being employed is increased collaboration with referring facilities, psychiatric disciplines and primary physicians as hospice work to support isolated patients and their families.

“We believe that no one should have to face serious illness or death alone,” Carla Davis, CEO of Heart of Hospice, told Hospice News. “Holistic, person-centered care delivered by hospice care teams plays a critical role in protecting and improving the mental health of vulnerable populations who would otherwise be left in isolation. The more we are able to work diligently alongside our facility partners to continue providing quality care, the better equipped we will be to prevent negative mental health outcomes in individuals facing serious mental illnesses.”

As COVID-19 cases and fatalities continue to climb, so does growing concern among hospice providers over the effects of isolation on the quality and experience of end-of-life care.

“Patients, even though imminent, often fight death until they are at peace and have said their good-byes or receive permission from their family to ‘let go,’” Cartwright told Hospice News. “Quality end-of-life experience and death for patients and their families is, and will be, jeopardized with the continued isolation of dying patients from their families.”

Complete Article ↪HERE↩!