Cooley 1Ra’Quayle L. CooleySusan LesterAdv. Lit/ Comp.26 September 2011 Hospice: Caring for the Elderly and Terminally Ill “For 20,000 Washingtonians every year, hospice is an end-of-life care option thatprovides dying patients and their loved ones with comfort, compassion and dignity” (Neuberger4). Hospice is a care facility for individuals who are terminally ill. Hospices all across the worldtend to focus on the care of the individual and the philosophy of care for the individual throughpalliative care. Hospice care has been seen as an institution were an individual can die peacefullyin his or her own home. Hospice care however is not just limited to those who are terminally ill.It is also for the elderly, mentally incapacitated, and for those who are in need of assistance.However inrecent years a hot topic issue is the care of the very individuals who are the elderly,mental incapacitated, and those who can’t assist themselves. As a result, care facilities such asnursing homes, retirement homes, and even hospices have been under scrutiny for the care thatthey are giving these individuals. It is not uncommon for nanny cams to be placed in anindividual’s home by the family of an elderly citizen who is being suspected of being abused bythe care facilitator. The burning question for many individuals is that “Have the care for thosewho are incapacitated, elderly or can’t fend for themselves have been compromised by the veryindividuals who care for them? If so has this been a direct affect from Western Civilization andmedical practices implemented?”
Cooley 2 The first thing to remember with medicine is that the patient always comes first. Aquestion that many ask is “How have a doctor’s prognosis been compromised when working in acare facility?”With the condition of the elderly in the United States along with the mentallyincapacitated and individuals who can’t physically help themselves in facilities like a nursinghome, psyche wards, or even in a rehabilitation facility it is very common for doctors to beresponsible for more than fifty patients at one time. In facilities such as a nursing home whereelderly patients are in need of physical rehabilitation are prescribed drugs by doctors can beoverwhelmingly dangerous just as Cruikshank points out, “Although adverse drugs reactionsaffect the old who live independently or with families as well as those who are institutionalized,the problem is especially serious among nursing home residents. Since this population is largelyfemale, the problem of overmedicating in nursing home residents is a woman’s issue. Somedrugs have similar names, resulting in mix-ups. Many falls in nursing homes result fromovermedication”. (Cruikshank 5). The issue with doctors seeing 50 elderly patients at one time isthat the doctor might overmedicate the patient without even knowing that they did. This is aresult of more than one doctor prescribing one patient at one time due to the lack ofcommunication that exists between them. A simply way of fixing this issue is passing a state lawthat requires for doctors to double check their patients records and current medication. By doingso and having doctors ask their patients if they are currently seeing more than one doctor willgreatly reduce the risk of the patient overdosing from overmedication. Granted that many doctorsmake medical errors when prescribing medication that could be potentially fatal to the patient agrave mistake that is very common is when doctors often overlook signs and symptoms ofpatients that have fatal illnesses. What isn’t a shock to most individuals is that out of any groupof doctors the ones that make the most medical mistakes are the generally the ones that just
Cooley 3graduated from medical school. As a result some states are beginning to pass laws that requirephysicians to obtain more sleep at so that less medical errors are being made on the job. As thePhiladelphia Inquirer points out in the article New rules prescribe shorter hours for youngphysicians the author, Gregory Thomas, states that “The mandate is billed as a means ofenhancing patient safety and residents quality of life by reducing physician fatigue and errors.But it will also boost hospital costs and further reduce the long hours that some doctors believeare critical to learning”.Doctors often make mistakes for various reasons some of the top reasonsthey make mistakes when making a prognosis with a patient is that they miss common signs.They are often overwhelmed and stressed because as a doctor they feel the need to not make amistake. In their profession it has become a dangerous liability to have too many mistakes withpatients which could lead to a malpractice suit or even worse--- being forced out of practice.Being blacklisted as a doctor and being forced out of practice is just some of the consequencesthat can end a doctor’s career. Some of the mistakes doctors make are not always medicalmistakes but are often sometimes thinking mistakes that can mentally blocking them frommaking the correct prognosis for their patient. This can be extremely potent in their field,especially when they are working with elderly or mentally disabled patients that are unable tocorrect doctors on simple mistakes that they might make with their patient. A common mistakein this area is not discussing preventative measures to elderly patients.Most doctors believe,“Why should I prescribe this patient medication to lower their cholesterol when their health isalready failing?” The fact of the matter is that every patient can and most likely will benefit fromany programs or medication that the doctor places them on. Usually, it is common for doctors tosee elderly patients who are often on multiple medications and don’t know about their patients’medical history. One way to prevent the doctor from making a mistake with elderly patients is to
Cooley 4have a relative or care-taker that is current on the individual’smedical history. By doing so, thiswill make the physician more aware of the patient’s medical history and as a result the physicianwill make less medical errors when speaking with the patient. While some mistakes such asprescribing the wrong medication and not being knowledgeable on the patient’s history isprimarily the doctor’s fault. What is even worse is the medical quick fix that can often be out ofthe doctor’s control. Americans, now more than ever have be known for wanting to have amedical quick for their health, especially the elderly. Secondly, compared to other countries and cultures, America, has been known forwanting to quickly solve things and move on to another topic. To many it seems that this hasoccurred in medicine as well. The number one question that is being asked is “How has the directlink between Americans wanting a quick fix (prognosis) and the elderly affected the quality ofcare for individuals in facilities like hospice?Many hardworking Americans place their healthaside and commonly choose to use over-the-counter drug prescriptions for diseases such as thecommon cold, the flu or something as a mild as the chicken pox’s.However what are the sideeffects to the elderly when the beginning to use over-the-counter medication along with theirprescribed medication. In a CNN report, Dr. Donna Fick, stated that “The number of prescriptionmedications an older person takes is the strongest predictor of their risk for future drug-relatedproblems” (Harding). A common problem for elderly patients and taking medication is that inconjunction with already taking their medication they also take over-the-counter medication. Forexample a common medication that people over the age of 57 to 85 take is warfarin. Warfarin isoften used as an anti-coagulant to prevent blood clots from forming or growing in the blood andin the vessels. If warfarin is used along with aspirin the two medications will counteract eachother causing the patient to severe bleeding hemorrhoids. A great alternative to having elderly
Cooley 5patients on different medications that could cause them unnecessary pain and suffering is to havethem talk to their doctor and ask questions about what type of medication is acceptable to takewhile there are on certain medications. Another issue with the elderly taking their medications isnot the fact that they are mixing medication with nonprescription medication but rather that theelderly are overdosing on their medication. As a result of overmedication some elderly patientsexperience a likelihood of “falls and metal confusion, but nondrug therapies can help reduce theuse of such medications” (Harding). The major issue with elderly patients overdosing onmedication is that it can not only cause them become disoriented and confused but it can alsoincrease the decline of the health. Many doctors or nurse practitioners would often tell theirelderly patients to take it easy on their medication. Elderly patients should at all times take theirmedication with supervision of their caretakers and should also be advised to not take more thanprescribed daily amount. A lasting issue with elderly patients consuming their medication is theissue of adverse and inverse reactions that comes along with overdosing on mediation Hardingpoints out that, “while any single drug might help people live longer, healthier lives, expertsworry that combination of drugs, along with over-the-counter products and dietary supplementscould be a recipe for disasters in terms of drug interactions. Statistically, one in three Americanadults’ ages 57-85 are taking at least more than five prescription drugs a day. In nursing homes,if the wrong medication is given to an elderly patient by an orderly an adverse reaction couldoccur that could result in that patient’s death. A solution to that problem is to always have thepatient double check their names on the medication bottles when they are asked to take theirprescription this will also cause them to have a daily ritual with knowing what medications theyshould be taking. This will cause them to become more aware as to what type of prescriptionthey are supposed to be taking. For the purpose of teaching the elderly of how to properly take
Cooley 6their medication a topic that should be discussed is the caretakers who help them take theirmedication. Lastly, the most important thing to remember with healthcare and the elderly is thequality of healthcare they might receive. Another question many might ask is “How has thequality of palliative care compare to other countries around the world in facilities likehospice?”Considering that, death, is treated and looked upon with much respect. However manyindividuals question the amount of respect many Americans have for death. As Julia Neubergerclaims in her article, Caring for the Dying is inadequate in Western Society, she writes that Jewsand Muslims “tend to argue for doing everything to keep people alive, life itself being seen as themost precious divine gift”.A concern for many individuals who place their loved ones in aHospice facility is that they will not be treated with the utmost care as far as their spiritual andmental well being is concerned. Daily prayers and customs from different religions have becomecompletely unrecognized for some individuals who are devote Christians, Buddhists, Jews, andeven Taoist. A simple solution to this problem is for the caretakers to undergo extensive trainingabout different religions. By having the caretakers undergo extensive training on differentreligions the will have a better understanding of how to treat patients from different religions.With a concern to different religions around the world and patients who belong to those religionsis the concern of how those patients will die. How one individual might view death will severelydiffer from another person. Kevin Irvine states in his article that the, “quality of life means onething for someone who is 42 and has been battling full-blown AIDS for five years, andsomething entirely different for a 22-year-old with a spinal-cord injury may live 60 more years.Different individuals from different religious backgrounds have various perspectives. As a result,many people want to die differently. Family member or even caretakers can speak to their loved
Cooley 7about their last rites and talk openly about their last days. Death is rite of passage for all humanbeings and should not be revered because it is something that is unknown. More importantly,when an elderly patient in a hospice facility is preparing their last moments some of them mightchoose instead to go to a more controversial route, assisted-physician suicide. For some, it givesthem a sense of control over their last moments when they have long battled cancer and knowingthat they will die soon. As Kevin Irvine points out in his article, “While some people with full-blown AIDS will not "get better," others with nonterminal disabilities will have symptoms andlife situations that wax and wane. One man with multiple sclerosis said he was seeking the so-called [euthanasia] services of Dr. Jack Kevorkian to avoid having to go into "a rat-infestednursing home”.The issue with the elderly and physician-assisted suicide is that some of theelderly are often not in a healthy-state of mind. Most often they will choose to opt for physician-assisted suicide instead of having to slowly die in a hospice facility or worse in a nursing home.An elderly patient should always speak with a psychiatrist and their doctor before they considerthe decision of physician-assisted suicide. Most often, elderly men and woman choose todecision because they feel neglected in some manner. The issue of euthanasia and the elderlywill always be present especially with those who are in hospice facilities. With the many controversial issues that are in the medical field it is still worth the risk ofbecoming a doctor. Most often the issues in the medical field are commonly moral issues such asabortion, euthanasia, and even religion. Once an individual takes an oath as a doctor or becomesa certified register nurse they have a moral obligation to aid the sick, dying, and disabled. Themedical field is not a career option for some who is strongly religious and is set against abortionbecause as a doctor that they will encounter female patients opting for abortion. For someindividuals the medical field can and will compromise their faith, morals and who they are as an
Cooley 8individual human being. As long as some one remembers not to sacrifice who they are as aperson anyone can become a doctor or nurse.
Cooley 9 Works CitedCruikshank, Margaret. “The Elderly Are Being Harmed by Overmedication .”Gale Opposing Viewpoints in Context.Ed. Sylvia Engdahl.GreenhavenPress , 2009. Web. 12 Sept. 2011.Harding, Anne. “Mixing Multiple Medications Causes Health Problems for Elderly Americans.”Gale Opposing Viewpoints in Context. CNN, 23 Dec. 2008. Web. 3 Oct. 2011.Irvine, Kevin. “Legalizing Patient-Assisted Suicide Would Lead to Patient Abuse.” Gale Opposing Viewpoints in Context.Ed. Gail N Hawkins.Greenhaven Press, 2002. Web. 11 Sept. 2011.Neuberger, Julia. “Caring for the Dying Is Inadequate in Western Society.” Opposing Viewpoints Resource Center.Ed. Andrea C Nakaya.Green haven Press, 2005.Web. 12 Sept. 2011.Thomas, Gregory. “New Rules Prescribe Shorter Hours for Young Doctors.” Gale Opposing Viewpoints in Context. Philadelphia Inquirer, 1 July 2011. Web. 2 Oct. 2011.