End of life care for elderly in united state Essay Example

  • Category:
  • Document type:
    Research Paper
  • Level:
  • Page:
  • Words:


End of Life Care for the Elderly in the United States


The United States has an ageing society just like the rest of the world. The number of ageing population between the years 2000 to 2050 is projected to rise by about 135 per cent (Wiener, 2016). In addition, the number of old individuals of 85 years and above is projected to rise to about 350 percent between 2000 and 2050 and they are the group that urgently requires both health as well as long-term care services (Wiener, 2016). Therefore, over this time frame, the population that is over the ages of 65 years in the United States will increase from 12.7 percent in 2000 to 20.3 percent in 2050 (Wiener, 2016). Therefore, there will be a high demand for healthcare services for the elderly in the United States.

End-of-life care relates to healthcare that is not only provided to patients at their final hours or days of their lives, but also to patients with a terminal sickness or a disease that has become advanced, progressive and incurable (Tucker, 2015). In addition, end-of-life care refers to health care that is provided to the elderly who have no capacity of taking care of themselves. This kind of care necessitates a wide variety of decisions such as queries of palliative care, medical experimentation, the ethics and efficiency of extraordinary medical interventions as well as the patient’s right to self-determination of treatment or even life (Tucker, 2015). These decisions are communicated both by the technical, economic as well as medical considerations factors such as bioethics. Furthermore, end-of-life care are subjugated to concerns of patient autonomy, which is determined by the patient as well as their families that influences their choice of either pursuing aggressive treatment or rather pull out the life support (Tucker, 2015). Therefore, this research paper will consider the ethical, legal and social integration regarding end-of-life care for the elderly in the United States. It will also evaluate their contribution and the wider health context for quality Improvement. Finally, it will discuss the implications for healthcare in relation to clinical and corporate context.

Evaluation of End of Life Care

There is nothing such as the “right” place to die. However, the hour of need approaches, individuals are hence obligated to arrive at a conclusive decision where they would prefer receiving end-of-life care (Giovanni, 2012). This decision ought to be thought out very carefully since it has both pros and cons to both at home as well hospital care. The majority of the elderly in the United States prefers care at home as their primary option (Tucker, 2015). This choice allows the family spend a considerable amount of time with the dying individual together. Furthermore, the majority of people also prefer being surrounded by things they recognize and treasure at their final hours. This choice will necessitate a member of the family to provide care to the afflicted which can be very difficult since they may not be trained to offer such services (Valente, 2016). Therefore, they need to hire a professional nurse to take care of the elderly, which comes at an extra cost for it is not covered in the insurance.

On the other hand, end-of-life home care for the elderly is also considered a very costly choice since the patient will need special equipment as well as numerous medications and a caregiver who checks on them at all times (Joshua and Wiener, 2003). Furthermore, this option also will necessitate the arrangement of a doctor’s appointment from time to time to check on the elderly. In addition, hospital end-of-life care in the United States is also another option majority of individuals prefer. This is because it is beneficial since it can be paid via insurance. In this case, the patient can be reassigned to the intensive care unit where he is supported with machines until the family members collect and say their goodbyes (Joshua and Wiener, 2003). Evaluation of end of life care can be analysed in different perspectives including ethical aspects, legal and social aspects.

Ethical Aspects

There is a wide range of various ethical and moral positions as well as arguments surrounding the matter of end of life care to the elderly in the United States. End of life for the aged in the United States has been impacted with issues such as: lack of resources; financial barriers; scarcity of providers; and cultural barriers and biases (Ludwick and Silva, 2003). There are numerous ethical challenges that can be talked about from these issues although the ethical challenges that really stands out is cultural biases. This is primarily because nurses can examine them in person and alter them in their day-to-day practices (Ludwick and Silva, 2003). Nurses dealing with the elderly fall to stereotyping and therefore, must analyze their beliefs as well as values regarding aging.

Coolen (2012) covers some of the ethical challenges regarding end of life care for the elderly in the United States health care system. First, the individual ethical implications of this topic may be omitted. Therefore, the author comments on the ethical responsibilities nurses have to train the public and simultaneously keep themselves well-informed about long-term care. In addition, the ethical concerns regarding the care of the elderly in their final hours examines consequent challenges such as resource allocation and end of life care to the elderly (Ludwick and Silva, 2003). For instance, medical practitioners have found circumstances where they are persuaded to go against the wishes of the dying person such prolonging or even commencing on a treatment, particularly when it was against the wishes of the dying individual (American Nurse Association, 2001). In this specific case, numerous queries arise such as: have we been in a circumstance where we failed to inquire on the type of care the dying individual needs?

Furthermore, Ludwick and Silva (2003) point out the behavioural component of successful aging. Ethical queries regarding both responsibility and preference of an individual client can be pointed out about their lifestyle choices although, the ethical queries may not seem as apparent. For instance, how often do we talk about exercises, cognitive activities as well as religious beliefs with the elderly?

Legal Aspects

There are a number of view-points when it comes to legal matters surrounding end of life care for the elderly in the United States. Advanced care planning entails conceiving decisions for ones’ future. It entails conversing with people who are closest to you such as a partner, doctor or family (Mion, 2003). Therefore, these advanced plan conveying inclinations concerning treatment can guide both families and healthcare professionals representing elderlies who have no capability of expressing themselves and making decisions for themselves. Therefore, under the Mental Capacity Act, it is currently probable to establish on record ‘advanced decisions’ so as to reject particular treatments in specific situations (Mion, 2003).

In legal aspects, the National Council of Palliative Care has come up with a summary guide noted down with patients’ relatives as well as their healthcare representatives in mind which is inclusive of other health and social care staff (Young, 2003). The issue offers information regarding the Mental Capacity Act as well as its effects on end of life care of the elderly and also comprises of a number of checklists. Furthermore, end of life care for elderly in the United States is also necessitates that if an individual decides to make an advanced decision of rejecting long-term care or treatment that is rendered life sustaining (Young, 2003), it ought to be in writing, signing and also witnessed. Additionally, if an elderly opts for a representative during their final period or they have a Lasting Power of Attorney, they are obliged to have their name put down in writing. The elderly are also encouraged to pursue advice from an experienced medical and healthcare professional especially when arriving at an advanced decision to reject treatment (Young, 2003). Furthermore, in the United States, an elderly is obliged to provide copies of wishes to those who are required to know such as a family member, caregiver, doctor or even a nurse.

Social Aspects

Social factors can also influence the views of individuals about phenomenon of death and dying. Such factors include: age, gender as well as social attitudes to death (Dying Matters, 2011). First, age influences end of life care to the elderly since a majority of young adults as well as adult individuals in the United States favour being cared for at the privacy of their home as long as they are offered high quality care and at the same time they are not as much burden to their family members or their caregivers (Dying Matters, 2011). However, studies conducted in the United States have indicated that a number of individuals, particularly the elderly of 65 years of age and above who stay by their own wish to remain at home for the longest time possible, though they would like to die elsewhere so that they are not alone at that time (Dying Matters, 2011). Therefore, the approach to death as well as dying can vary over the course of an individual’s lifetime. Therefore, as individuals grow older, the perspective of death becomes more relevant and individuals may become less comfortable conversing such matters.

In addition, gender is another social factor that affects end of life care for the elderly. Gender is an element in how individuals perceive death and dying since studies have indicated that elderly females are greatly worried about being a burden to their families as well as their caregivers (Bennet and Flaherty-Robb, 2003). On the other hand, elderly males worry more about the fiscal effects of their end of life care for their families. Moreover, social attitudes towards death also affects end of life care to the elderly in the United States. Individuals tend to live longer and often spend their final hour in the hospital or hospices. Therefore, the aspect of death has become ‘hidden’ in today’s society. It is often removed from day-to-day life and therefore people become more hesitant to talk about it or even strategize for it (Bennet and Flaherty-Robb, 2003).

Quality Improvement to End of Life Care

There are numerous clinical challenges underlying end of life care for the elderly patients. However, there are lots of interventions that clinicians perform in order to deal with the emotional as well as the physical symptoms of an elderly patient at the end of life (Kayser-Jones et al., 2003). First, avoidance of clinical nihilism for instance, avoiding to think that there is nothing left to be done. Most at times, families often value a physician for simply listening to their worries more than any other particular physical intervention (Coolen, 2012). Such approach will enable physicians offer better and personalized care to the elderly patient’s needs and concerns. Therefore, the clinicians can provide a sense of reassurance by letting the patients know what to expect and promising not to abandon them at the end of the day (Bennet and Flaherty-Robb, 2003).

Secondly, the matter for physicians taking care of elderly individuals is to remember that even at the end of life, there are some conditions that can be treated in order to enhance the quality of life (National Institute of Aging, 2016). Primary care physicians who offer care to the elderly ought to ensure that they cover each of these areas for example, structuring a process of care. The work of caring for elderly individuals should be done by a multidisciplinary team which can assist in distributing the numerous tasks of this work in order for the staff can assist each other in difficult moments (National Institute of Aging, 2016). Moreover, this interdisciplinary structure identifies that the end of life care for the elderly is connected with substantial personal burdens for the caregivers.

Most individuals wish to die in their homes, although a majority of them in the United States end up dying in a hospital (National Institute of Aging, 2016). Therefore, to improve the end of life care for the elderly, caregivers should educate staff members, recognize and evaluate the individual who require care, enforce care pathways and ascertain access to specialist palliative care teams (National Institute of Aging, 2016). Such care has to fit the requirements of the elderly who most at times have illnesses such as cardiovascular illnesses, sensory loss and arthritis to name a few. Therefore, coping with these numerous requirements within the hospital setting requires both skill and great team work between experts for instance, geriatricians, pharmacists, dieticians, oncologists, palliative care clinicians, nurse as well as social workers (National Institute of Aging, 2016).

A systematic literature review has indicated that hospital palliative care teams are effective in enhancing symptoms as well as other problems. Therefore, it is essential to scrutinize how such a multidisciplinary palliative care teams formulate over time and how they contribute offering care in both the hospital setting as well as the home care support service (Hartman-Stein and Potkanowicz, 2003). Additionally, in the United States, there is a lack of state funded infrastructure for the care of the elderly, which leads to a great deal of burden to families. Informal caregivers most at times are not well-equipped to manage pain and also control other symptoms (Young, 2003). Therefore, policy-makers in the United States have to come up with initiatives that cover the domain by offering intensive home support, offering support for families as well as measuring and addressing risk factors in order to increase high quality care at home until the end of life (Mion, 2003).

Implications of End of Life Care

End of life care for the elderly requires improvement. Elderly patients regarded five factors to be essential in order to maintain a “good” health even in their final periods (Kayser-Jones et al., 2003). These factors are: managing symptoms, attaining a sense of control, strengthening of relationships, avoiding prolongation of dying and dismissing burden placed on the family. Advanced care for the elderly has brought about numerous benefits to the healthcare society because it entails preparation or end of life care and death, strengthens personal relationships, frees burden bestowed on families and also the informal communication of the future wishes (National Institute of Aging, 2016). Therefore, if advanced care is performed carefully by trained non-medical staff, it will improve the end of life care of the elderly by allowing the wishes of the elderly patients to be determined, documented as well as being respected at their final period.

In addition, the emotional distress as well as other pressures underlying the situations where elderly patients are coming to their end of life sometimes results to misunderstandings as well as conflict between physicians, the patients and those close to them (Bennet and Flaherty-Robb, 2003). Therefore, with end of life care, this phenomenon can easily be evaded via early, sensitive discussion as well as planning about the most appropriate methods of taking good care of the elderly patients. Additionally, end of life care to the elderly also offers professional and special pain and symptoms management permitting the elderly to be as comfortable and as pain free as possible (Valente, 2016). Also, it cares not only for the elderly patient, but also for the whole family unit who share a significant relationship with.

In addition, from recent studies, individuals who are subjected to end of life care tend to live longer than those that aren’t subjected to such treatment (Joshua and Wiener, 2003). This is primarily because when subjected to such treatment, their health issues such as cardiovascular diseases can be monitored easily and attended to at the right moment. Furthermore, end of life care can be beneficial to the clinicians since it develops a multidisciplinary team of well-informed specialists as well as volunteers to adequately offer care for individuals as well as their elderly loved ones (Hartman-Stein and Potkanowicz, 2003). Another implication end of life care has is that it is a very cost effective substitute for extreme hospital costs and traditional institutional care. Therefore majority of people in the United States prefers end of life care for their elderlies since it provides both financial relief as well as the burden to the families afflicted (Young, 2003).


To sum up, paying attention to health care policies or the conflicted policies, when it pertains end of life care for the elderly, it is the crucial duties of every health care specialists. In discussing the level of variations essential to enforce cost effective, ethically considerate, legally as well as socially acceptable variations in the end of life care. There are numerous instances of great work being done performed with respect to end of life care of the elderly across the United States that have nothing to do with both the policies as well as the federal government intervention therefore these attempts should increase and continue. Healthcare specialists should understand that they have power on two different levels, that is, as individuals and as specialists. So, when it comes to end of life care for the elderly, healthcare specialists have the ethical duties to help the elderly patients get the care and life they deserve in their final days of their lives, and in a majority of instances that may demand helping them to die respect at the place of their choice and appreciated with those they loved for a life-time. Additionally, nurses, professionals and other health care specialists in the United States have the ability, power and knowledge to assist shape novel regulations and laws when it comes to end of life care. Moreover, in order to ensure that end of life care to the elderly is properly executed, physicians have to avoid any form of clinical nihilism for instance, avoiding to think that there is nothing left to be done. They also should introduce an interdisciplinary team that would help them take adequate care of the elderly at their final periods. Furthermore, caregivers should also educate their staff members so that they gain the skills to offer help to those that require it. Finally, end of life care has implications such as: managing symptoms, strengthening relationships, dismissing burdens to families and attaining a sense of control.


American Nurses Association. (2001). Code of ethics for nurses with interpretive statements. Washington, DC: American Nurses Publishing. Retrieved 7th Sept. 2016 from www.nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/EthicsStandards/CodeofEthics.aspx

Bennett, J., & Flaherty-Robb, M. (2003). Issues affecting the health of older citizens: Meeting the challenge. Online Journal of Issues in Nursing, 8(2), Article 1. Retrieved 7th Sept. 2016 from www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume82003/No2May2003/OlderCitizensHealthIssues.aspx

Coolen P. R. (2012). Cultural Relevance in End of Life. Retrieved 7th Sept. 2016 from https://ethnomed.org/clinical/end-of-life/cultural-relevance-in-end-of-life-care

Dying Matters. (2011). Legal and Ethical Issues. [online] Retrieved 7th Sept. 2016 from http://www.dyingmatters.org/page/legal-and-ethical-issues

Giovanni L. A. (2012). End of Life Care in the United States. Retrieved 7th Sept. 2016 from http://www.medscape.com/viewarticle/765825_2

Hartman-Stein, P., & Potkanowicz, E. (2003). Behavioral determinants of healthy aging: Good news for the baby boomer generation. Online Journal of Issues in Nursing, 8(2), Article 5. Retrieved 7th Sept. 2016 from www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume82003/No2May2003/BehaviorandHealthyAging.aspx

Joshua M. Wiener, D. (2003). End-of-life care in the United States: policy issues and model programs of integrated care. International Journal of Integrated Care, [online] 3. Retrieved 7th Sept. 2016 from

Kayser-Jones, J. et al., (2003). Factors That Influence End-of-Life Care in Nursing Homes: The Physical Environment, Inadequate Staffing, and Lack of Supervision. The Gerontologist, [online] 43(suppl 2), pp.76-84. Retrieved 7th Sept. 2016 from http://gerontologist.oxfordjournals.org/content/43/suppl_2/76.full

Ludwick, R., Silva, M. (2003). Ethics Column: «Ethical Challenges in the Care of Elderly Persons». Online Journal of Issues in Nursing. Vol. 9 No. 1. Retrieved 7th Sept. 2016 from http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume92004/No1Jan04/EthicalChallenges.html

Mion, L. (2003). Care provision for older adults: Who will provide? Online Journal of Issues in Nursing, 8(2), Article 3. Retrieved 7th Sept. 2016 from www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume82003/No2May2003/CareProvisionforOlderAdults.aspx

National Institute on Aging. (2016). Care Options at the End of Life. [online] Retrieved 7th Sept. 2016 from https://www.nia.nih.gov/health/publication/end-life-helping-comfort-and-care/care-options-end-life

Tucker J. A. (2015). End of Life Care in America is a Scam. Retrieved 7th Sept. 2016 from http://europe.newsweek.com/end-life-care-america-scam-300973?rm=eu

Valente, S. (2016). End-of-Life Care Fact Sheet. [online] Retrieved 7th Sept. 2016 from http://www.apa.org/pi/aging/programs/eol/end-of-life-factsheet.aspx

Wiener J. M. (2016). Population ageing in the United States of America: implications for public programmes. International Journal of Epidemiology. Vol. 31, Issue 4. 776-781. Retrieved 7th Sept. 2016 from

Young, H. (2003). Challenges and solutions for care of frail older adults. Online Journal of Issues in Nursing, 8(2), Article 4. Retrieved 7th Sept. 2016 from www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume82003/No2May2003/OlderAdultsCareSolutions.aspx