Caring for Patients with Limited Prognosis: Negotiating Goals of Care and Planning for the End-of-Life

• Published in: Hospitalists' Guide to the Care of Older Patients pp. 47 - 64
• Main Authors: Wesorick, David H, Malani, Preeti N, Williams, Brent C
• Format: Book Chapter
• Language: English
• Published: United States John Wiley & Sons, Incorporated 2013; Wiley; John Wiley & Sons, Inc
• Subjects: debility; dementia; end-of-life; family meeting; geriatric patients; hospice care; limited prognosis; palliative care
• ISBN: 9781118127926; 1118127927
• DOI: 10.1002/9781118674963.ch5

This chapter reviews the unique challenges facing geriatric patients with limited prognosis; the core concepts of palliative and hospice care; existing concepts and tools of prognostication in the elderly; techniques to facilitate goals of care discussion; and the means by which effective planning for end-of-life care can occur. It focuses on models of prognosis for dementia and debility, as both are common conditions under which patients can often meet hospice admission criteria. The chapter provides the hospitalist with practical guidance surrounding these important aspects of comprehensive care for the older patient. Decisions regarding goals of care can involve not only the goals of the patient, but often those of multiple family members. For this reason, a section is structured around the planning and implementation of a family meeting during which prognosis and goals of care are discussed.