What are the care at the end of life

In the same way that most of us need medical support at birth and all of us from a family member, this will happen at the time of death.

Death is an inevitable and universal event, which is reached either by isolated diseases that have evolved to the final stages, or by multiple health problems that in combination make life impossible, or by having reached a state of extreme fragility with an absolute lack of functional reserve. It is these situations that are called terminals.

There are several definitions of a terminal illness or situation, with times, complementary tests or other data, but for simplicity it can be said that a patient with a terminal illness is one whose death is known to be certain and in a not too distant time and in whom it has been abandoned the medical therapeutic effort to concentrate on the relief of symptoms and support for the patient and their families. This comprehensive care is what is called palliative care.

Death is a natural and unavoidable event that ends life. However, in a health care system built on the model of curative therapy, health professionals have often been trained and have lived their professional practice, as if the death process did not exist; Many medical professionals do not have incorporated action in the approach of the patient at the end of his life, how to communicate the truth of the irreversible situation, palliative treatments and emotional support to the patient and his family in this difficult situation. of decisions. He is even often unaware of the legal and ethical implications of the dying process.

Palliative medicine is known primarily for its role at the end of life in cancer patients; However, it also applies to advanced diseases that have come to an end, such as heart, respiratory, liver or kidney failure, dementia or in extremely frail elderly patients. In any of these situations, oncological or not, the principles of palliative care must be the same:

• Affirm life and accept death as a natural process. Do not hasten or delay death.
• Relieve pain and other stressful symptoms.
• Integrate psychological and spiritual aspects into patient care.
• Maintain as much activity as possible until death comes.
• Help the family during the patient's illness and later after the death in mourning.

People facing terminal situations generally have wishes that must be taken into account:

• Adequately control pain and various symptoms.
• Do not inappropriately prolong life.
• Maintain a sense of control.
• Ease the burden on the caregiver.
• Intensify relationship with loved ones.

Death is a natural and unavoidable event that ends life. However, in a health care system built on the model of curative therapy, health professionals have often been trained and have lived their professional practice, as if the death process did not exist; Many medical professionals do not have incorporated action in the approach of the patient at the end of his life, how to communicate the truth of the irreversible situation, palliative treatments and emotional support to the patient and his family in this difficult situation. of decisions. He is even often unaware of the legal and ethical implications of the dying process.

cancer patients are immersed in a relatively simple process to predict, as their vital function "slides" continuously and progressively to the end. However, in people suffering from chronic advanced diseases this process is more complicated, since it is not so progressive, since there are sudden deteriorations that can be recovered or not, which would then be the end. This evolution is very difficult to predict, even by health professionals.

In older people, end-of-life situations have different characteristics from those of younger terminal patients, since there is usually greater acceptance of the fact of death as something irremediable. Symptoms are often different (for example, less pain perception), being more difficult to recognize, with atypical presentations and with greater functional repercussion.

The coexistence of several chronic diseases, some severe, cognitive disorders and the polypharmacy they involve can cause the symptoms, discomfort and anxiety to be underestimated by health personnel.

Of interest

Palliative medicine and geriatrics advocate a dignified death, ideally at home and surrounded by family and loved ones. But despite the fact that the majority of elderly patients prefer to die at home, this is not the case, due to difficulties in the family environment and the correct 24-hour care coverage with adequate coordination between all levels of care.

It is in the moments of the end of life when it is more necessary than to be offered integral support, humanity, empathy and dignity towards the patient and their environment, both on the part of family members and caregivers as well as health personnel.