End-of-life care becomes an issue at some point for elderly clients. Even with the emergence of palliative care programs and hospice programs, the majority of elderly people do not die in their own home as is their preference. What are the reasons for this trend? Discuss what you can do as a nurse to support your clients in end-of-life care and in supporting their desires. Support your response with evidence-based literature

Introduction

End-of-life care is a critical aspect of nursing practice, particularly for elderly clients. Despite the availability of palliative care and hospice programs, many older adults do not have the opportunity to die in their preferred setting, such as their own home. This trend raises concerns regarding the quality of end-of-life care and the need for healthcare professionals, particularly nurses, to support their clients’ desires. This essay aims to discuss the reasons behind the trend of elderly clients not being able to die in their desired location and explore the nurse’s role in providing end-of-life care that aligns with clients’ preferences. To do so, evidence-based literature will be incorporated to support the arguments presented.

Reasons for the trend

Several factors contribute to the trend of elderly clients not being able to die in their preferred setting, specifically their own home. These factors can be broadly categorized into systemic, healthcare, and personal factors.

Systemic factors refer to broader societal and structural influences that impact end-of-life care. One significant systemic factor is the lack of supportive policies and resources for aging individuals. Many healthcare systems are not adequately equipped to meet the needs of the aging population, resulting in limited access to appropriate end-of-life care settings, such as home-based palliative care (Wachterman et al., 2019). This leads to elderly individuals seeking alternative care options, such as hospitals or nursing homes, which may not align with their preferences.

Another systemic factor is the fragmentation and lack of coordination among healthcare providers. End-of-life care often involves multiple healthcare professionals from different settings, including primary care providers, specialists, and hospice professionals. The lack of effective communication and coordination among these healthcare providers can hinder the continuum of care and result in elderly clients receiving care that does not align with their desires (Wachterman et al., 2019).

Furthermore, healthcare factors contribute to this trend. One significant healthcare factor is the overemphasis on curative treatments, even when the probability of success is minimal. Healthcare professionals often prioritize extending life rather than ensuring the quality of life at the end stages. This approach can result in elderly clients receiving aggressive treatments that may compromise their desire for a peaceful and comfortable death (Higginson & Sarmento, 2016).

Additionally, healthcare providers may lack the necessary skills and knowledge to provide effective palliative and end-of-life care. A study by Brazil et al. (2019) found that healthcare professionals rated their knowledge of palliative care as inadequate, leading to suboptimal care provision and increased reliance on hospital-based interventions. This limitation can further contribute to the trend of elderly clients dying outside their desired setting.

Personal factors should also be considered when examining this trend. Many elderly individuals may lack social support structures, such as family or friends, which can make it challenging to remain at home during the end stages of life. Moreover, fears related to the burden they may impose on their loved ones can influence their decision to seek institutional care (Dumitrescu et al., 2020).

By understanding these reasons, nurses can identify potential barriers in end-of-life care and develop strategies to support their clients’ desires.