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Home care and end of life issues (Proceedings)


"The death we fear most is dying in pain, unnoticed, and isolated from loved ones. Concern about such an undignified and difficult death has engendered the debate over authorizing voluntary active euthanasia and physician-assisted suicide. Death is fundamental to the nature of being human." (Anon.)

It is the rare adult who does not have an emotional response to thoughts of dying. We are all inherently aware of our mortality and to that of those around us. No different from our clients, we fear the pain and suffering of friends and companions, human or non-human. Nor do we become elated when considering the probabilities of terminal illness and long-term nursing care.

What is aging? To paraphrase from Robbins1: Aging begins at the moment of conception, involves differentiation and maturation and, at some point, leads to the progressive loss of functional capacity characteristic of senescence ending in death. This occurs at an organismal level as well as at a cellular level. The former may be affected by genetics, social environment, nutrition, and the occurrence of age-related diseases. Cellular aging, on the other hand, includes progressive accumulation of sublethal injury (e.g., from free radical damage), resulting in either cell death or diminished capacity of the cell to repair itself.

Why consider this? Home care and end of life inherently encompasses matters of age-related and age-appropriate illnesses. In cats, these include most significantly renal insufficiency progressing to failure, hyperthyroidism, diabetes mellitus, degenerative joint disorders, neoplasia and chronic digestive disorders including inflammatory bowel disease, pancreatitis and cholangiohepatitis. In some cases, by addressing organ and cell function, we can impact well-being.

Just as we match nutritional and preventative medical recommendations to life-stage, so too can we match stages and types of care to the final stages in life.

1. 1-Support function
2. 2-Alleviate discomfort, optimize comfort
3. 3-Preparing for an ending; dying with dignity
4. 4-Caring for the caregivers