J Palliat Care
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Hospices provide palliative care to persons who are dying and supportive care to their family caregivers. As death approaches, these family caregivers become increasingly responsible for providing the majority of daily care. Although research has documented their distress, little work has evaluated the broader impact of caregiving on quality of life (QOL). ⋯ There were moderate correlations with overall mental health (r = 0.68) and low correlations with overall physical health (r = 0.01). Low correlations were observed with patient's performance status (r = 0.09). The CQOLC appears to possess adequate validity and internal consistency in this revalidation sample.
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The number of elderly Canadians is likely to double in 20 years, spurring a discussion of end-of-life care. We analyze the literature on the costs of this care and compare cost assessments of different models of palliative care. The cost of treatments for which there is little empirical support is factored into our cost-savings analysis and the methodological limits of cost-analysis studies are also discussed. We conclude that (a) depending upon the model of care, costs of end-of-life care are considerable, (b) costs of care become more expensive with distance from the home setting, (c) cost savings reported in palliative care settings may be a function of nearness to death; (d) family expenses on end-of-life care are substantial and are not factored into most cost-analysis studies, (e) a two-tiered system of palliative home care allows families with higher incomes to afford help in supporting home deaths, and (f) some treatments given to dying patients are costly while yielding little benefit.
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A strong and often polarized debate has taken place during recent years concerning the consequences of dehydration in the terminally ill patient. When a patient has a severely restricted oral intake or is found to be dehydrated, the decision to administer fluids should be individualized and made on the basis of a careful assessment that considers problems related to dehydration, potential risks and benefits of fluid replacement, and patients' and families' wishes. ⋯ These include different modes of hypodermoclysis, intravenous hydration, use of the nasogastric route, and proctoclysis. Arguments for and against rehydration have been previously addressed by other authors and fall outside the scope of this review.