Missouri medicine
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Three-fourths of those who die in America are 65 or older. In all but the cases where death is sudden and unexpected, decisions frequently must be made about whether to limit treatment. In this paper, we provide a framework and specific tools that may help physicians in talking to older patients and their family members about end-of-life care. ⋯ Defining goals of care. 4. Implementing a management plan consistent with those goals. The paper concludes with special considerations about four common experiences of dying as an older person: chronic diseases with acute exacerbations (e.g. congestive heart failure or chronic obstructive lung disease), cancer, end stage dementia, and unexpected catastrophic decline.
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Cultural origins influence the way patients and health care providers think about care and treatment at the end-of-life. With increasing ethnic diversity there is greater chance that clinical encounters will occur between individuals of different backgrounds, therefore there is greater risk of misunderstanding. Health care providers should be mindful of cultural differences when informing patients, discussing advance care planning, responding to requests for assistance in dying, and responding to requests for limiting treatment.