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"We exploit the uncertainty about the end of our existence to live as if we are not going to die."

—K.E. Løgstrup


By the end of this chapter, readers will be able to:

  1. Argue for occupational and physiotherapy services as a part of end-of-life and palliative care services.

  2. Describe and discuss contemporary definitions and understandings of end-of-life and palliative care and hospice philosophy.

  3. Have knowledge about contemporary criteria for the "good" death and cultural implications.

  4. Describe the end-of-life challenge as it relates to older people, human existence, and functioning (life span development/aging).

  5. Describe the consequences of how end-of-life circumstances of an older person may affect close family and relatives.

  6. Understand the palliative care needs related to occupational therapy and physiotherapy, including activity and participation (functioning) of older people facing end of life.

  7. Understand international health policy and political-societal/environmental factors as they relate to palliative care services for older people.

  8. Identify and discuss roles for occupational therapists and physiotherapists in palliative care as an interdisciplinary service including interventions and implications for collaboration and clinical practice.

  9. Identify and critically reflect on appropriate outcomes in palliative care as well as ethical dilemmas.

Clinical Vignette

Sarah Winford is a 75-year-old woman with lung cancer that has metastasized to liver and brain. No treatment is available. She lives in a house in the countryside with her partner Jim. Sarah has two sons, Peter and Poul. Peter is married and has a daughter. Poul lives by himself and has had difficulties establishing a life on his own. Sarah has always been active and has many interests; however, she is increasingly burdened by breathlessness and side effects from chemotherapy, which cause pain in her fingers and toes. Sarah worries about decline, and how her sons and Jim will manage when she is no longer there. The symptoms of fatigue and pain especially impinge on her daily activities, keeping her from doing even the smallest tasks and forcing her into passivity and dependency.

  1. In addition to her concerns about her husband and sons, what might be significant issues for Sarah at this point in her care?

  2. How might her resources to engage in occupations best be assessed and prioritized?

The end-of-life phase is significant because it potentially will touch every family and individual in some way as they strive to deal with closure, transition, grief, mourning, and life itself.

As people grow old, their awareness of the end of life is accentuated, due to aging, including decreasing abilities and deterioration, and possibly to illness. As the population of older people continues to grow, so does the need for health-care services, including attention to health policies and ethical responsibility.

In working with people facing the end-of-life and terminal illness, occupational therapists and physiotherapists can serve a significant role by addressing issues related to physical and psychosocial functioning ...

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