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“We exploit the uncertainty about the end of our existence to live as if we were not to die.”
—K.E. Løgstrup
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LEARNING OUTCOMES
28-1. Articulate contemporary definitions and understandings of palliative care and hospice philosophy.
28-2. Explain the role of occupational therapy as a part of hospice and palliative care services, also in relation to interprofessional partners.
28-3. Reflect on end-of-life circumstances among older adults like general ageing, functional changes, and existential challenges such as grief and bereavement.
28-4. Critically appraise programs addressing the everyday life needs of older adults facing limited life expectancy in relation to occupational therapy.
28-5. Apply knowledge about health policy and political-societal systems as they pertain to documentation, payment, and reimbursement models in hospice and palliative care services in the United States and internationally.
28-6. Advocate for clients and palliative care services, including occupational therapy interventions and implications for collaboration and clinical practice.
28-7. Critically reflect on appropriate outcomes in palliative care.
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Mini Case Study
Sarah Winford is a 75-year-old woman with lung cancer that has metastasized to her 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.
Provocative Questions
In addition to her concerns about her partner and sons, what might be significant issues for Sarah at this point in her care?
How might her resources to engage in occupations best be assessed and prioritized?
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Hospice and palliative care concerns the services for persons with a life-limiting illness facing the end of life. The period during which hospice and palliative care may be required can last for days, weeks, months, or years and hence does not only pertain to the terminal phases and dying. The need for hospice and palliative care continues to rise due to the growth of life expectancy and increases in noncommunicable diseases (American Occupational Therapy Association [AOTA], 2023). Older adults in particular may need end-of-life hospice and palliative care as their life expectancy is affected by aging, including decreasing abilities and deterioration, and incurable diseases. Their families may need support as they strive to deal with closure, transition, grief, and bereavement. Occupational therapists can play a significant role in hospice and palliative care for older adults with life-limiting illness facing the end of life, by addressing issues related ...