49 End-of-Life Issues

Life Expectancy

Life expectancy is a summary measure of the overall health of a population. It represents the average number of years of life remaining to a person at a given age if death rates were to remain constant. In the United States, improvements in health have resulted in increased life expectancy and contributed to the growth of the older population over the past century.

Americans are living longer than ever before. Life expectancies at both age 65 and age 85 have increased. Under current mortality conditions, people who survive to age 65 can expect to live an average of 18.5 more years, about 4 years longer than people age 65 in 1960. The life expectancy of people who survive to age 85 today is 6.8 years for women and 5.7 years for men.

Life expectancy varies by race, but the difference decreases with age. In 2006, life expectancy at birth was 5 years higher for white people than for black people. At age 65, white people can expect to live an average of 1.5 years longer than black people. Among those who survive to age 85, however, the life expectancy among black people is slightly higher (6.7 years) than white people (6.3 years).

Life expectancy at age 65 in the United States is lower than that of many other industrialized nations. In 2005, women age 65 in Japan could expect to live on average 3.7 years longer than women in the United States. Among men, the difference was 1.3 years.

Heart disease and cancer are the top two leading causes of death among all people age 65 and over, irrespective of sex, race, or Hispanic origin. Other causes of death vary among older people by sex and race and Hispanic origin. For example, men have higher suicide rates than do women at all ages, with the largest difference occurring at age 85 and over (43 deaths per 100,000 population for men compared with 3 per 100,000 for women). Non-Hispanic white men age 85 and over have the highest rate of suicide overall at 48 deaths per 100,000.

End-of-Life Issues

Sometimes, in spite of treatment, a condition or illness will cause death. In those cases, patients can decide what they do and do not want done. They can decide whether they want aggressive treatment that might prolong life or whether they prefer to stop treatment, which could mean dying sooner but more comfortably. They may want to plan their own funeral. Advance directives can help make the patient’s wishes clear to families and health care providers.

Care at the end of life focuses on making patients comfortable. They still receive medicines and treatments to control pain and other symptoms. Some patients choose to die at home. Others enter a hospital or a hospice. Either way, services are available to help patients and their families deal with issues surrounding death.

Costs of End-of-Life Care

End-of-life care is often a controversial subject, and when policymakers are looking for ways to control Medicare costs, such care typically comes up in the discussion. That’s not surprising, because end-of-life care accounted for more than one-quarter of Medicare spending last year, according to background information in the study. One concern is that this spending may be largely earmarked for aggressive care that’s not necessarily what the patient might have wanted.

And, that’s where advance directives can be useful. They allow patients to document their wishes, whether they want all life-sustaining measures to be taken or if they’d prefer to avoid such procedures.

Advance Directives

What kind of medical care would you want if you were too ill or hurt to express your wishes? Advance directives are legal documents that allow you to convey your decisions about end-of-life care ahead of time. They provide a way for you to communicate your wishes to family, friends and health care professionals, and to avoid confusion later on.

A living will tells how you feel about care intended to sustain life. You can accept or refuse medical care. There are many issues to address, including

• The use of dialysis and breathing machines
• If you want to be resuscitated if breathing or heartbeat stops
• Tube feeding
• Organ or tissue donation

A durable power of attorney for health care is a document that names your health care proxy. Your proxy is someone you trust to make health decisions if you are unable to do so.

Hospice Care

Hospice care is end-of-life care provided by health professionals and volunteers. They give medical, psychological and spiritual support. The goal of the care is to help people who are dying have peace, comfort and dignity. The caregivers try to control pain and other symptoms so a person can remain as alert and comfortable as possible. Hospice programs also provide services to support a patient’s family.
Usually, a hospice patient is expected to live 6 months or less. Hospice care can take place

• At home
• At a hospice center
• In a hospital
• In a skilled nursing facility