Improving End-of-Life Care With MS

Discussions about end-of-life issues are often taboo in our culture — until we are "suddenly" faced with unpleasant realities and challenging decisions. Although many deaths occur unexpectedly, a large number of deaths follow a prolonged period of decline in health due to a progressive disease. This path of decline has been termed "progressive dwindling."

Four broad trajectories of dying in an aging population were identified in a study of Medicare beneficiaries:

• Twenty percent of deaths followed illnesses, such as cancer, characterized by a clear clinical transition from treatable to untreatable progression.
• Twenty percent of deaths were related to progressive long-term conditions, such as COPD, complicated by acute attacks that increase the likelihood of death.
• Twenty percent of deaths were classified as sudden deaths, such as those following a fatal heart attack or accident.
• Forty percent of deaths followed a prolonged period of progressive dwindling associated with conditions such as Alzheimer’s disease or other degenerative conditions.

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Living with Advanced MS: Improving End-of-Life Care