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Hospice nurses managing chronic disease symptoms
Patients over age 85 present new challenges
As the U.S. population ages, it makes sense that hospice patients will be older as well. Results of the hospice data collected by the National Hospice and Palliative Care Organization (NHPCO) show a 3.4% increase in patients older than age 85 between 2006 and 2007, with 36.6% of all hospice patients older than age 85.
"My hospice has seen increasingly older patients," says Gretchen M. Brown, MSW, president and CEO of the Hospice of the Bluegrass in Lexington, KY, and chairwoman of the NHPCO board of directors. "About one-third of our patients are age 80 and over," she says.
"Older patients will often require more support from the hospice," says Brown. Older patients often have one or more chronic diseases in addition to the diagnosis that makes them eligible for hospice, so nurses must be attuned to managing symptoms of multiple conditions, she says.
Caregiving is another area that presents special problems in the older patient, says Brown. "A 90-year-old patient may have a 90-year-old spouse and a 70-year-old daughter, neither of whom can provide all of the care needed for the patient," she explains. In this situation, Brown's staff often work with the family to find alternative care such as a nursing home, she says.
Nursing homes have affected the age of hospice patients, says Brown. "We have an increasing number of referrals from nursing homes," she says.
As this trend has increased, Brown's agency set up a team to see only nursing home patients. "The needs of a nursing home patient are similar to a homebound patient, but they are cared for by professionals throughout the day rather than family members," she says.
Setting up a specialized team was done to make sure that hospice staff visiting the nursing home patients understood nursing home regulations that might affect who is responsible for different care activities, Brown says. "Having staff members that understand nursing home staff members' responsibilities improves communications between all caregivers," she says.