What to expect over time, living with a chronic or terminal condition
Barbara Okun, a professor of counseling psychology at Northeastern and a clinical instructor at Harvard Medical School
“When does dying begin?” This is a question often asked and just as often, there’s no satisfactory answer to be given
There are some health conditions whose journey can be predicted to a certain degree.
From Best Practice Guidelines for End of Life (Registered Nurses Association of Ontario-RNAO)
1. For most cancers: a short period of obvious decline leading to death.
2. For patients with chronic organ failure (kidney, liver, lung, heart): long-term disability with periodic worsening and unpredictable timing of death.
3. For those with frailty and dementia, a slow dwindling course to death.
More than one ailment or illness (in medicalese: ‘co-morbidities’) can be common, and interactions between illnesses and their treatment can affect the course and outlook (in medicalese:’prognosis’) making it even harder to ‘plan’, but always worthwhile to ask about possible crisis points along the journey.
Examples of co-morbidities:
- Arthritis plus heart disease, diabetes and chronic obstructive pulmonary disorder (COPD–also called lung disease)
- Neurological disorders (Parkinsons, ALS, Huntington’s) plus depression, stomach disorders
- Dementia (Alzheimer’s, Vascular Dementia, Lewey Body Disease) plus cancer and bladder infections
- Chronic kidney disease plus congestive heart failure and diabetes
- Mental Health (depression, anxiety, bi-polar) plus rheumatoid arthritis and cancer
Interesting reading: Infections in the Elderly: are antibiotics always the best treatment?