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Lung diseases

When to call in hospice for copd & emphysema

01/30/2006

Question:

I am a caregiver for my 79 year old mother who has been diagnosed in end-stage emphysema and copd. She is on 20 meds per day and 3 liters of oxygen thru a concentrator 24\7 with 6 nebulizer treatments ie xopenex and atrovent daily. She now has developed copd of which she is on 6.25 mg of coreg, 1x in the am and 2x at night. I am noticing an increase in lethargy and reluctance to move, even walking back and forth in her bedroom is a chore. She has become a cardiac "cripple" and fights my urging her to get up and "move". I am at a loss how to correctly communicate these issues to her doctor and ask the right questions to both her pulmo doc and her cardio..I see her failing and am torn between my own emotions and the reality of what is happening. I work full-time and have alot of professional people coming each day to the house..ie phlebotomists,county caregivers,visiting nurses,oxygen company, etc..I am aware that hospice is for end of life sustaining approx 6mos out. Can you offer me any advice on how to address these issues with the doctors who are on a limited time-frame? I feel unresolved much of the time when I have questions...I do write them down too..thank you, 

Answer:

These are very difficult situations and you are asking all the right questions.

It sounds as if your mother has severe COPD and has significant heart failure as well; and you have noticed a deterioration in her overall level of functioning.  One of the first questions is what are her wishes?  Does she have a living will?  Does she want life sustaining measures such as mechancial ventilatory support or CPR-cardiopulmonary resuscitation, utilized in her care?  If she does, then she is not a candidate for hospice.  If she doesn't,  she may be a candidate for hospice care.  Our hospice programs have nurses who will assess patients to determine if they are candidates for the hospice program.  They are also very knowledgeable about all aspects of the hospice program and will be able to answer your questions about medications, home health aides and other support staff. 

For your mother's next office visit, you might request a longer visit time to discuss these issues and to inquire about obtaining a hospice evaluation or you might want to contact the hospice program directly.  Unfortunately, some specialists including cardiologists and pulmonologists leave these issues up to the patient and the family physician or internist.  If the specialists won't discuss these issues with you, discuss them with your mother's regular physician.

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Response by:

Ralph   Panos, MD Ralph Panos, MD
Associate Professor
College of Medicine
University of Cincinnati