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Cuidados paliativos

Bibliografía recomendada

Comfort Care for Patients Dying in the Hospital

For hospitalized patients whose death is imminent, palliative care can alleviate distressing symptoms that are common during the last few days or weeks of life. The essentials of such care that are presented in this review are intended to provide both generalists and specialists in fields other than palliative care with a practical, evidence-based approach to alleviating these symptoms in patients who are dying in a hospital. Communication skills that are essential to personalized care and goal setting are described briefly; the alleviation of the psychosocial and spiritual suffering that is often faced by terminally ill patients and their families is addressed only incidentally.

N Engl J Med 2015;373:2549-61

Palliative care

By 2030, 20 percent of the U.S. population will be over the age of 65 years.For most people, the years after the age of 65 are a time of good health, independence, and integration of a life’s work and experience. Eventually, most adults will have one or more chronic illnesses with which they will live for years before they die. These years are often characterized by physical and psychological distress, progressive functional dependence and frailty, and increased needs for family and external support. Studies suggest that medical care for patients with serious and advanced illnesses is characterized by the undertreatment of symptoms, conflict about who should make decisions about the patient’s care, impairments in caregivers’ physical and psychological health, and depletion of family resources.

N Engl J Med 2004;350:2582-90

Antimicrobials at the End of Life

Patients in the final stage of an advanced illness often face challenging decisions about the direction of their overall medical care and treatment of specific complications that occur as the end of life approaches. Infections and febrile episodes are among the most common acute complications experienced by terminally ill patients. Close to 90% of hospitalized patients with advanced cancer receive antimicrobials during the week prior to death, and 42% of nursing home residents with advanced dementia are prescribed antimicrobials during the last 2 weeks of life. Approximately one-quarter of hospice recipients, for whom the intended goal of care is comfort, receive antimicrobials during the final weeks of life. Research suggests that antimicrobials are commonly prescribed to dying patients in the absence of adequate clinical symptoms to support a bacterial infection. How decisions for suspected infections are made in these patients warrants increased scrutiny by clinicians, patients, and family members.

JAMA 2015;314(19):2017-8