Case study

Question 1
 An 85-year-old man with New York Heart Association class IV heart failure, hypertension, and moderate Alzheimer’s disease, who lives at home with his 84-year-old wife, arrives at his primary doctor’s office with complaints of worsening heart failure symptoms, including breathlessness, extreme fatigue, poor appetite, and continence problems.  His wife is feeling overwhelmed with his declining health and worries when he is not able to catch his breath and will no longer eat the food she fixes for him.
a.       Is this man a candidate for palliative care?
b.      What is palliative care and how is it different from hospice care?
c.       What is the goal of palliative care and what interventions might be tried to achieve these goals.

Question 2
 
The patient in Question #1 has been receiving palliative care for 6 months and has had improvement in some of his symptoms, but with worsening dementia, he gets up one night to use the bathroom and falls.  He is admitted to the hospital with a hip fracture and has an open reduction and internal fixation.  His postoperative course is complicated by pneumonia, delirium, pressure ulcers on his heels and sacrum, and weight loss. His wife is concerned about the ability to care for him and the doctor has told her that his dementia and heart failure have steadily progressed and recommends hospice care?
a.       Is this man a candidate for hospice care?
b.    What factors about the patient do you think have prompted the doctor to suggest hospice care instead of continuing with palliative care?

Question 3
 After studying this patient’s course of treatment, what do you see as the pros and cons of using Palliative and Hospice Care for patients?