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Eye Care For the End of Life Patient

Many patients in end-of-life care in Santa Clara and elsewhere suffer from eye conditions and diseases. With National Glaucoma Awareness Month upon us, we thought it would be fitting to talk about glaucoma and other conditions such as cataracts that commonly plague hospice patients. The Glaucoma Research Foundation says that more than three million people in this country have glaucoma (mostly older adults and elderly), with more than 4.2 million estimated to have it by 2030. This is a top cause of irreversible blindness, but half of the people aren’t even aware they have it.

Facts About Glaucoma

The tricky thing about glaucoma is that there are often no initial symptoms, which means many people don’t know they have it till they have an exam by a doctor. And usually, some type of vision loss is what prompts them to visit the doctor in the first place. As you can imagine, this is why regular screenings are integral for us as we age. We will be living in an epidemic of blindness if more awareness cannot be raised about eye exams to preserve and maintain eye health.

Glaucoma damages the eye’s optic nerve, and it only worsens over time. Linked to a pressure buildup inside the eye, this is usually a later symptom in the elderly. This increased pressure is called intraocular pressure, and it has the potential to damage the optic nerve. It’s this nerve that’s responsible for sending images to your brain, according to WebMD. When left untreated, glaucoma will quickly progress to result in permanent loss of vision or total blindness within a few years.

Hospice Patients With Glaucoma

Many older adults in hospice already have the severe vision loss that is associated with glaucoma. Ophthalmology Times says after the patient’s ophthalmologist has eliminated all other factors that could have contributed to progression, it’s time to start talking about palliative care to maintain comfort. Once all vision is lost, it’s important to keep the pressure low enough to keep pain at bay. Pain does not just originate from pressure. Rather, corneal bullae (these are basically small vessels in the cornea) can start to form and then rupture, causing even more pain. The hospice team can administer medication to control this pain.

While physicians and nurses on the hospice team can’t do anything to slow the blindness progression, they can provide comfort and sympathy for the patient and their condition. They can help manage pain as well as the effects of the blindness itself, taking some time to acknowledge the patient’s feelings of isolation, helplessness, and loss of independence. Being on the alert for signs of depression is also imperative, as is the sensitivity that should be brought to cultural differences and the perceptions that blindness represents for each individual.

The hospice care team will have to help the patient and family members transition to a new type of care. For years, the patients and their caregivers may have been administering daily drops and medications to reverse the effects of glaucoma, so it can be quite the shock to learn how to adopt more of a pain control and management role from now on. It’s important to have conversations with glaucoma patients in hospice, re-evaluating the need for each kind of medicine and determining if additional drops or medicines bring enough of a benefit to the patient as they progress through end-of-life care.

It’s also important to revisit the use of prescription drugs because they can cause distressing symptoms as the patient nears end of life, such as nausea, pain, anxiety, and constipation. Sometimes drugs used to treat the initial condition can cause adverse symptoms that are often more alarming and distressing than the initial condition. This is what prompts the shift from palliative care to comfort measures.

Cataracts and Hospice Patients

Now a word on cataracts. These involve the clouding of a normally clear eye lens — kind of looking through a fogged-up window. This clouded vision makes it harder for the person to read, drive, or even see their loved ones’ facial expressions. Cataracts are very common in hospice patients, for whom the focus is usually comfort care and management. But sometimes, cataract surgery is granted so the patient can improve their quality of life in their remaining months.

In the case of Vincent Thomas, he had been battling multiple myeloma for some time and was in hospice. He asked his doctors to perform cataract surgery so he could see his family and spend quality time with them before he died. Despite only having weeks to live, his surgeons agreed. Thomas was able to regain his independence, drive himself to his appointments, and even attend a family reunion to visit with relatives he hadn’t seen in years. Best of all, he was able to play with his grandchildren for the last time. He died a few weeks later. The doctors who agreed to the surgery came under fire for conducting a costly surgery on a dying man, but they did it so their patient could fully enjoy his remaining days on this earth. And did he ever!

Contact Pathways Home Health and Hospice

To learn more about our end-of-life care services and how we can maintain comfort for your senior suffering from glaucoma and other eye conditions, contact us at 888-978-1306.