Psychologists can use several careful strategies to help older adults receive the best possible end-of-life care, says psychologist William Haley, PhD, director of the School of Aging Studies at the University of South Florida. These include:

  • Encouraging use of advance directives. Most Americans do not complete advance directives, such as durable powers of attorney or living wills. Such steps can allow older adults to receive the kind of end-of-life care they prefer if they become incapacitated due to illness. Psychologists can help patients face the need for such advance planning and think through their wishes and values.

  • Conducting careful psychological assessments. Psychological assessment may identify undetected problems including dementia, delirium, anxiety, depression and behavioral disturbances. Psychologists can play key roles in managing these problems if diagnosed. Psychologists also can provide assessments of levels of deterioration in patients with dementia and delirium--key to helping family members and health-care workers determine patients' capacity for making their own health-care decisions.

  • Treating psychological stress associated with death. Psychologists can help patients communicate with their health-care team, find meaning in their lives, maintain their social connections and supports, address unfinished business with family members and maintain a sense of control over their dying process.

  • Guiding family members through difficult decisions. Family members may not understand the level of psychological deterioration in their elderly loved-one, so it's crucial to prepare them for likely personality changes and cognitive decline. Families may also have to make difficult decisions, such as whether to withhold treatment that would extend life in patients with a poor quality of life.

"Even when death is imminent, psychologists can make important contributions both in working with dying persons and in supporting their family caregivers through the difficult time," Haley says.

--K. KERSTING