XXXX : the last year of life.

@entity1 @entity5837 @entity1442 @entity1576 @entity1030 @entity204
Nearly one quarter million Americans die with or of advanced @entity1030 ( @entity1030 ) each year. Many @entity1 die after a prolonged functional decline that is accompanied by much suffering. Though difficult prognostically and emotionally, anticipation of @entity204 opens the door to planning and preparing for terminal care. Epidemiologists have begun to identify characteristics of @entity1030 @entity1 who are most likely to die within 6-12 months, including severe, irreversible airflow obstruction, severely impaired and declining exercise capacity and performance status, older age, concomitant cardiovascular or other co-morbid disease, and a history of recent hospitalizations for acute care. Clinicians are encouraged to raise the difficult subject of planning for @entity204 when many of these characteristics apply. @entity1 with @entity1442 are often receptive to the recommendation of a dual agenda: "Hope for and expect the best, and prepare for the worst." Medical advance planning is best pursued in an out- @entity1 office during a prescheduled, 3-way conversation between @entity1 , health care proxy, and physician. An advance directive can be written after the meeting to summarize the conversation. Clinicians should consider recommending hospice care when a @entity1030 @entity1 is at high risk of @entity1576 from the next @entity5837 and in need of frequent or specialized home care. Preparation for @entity204 should include a realistic appraisal of the prospects for dying peacefully at home and a contingency plan for terminal hospitalization, should the need arise.
