Symptoms Related to Diseases at their Endstage

AMYOTROPHIC LATERAL SCLEROSIS

Unable to walk, needs assist with ADLs

Barely intelligible speech Difficulty swallowing

Oral intake insufficient to sustain life

Significant dyspnea on O2 at rest

May have feeding tube

Comorbidities: pneumonia, URI, sepsis.

ALZHEIMER'S / ENDSTAGE DEMENTIA

Speech limited to <6 words/day (may repeat)

Unable to ambulate or sit up unsupported

Urinary and fecal incontinence

Weight loss

Difficulty swallowing

Comorbidities: Aspiration pneumonia, UTI, Sepsis, Decubiti

DEBILITY UNSPECIFIED

Multiple comorbidities with no primary diagnosis

Use indicators from Eligibility Guidelines above

FAILURE TO THRIVE

Declines enteral/parenteral support

Not responding to nutritional support

Needs assist with personal care

Body Mass Index <22 kg/m2

Weight Loss

CARDIAC DISEASE

Recurrent CHF and/or angina

Minimal activity causes dyspnea or angina

Pt. optimally treated with diuretics, vasodilators, ACE inhibitors or combination of hydralazine and nitrates.

Angina at rest, noncandidate for invasive procedures

Ejection Fraction 20% or less

LIVER DISEASE

Hepatic encephalopathy refractory to Tx

Recurrent variceal bleeding

Ascites despite optimal treatment

Peritonitis

Hepatorenal syndrome

Serum albumin <2.5 g/dl

PTT > 5 sec above control

PULMONARY DISEASE / COPD

Disabling dyspnea at rest, bed to chair only

Recurrent pulmonary infections

Frequent hospitalizations

RENAL DISEASE

Pt. not seeking dialysis or renal transplant

Creatinine clearance <10 cc/min (diabetics <15 cc)

Serum creatinine > 8.0 mg/dl (diabetics > 6.0)

In absence of one of these findings, rapid decline or comorbidities may also support eligibility for hospice care

STROKE and COMA

Decreased level of consciousness

Post-stroke dementia

Mostly bedbound

Needs assist with personal care

Difficulty swallowing

Comorbidities: Aspiration pneumonia, URI, sepsis