What is the time of the terminally ill?

A terminal or life-limiting illness is a disease or condition which cannot be cured and is likely to lead to a person’s death or it has progressed to the point where it cannot be cured. Getting such a diagnosis or for a loved one can be a frightening experience. Many people will be unable to take everything in. Coming to terms with death in a case of terminal illness is likely to be a difficult experience, and individuals who have a terminal illness may experience conflicting and varied emotions. Upon first receiving their diagnosis, an individual may feel numb, possibly calm, or even accept the news in a matter-of-fact way, as if they have not yet fully absorbed the reality of the situation. Many people might experience uncertainty, as they do not know exactly how much longer they will live or how their body will change as the disease progresses. Sadness, fear, anger, frustration, regret, and uncertainty may eventually be followed by feelings of acceptance and relief.

What are the causes of terminal illnesses?

The following diseases can be classified as terminal diseases which has no cure and death is expected from the disease.

  • Advanced End Stage Senescence or Debility
  • Amyotrophic Lateral Sclerosis (ALS)
  • Liver Disease
  • Pulmonary or lung Disease like Chronic Obstructive pulmonary disease
  • Dementia (including Alzheimer’s)
  • Neurological diseases like Parkinson’s disease
  • Motor neuron diseases
  • Advanced heart disease
  • Adult Failure to Thrive
  • HIV
  • Cancers like breast cancer, prostate cancer, colorectal cancer and lung cancer
  • Stroke and Coma

Terminal illness is actually a broad term that can include many different medical diagnoses. Some of the diseases listed above such as amyotrophic lateral sclerosis (ALS), are known to be terminal from the time of diagnosis, while others may not necessarily be terminal at first onset. An example is HIV. If a person diagnosed with this disease starts therapy on time, they may have an almost normal life span, while in other cases, the advanced stage of the disease is terminal. Cancer can also be treated in many cases but may be terminal in other cases, some may have a slow progression, while some can have a relatively quick progression from diagnosis to death.

According to the WHO, Cancer is a leading cause of terminal illness diagnoses worldwide, accounting for nearly 10 million deaths in 2020, or nearly one in six deaths. The commonest cancers were lung cancer, colorectal cancers, liver cancer, stomach and breast cancers.

What is the time of the terminally ill?

Estimating the life expectancy is of a terminally ill person is utmost importance to patients, families, and health care professionals. Many important health care decisions, such as those regarding chemotherapy use, hospice referral, advance care planning, discharge planning, and personal finances, are dependent on the expected survival duration.

There have been different definitions of the time frame the terminally ill have. Different time frames have been proposed by different professional bodies and researchers, some define it as less than 24 months, others as less than 12 months, others as less than nine months, and yet others define it as less than six months.  While the generally accepted time frame is less than six months, some insurance companies define the time frame as less than 12 months, while others accept less than 24 months.

Estimating the exact time of death can be challenging for doctors. A study reported that physicians, on average, predicted that their dying patients would live 5.3 times longer than they actually did. In only 20 percent of cases were the doctors’ predictions accurate.

In a study among terminally ill among cancer patients, patients with prostate cancer had the longest time frame before death, whereas those with hematologic cancer had the shortest remaining lifetime. Non cancer patients also generally had shorter time to death than those with cancer diagnosis.

Among terminally ill patients, there is another concept called  Impending death, or actively dying. This, refers to the process in which patients who are expected to die within 3 days exhibit a set of symptoms. In the final days of life, they often experience progressive decline in all their functions including their neurocognitive, cardiovascular, respiratory, gastrointestinal, genitourinary, and muscular function. This is a sign that the dying process has started and death is imminent.

 What are the health needs of the terminally ill?

The focus of care among the terminally ill is often on the quality of the remaining life, and dying with as much dignity as possible and not prolonging life. The health needs include: control of symptoms of disease like pain, constipation, emotional support, and mental health services for the dying person and families.

It is usually a good idea to nurse terminally ill patients in a special kind of care setting that cater for the terminally ill called the hospice except otherwise requested by the individual. Hospice care decreases the burden on family, decreases the family’s likelihood of having a complicated grief and prepares family members for their loved one’s death. Hospice also allows a patient to be cared for at a facility for a period of time, not because the patient needs it, but because the family caregiver needs a break. This is known as respite care.

If you or your loved one have been diagnosed with a terminal illness, you may have to make some tough end of life decisions at this critical time; meet your doctors for further care; your insurance, if you have any, and it is generally a very good idea to join a support group to help you and your loved one navigate the difficult terrain of the dying process and death.