End of life issues in older patients.

Elderly patients with cancer at the end of their life have very unique features associated with their care. As the population of the United States ages, these issues will involve more patients, and end-of-life care has the possibility of consuming more health care costs. With regard to unique care issues, the elderly with cancer at the end of their life are more at risk for untreated pain and depression and are more likely to commit suicide than their younger counter parts. Advance directives are important to discuss with patients and their families so that the patient can designate an individual as the health care proxy and so that discussion around end-of-life care can occur before patients clinically decline so that patients' wishes are known and futile care can be avoided. Hospice care is a Medicare-sponsored program that elderly and nonelderly patients can enter for the last 6 months of their lives. This article discusses barriers to hospice referral.