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Clinical Crossroads Update
August 10, 2011

Update: An 86-Year-Old Woman With Cardiac Cachexia Contemplating the End of Her Life: Review of Hospice Care

JAMA. 2011;306(6):645. doi:10.1001/jama.2011.1134

In a Clinical Crossroads article published in January 2010,1 Jean Kutner, MD, MSPH, discussed decision making concerning end-of-life care and the use of hospice. The patient, Mrs H, was an introspective 86-year-old woman with progressive congestive heart failure and multiple comorbidities, including varying degrees of depression. She required assistance with instrumental activities of daily living and considered herself to have led a full and “exciting” life. Mrs H contemplated suicide as an alternative to a life of dependency. Drawing on the Seattle Heart Failure Model, Dr Kutner estimated a mean survival of 2.8 years and a 41% risk of mortality within 1 year. She recommended that Mrs H and her daughter, who lived 200 miles away, meet with a palliative care team and consider hospice care, viewing this as an important step toward helping Mrs H determine how to spend the end of her life.