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End-Of-Life Diseases: Part 1


Which terminal illnesses are accepted in hospice care?

It is a common Myth that hospice is only for patients with cancer.  Even though, in some countries, hospice patients are required to have a 6 month or less prognosis, studies have shown that life expectancy is over-estimated no matter what the terminal diagnosis the patient has. Studies also show that patients who are admitted earlier, rather than later, to hospice care live longer and have better quality of life than those who are admitted in the last few days or weeks of life. 

Amyotrophic Lateral Sclerosis (ALS)

End-Stage Cancer

Chronic Obstructive Pulmonary Disease

(COPD: Type 1 OR Type 2)


End-Stage Dementia/Alzheimer’s Disease

End-Stage Diabetes   

Heart Disease


Huntington’s Disease

End-Stage Liver Disease

End-Stage Lung Disease

End-Stage Multiple Sclerosis 

End-Stage Muscular Dystrophy 

Myasthenia Gravis

End-Stage Parkinson’s Disease

End-Stage Prostate Cancer

End-Stage Renal Failure (Kidney Failure)

Patients with any terminal diagnosis are eligible.

However, the most common end-stage diseases treated in hospice care are: 


Eligibility Guidelines: 

  • Hospice services are available across the lifespan to anyone who needs them.

  • Hospice provides comfort care and services to patients with any terminal diagnosis, not only cancer. Hospice admits patients with both cancer and non-cancer diagnoses.


General Criteria for Hospice Care

  • The patient has a prognosis of less than 6 months if the disease runs its normal course. 

  • The terminal diagnosis and prognosis is confirmed in writing by two physicians.

  • The patient and family choose to focus on comfort, rather than curative treatments.

Type 2 Diabetes and Life Expectancy

By Jennifer Huizen

Reviewed by Deborah Weatherspoon, PhD, RN, CRNA

Diabetes can have serious health implications that affect life expectancy. The impact depends on various factors, such as how soon a person receives a diagnosis and treatment, and how well they and their healthcare team manage the condition.

Other influential factors include the severity and progression of symptoms, any complications, and how the body responds to treatment.

When they get a diagnosis of type 2 diabetes, many people ask how it will affect the length of their life. Diabetes is complex, with many variables and possible complications, and each person is different. It is hard to know how the condition will affect an individual’s life expectancy.

However, it appears likely that, with an early diagnosis and effective management, many people can expect to live as long as those without diabetes and to have a good quality of life.

This article will look at the factors that influence a person with type 2 diabetes’ life expectancy and how to maximize it.


What increases the risk?

A healthful diet with plenty of fiber (along with water/fluids) can help improve the life expectancy of people with diabetes.

A wide range of health and treatment factors affect diabetes’ impact.

Anything that worsens diabetes or increases the risk of developing it is likely to also shorten the life expectancy of a person with the disease.


Common risk factors that can decrease life expectancy in people with diabetes include:

  • Being overweight or having obesity, particularly if it involves excess fat in the abdomen

  • Having a diet that is low in fiber and high in sugar, fat, and salt.

  • Smoking

  • Engaging in low levels of physical activity

  • Getting little sleep

  • Having high levels of stress

Tips for a better life expectancy

with Diabetes

Recommendations for increasing life expectancy in people with diabetes are similar to management and prevention tips.


1. Eating healthy

A person should limit the consumption of foods that contain simple sugars, such as juices and candies, as these can cause blood sugar spikes. Also, it is better to eat complex, rather than simple, carbohydrates.These are in whole grains and legumes, for example.

2. Exercising

The Office of Disease Prevention and Health Promotion recommend that adults get at least 150-300 minutes of moderately intense aerobic exercise each week, such as brisk walking or dancing.

3. Losing weight

In people with excess weight, losing 5-10 percent can significantly reduce the impact of diabetes.

4. Monitoring and treating blood sugar levels

Tracking these levels allows a person to identify peaks, and they can then address the cause. Also, medications such as Metformin can help stabilize blood sugar levels, but only if a person takes them as the doctor prescribes.

5. Following the treatment plan

This includes attending regular screenings and following the doctor’s instructions about lifestyle strategies and medications. Blood glucose monitoring kits are available for purchase online.

6. Managing cardiovascular risks

Many health conditions can increase the effects of diabetes, such as kidney and heart disease, high blood pressure, and high cholesterol. Cardiovascular disease is the main cause of death among people with diabetes.


For people with atherosclerosis and cardiovascular disease and type 2 diabetes, 2018 guidelines recommend that doctors prescribe medications for these issues as part of an overall diabetes treatment plan.

7. Preventing infections

Regular hand-washing can reduce the risk of infections.

People with diabetes have a higher risk of developing infections, such as influenza, pneumonia, and urinary tract infections.

*An infection that is relatively minor in a person without diabetes can become life-threatening in a person with the disease.

*Also, skin wounds can take longer to heal, and if they become ulcerated, amputation may be necessary. This can reduce a person’s life expectancy, according to the research charity Diabetes UK.

*To prevent these complications:

  • Practice good hygiene, including hand-washing

  • Protect against the flu and other illnesses

  • Check the feet and the rest of the body regularly for wounds that may need attention.

        Seek medical help early for infections, including chest infections​

8. Reducing stress

Stress stimulates the release of hormones that can raise blood sugar and interfere with insulin regulation. Yoga, meditation, and speaking with a mental health professional or counselor can help combat stress.

9. Other healthful lifestyle choices

These include getting enough sleep and refraining from smoking. 


Amyotrophic lateral sclerosis (ALS)


I Have ALS.

 Now What? 


Amyotrophic lateral sclerosis (ALS) is a nervous system disease that attacks nerve cells called neurons in your brain and spinal cord. These neurons transmit messages from your brain and spinal cord to your voluntary muscles – the ones you can control, like in your arms and legs. ALS is the most common type of motor neuron disease. It is sometimes called Lou Gehrig’s disease, after the famous baseball player who had the condition. 

At first, ALS causes mild muscle problems. Some people may notice:

  • Trouble walking or running

  • Trouble writing

  • Speech problems

As the disease progresses, the person loses strength and eventually cannot move. Intellectual abilities remain intact although emotions may be effected. In the later stages, amyotrophic lateral sclerosis (ALS) affects the nerves/muscles that control breathing. At end-stage, ALS is considered a hospice-appropriate disease. Most patients eventually pass away from respiratory depression. 

Progressive Symptoms:

Signs and symptoms of ALS vary greatly from person to person, depending on which neurons are affected.


As ALS progresses, signs and symptoms might include:

  • Difficulty walking or doing normal daily activities

  • Tripping and falling

  • Weakness in your leg, feet or ankles

  • Hand weakness or clumsiness

  • Slurred speech, possibly leading to inability to speak

  • Trouble swallowing/Drooling

  • Muscle cramps and twitching in your arms, shoulders and tongue

  • Inappropriate crying, laughing or yawning

  • Cognitive and behavioral changes

ALS often starts in the hands, feet or limbs, and then spreads to other parts of your body. As the disease advances and nerve cells are destroyed, your muscles get weaker. This eventually affects chewing, swallowing, speaking and breathing.

There's generally no pain in the early stages of ALS, and pain is uncommon in the later stages. ALS doesn't usually affect your bladder control or your senses. One's intellect usually, usually, but not always, remains intact. 

Pain in ALS 

By Ileana Howard, MD

Does ALS cause pain?

The answer is yes, although in most cases it does so indirectly. From what we know at this time, the disease process in ALS only affects the nerve cells controlling strength (motor neurons) in the brain, spinal cord, and peripheral nerves. Fortunately, these nerves don’t send pain signals back up to the brain.

Unfortunately, there are several reasons that the weakness associated

with ALS can cause pain:

  • Weak muscles can cause extra strain on muscles and joints, which often causes pain. This is most common in the neck, shoulders, and back.

  • Immobility or the inability to change positions or roll in bed can cause abnormal skin pressure and result in pain or wounds (known as "decubitus ulcers" or more commonly known as "bed sores.")

  • Medical treatments, like feeding tube or tracheostomy tube placement, can cause discomfort. In most cases, this is temporary following a
    tube placement.

  • Constipation is common in ALS and can be really uncomfortable.

  • Muscle cramps, tightness, or spasms

The good news is…

That most of this pain is treatable, and there are a wealth of options at hand to minimize pain and maximize quality of life and function for persons with ALS.


ALS affects the nerve cells that control voluntary muscle movements such as walking and talking (motor neurons). ALS causes the motor neurons to gradually deteriorate, and then die. Motor neurons extend from the brain to the spinal cord to muscles throughout the body. When motor neurons are damaged, they stop sending messages to the muscles, so the muscles can't function.

ALS is inherited in 5% to 10% of people. For the rest, the cause isn't known.

Researchers continue to study possible causes of ALS. Most theories center on a complex interaction between genetic and environmental factors.

Risk factors

Established risk factors for ALS include:

  • Heredity. Five to 10 percent of the people with ALS inherited it (familial ALS). In most people with familial ALS, their children have a 50-50 chance of developing the disease.

  • Age. ALS risk increases with age, and is most common between the ages of 40 and the mid-60s.

  • Gender: Before the age of 65, slightly more men than women develop ALS. This sex difference disappears after age 70.

  • Genetics. Some studies examining the entire human genome found many similarities in the genetic variations of people with familial ALS and some people with non-inherited ALS. These genetic variations might make people more susceptible to ALS.

Environmental factors, such as the following, might trigger ALS:

  • Smoking. Smoking is the only likely environmental risk factor for ALS. The risk seems to be greatest for women, particularly after menopause.

  • Environmental toxin exposure. Some evidence suggests that exposure to lead or other substances in the workplace or at home might be linked to ALS. Much study has been done, but no single agent or chemical has been consistently associated with ALS.

  • Military service. Studies indicate that people who have served in the military are at higher risk of ALS. It's unclear what about military service might trigger the development of ALS. It might include exposure to certain metals or chemicals, traumatic injuries, viral infections, and intense exertion.



As the disease progresses, ALS causes complications, such as:

Breathing problems

Over time, ALS paralyzes the muscles you use to breathe. You might need a device to help you breathe at night, similar to what someone with sleep apnea might wear. For example, you may be given continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BiPAP) to assist with your breathing at night.

Some people with advanced ALS choose to have a tracheostomy — a surgically created hole at the front of the neck leading to the windpipe (trachea) — for full-time use of a respirator that inflates and deflates their lungs.

The most common cause of death for people with ALS is respiratory failure. On average, death occurs within three to five years after symptoms begin. However, some people with ALS live 10 or more years.


Speaking problems

Most people with ALS develop trouble speaking. This usually starts as occasional, mild slurring of words, but becomes more severe. Speech eventually becomes difficult for others to understand, and people with ALS often rely on other communication technologies to communicate.

Eating problems

People with ALS can develop malnutrition and dehydration from damage to the muscles that control swallowing. They are also at higher risk of getting food, liquids or saliva into the lungs, which can cause pneumonia. A feeding tube can reduce these risks and ensure proper hydration and nutrition.


Some people with ALS have problems with memory and decision-making, and some are eventually diagnosed with a form of dementia called fronto-temporal dementia.



Cardiac/Heart Disease


Heart disease is a term covering any disorder of the heart.

Unlike cardiovascular disease, which describes problems with the blood vessels and circulatory system as well as the heart, heart disease refers to issues and deformities in the heart itself.

According to the Centers for Disease Control (CDC), heart disease is the leading cause of death in the United Kingdom, United States, Canada, and Australia. One in every four deaths in the U.S. occurs as a result of heart disease.

Fast facts on heart disease


  • One in every four deaths in the U.S. is related to heart disease.

  • Coronary heart disease, arrhythmia, and myocardial infarction are some examples of heart disease.

  • Heart disease might be treated with medication or surgery.

  • Quitting smoking and exercising regularly can help prevent heart disease.


There are many different types of heart disease.

There are many types of heart disease that affect different parts of the organ and occur in different ways.

Congenital heart disease

This is a general term for some deformities of the heart that have been present since birth. Examples include:

  • Septal defects: There is a hole between the two chambers of the heart.

  • Obstruction defects: The flow of blood through various chambers of the heart is partially or totally blocked.

  • Cyanotic heart disease: A defect in the heart causes a shortage of oxygen around the body.


Arrhythmia is an irregular heartbeat.

There are several ways in which a heartbeat can lose its regular rhythm. These include:

  • tachycardia, when the heart beats too fast

  • bradycardia, when the heart beats too slowly

  • premature ventricular contractions, or additional, abnormal beats

  • fibrillation, when the heartbeat is irregular

Arrhythmias occur when the electrical impulses in the heart that coordinate the heartbeat do not work properly. These make the heart beat in a way it should not, whether that be too fast, too slowly, or too erratically.

Irregular heartbeats are common, and all people experience them. They feel like a fluttering or a racing heart. However, when they change too much or occur because of a damaged or weak heart, they need to be taken more seriously and treated.

Arrhythmias can become fatal.

Coronary artery disease

The coronary arteries supply the heart muscle with nutrients and oxygen by circulating blood.

Coronary arteries can become diseased or damaged, usually because of plaque deposits that contain cholesterol. Plaque build-up narrows the coronary arteries, and this causes the heart to receive less oxygen and nutrients.

Dilated cardiomyopathy

The heart chambers become dilated as a result of heart muscle weakness and cannot pump blood properly. The most common reason is that not enough oxygen reaches the heart muscle, due to coronary artery disease. This usually affects the left ventricle.

Myocardial infarction

This is also known as a heart attack, cardiac infarction, and coronary thrombosis. An interrupted blood flow damages or destroys part of the heart muscle. This is usually caused by a blood clot that develops in one of the coronary arteries and can also occur if an artery suddenly narrows or spasms.

Heart failure

Also known as congestive heart failure, heart failure occurs when the heart does not pump blood around the body efficiently.

The left or right side of the heart might be affected. Rarely, both sides are. Coronary artery disease or high blood pressure can, over time, leave the heart too stiff or weak to fill and pump properly.

Hypertrophic cardiomyopathy

This is a genetic disorder in which the wall of the left ventricle thickens, making it harder for blood to be pumped out of the heart. This is the leading cause of sudden death in athletes. A parent with hypertrophic cardiomyopathy has a 50 percent chance of passing the disorder on to their children.

Mitral regurgitation

Also known as mitral valve regurgitation, mitral insufficiency, or mitral incompetence, this occurs when the mitral valve in the heart does not close tightly enough. This allows blood to flow back into the heart when it should leave. As a result, blood cannot move through the heart or the body efficiently.

People with this type of heart condition often feel tired and out of breath.

Mitral valve prolapse

The valve between the left atrium and left ventricle does not fully close, it bulges upwards, or back into the atrium. In most people, the condition is not life-threatening, and no treatment is required. Some people, especially if the condition is marked by mitral regurgitation, may require treatment.

Pulmonary stenosis

It becomes hard for the heart to pump blood from the right ventricle into the pulmonary artery because the pulmonary valve is too tight. The right ventricle has to work harder to overcome the obstruction. An infant with severe stenosis can turn blue. Older children will generally have no symptoms.

Treatment is needed if the pressure in the right ventricle is too high, and a balloon valvuloplasty or open-heart surgery may be performed to clear an obstruction.


Did You Know...?



The symptoms of heart disease depend on which condition is affecting an individual.

However, common symptoms include chest pain, breathlessness, and heart palpitations. The chest pain common to many types of heart disease is known as angina, or angina pectoris, and occurs when a part of the heart does not receive enough oxygen.

Angina can be triggered by stressful events or physical exertion and normally lasts under 10 minutes.

Heart attacks can also occur as a result of different types of heart disease. The signs of a heart attack are similar to angina except that they can occur during rest and tend to be more severe.

The symptoms of a heart attack can sometimes resemble indigestion. Heartburn and a stomach ache can occur, as well as a heavy feeling in the chest.

Other symptoms of a heart attack include:

  • pain that travels through the body, for example from the chest to the arms, neck, back, abdomen, or jaw

  • lightheadedness and dizzy sensations

  • profuse sweating

  • nausea and vomiting

Heart failure is also an outcome of heart disease, and breathlessness can occur when the heart becomes too weak to circulate blood.

Some heart conditions occur with no symptoms at all, especially in older adults and individuals with diabetes.

The term ‘congenital heart disease‘ covers a range of conditions, but the general symptoms include:

  • sweating

  • high levels of fatigue

  • fast heartbeat and breathing

  • breathlessness

  • chest pain

  • a blue tint to the skin

  • clubbed fingernails

In severe cases, symptoms can occur from birth. However, these symptoms might not develop until a person is older than 13 years.


Heart disease is caused by damage to all or part of the heart, damage to the coronary arteries, or a poor supply of nutrients and oxygen to the organ.

Some types of heart disease, such as hypertrophic cardiomyopathy, are genetic. These, alongside congenital heart defects, can occur before a person is born.

There are a number of lifestyle choices that can increase the risk of heart disease. These include:

  • high blood pressure and cholesterol

  • smoking

  • overweight and obesity

  • diabetes

  • family history

  • a diet of junk food

  • age

  • a history of preeclampsia during pregnancy

  • staying in a stationary position for extended periods of time, such as sitting at work​.


There are two main lines of treatment for heart disease. Initially, a person can attempt to treat the heart condition using medications. If these do not have the desired effect, surgical options are available to help correct the issue.

Heart surgery is an option for people with heart disease, but it can be debilitating.

Heart surgery is an intensive option from which it can take a long time to recover.

However, they can be effective in treating blockages and heart problems for which medications may not be effective, especially in the advanced stages of heart disease.


The most common surgeries include:

  • angioplasty, in which a balloon catheter is inserted to widen narrowed blood vessels that might be restricting blood flow to the heart

  • coronary artery bypass surgery, which allows blood flow to reach a blocked part of the heart in people with blocked arteries

  • surgery to repair or replace faulty heart valves

  • pacemakers, or electronic machines that regulate a heartbeat for people with arrhythmia

Heart transplants are another option. However, it is often difficult to find a suitable heart of the right size and blood type in the required time. People are put on a waiting list for donor organs and can sometimes wait years.


Some types of heart disease, such as those that are present from birth, cannot be prevented.

Other types, however, can be prevented by taking the following measures:

  • Eat a balanced diet. Stick to low-fat, high-fiber foods and be sure to consume five portions of fresh fruit and vegetables each day. Increase your intake of whole grains and reduce the amount of salt and sugar in the diet. Make sure the fats in the diet are mostly unsaturated.

  • Exercise regularly. This will strengthen the heart and circulatory system, reduce cholesterol, and maintain blood pressure.

  • Maintain a healthy body weight for your height. Click here to calculate your current and target body mass index (BMI).

  • If you smoke, quit. Smoking is a major risk factor for heart and cardiovascular conditions.

  • Stop the intake of alcohol. 

  • Control conditions that affect heart health as a complication, such as high blood pressure or diabetes.

While these steps do not completely eliminate the risk of heart disease, they can help improve overall health and greatly reduce the chances of heart complications.



Exercise is one easy way to keep heart disease at bay.

Heart disease is the most common cause of death for both sexes. Here are some statistics demonstrating the scale of heart disease in the U.S.

  • Heart disease causes the deaths of around 630,000 people in the U.S. each year.

  • In the U.S., a person has a heart attack every 40 seconds, and at least one person dies per minute from an event related to heart problems.

  • The health burden placed by heart disease on the U.S. economy is around $200 billion.

  • The most common type of heart disease is coronary heart disease.

  • Mississippi is the state with the highest rate of death from heart disease at 233.1 deaths per 100,000 members of the population. The state is closely followed by Oklahoma, Arkansas, Alabama, and Louisiana. Minnesota, Hawaii, and Colorado have the lowest rates.


Advances are being made every day in the research and treatment of heart disease.

A recent study, to be presented at 2018’s annual Radiological Society of North America meeting, has shown that fat distribution across the body increases the risk of heart disease and other cardiometabolic conditions in women.

The 69th Annual Conference of the Cardiological Society of India recently saw the presentation of findings that showed the risk of heart disease increase by 500 percent with baldness and gray hair in men.

Smoking just one cigarette each day can increase the risk of heart disease, according to a new study in the BMJ. The research suggests that cutting out cigarettes completely is the only way to reduce this risk, as opposed to simply cutting down the number of cigarettes.

In other news, a study in the New England Journal of Medicine has linked flu to heart attacks in groups of people who are at risk of heart disease.

A new study also suggests that restless leg syndrome (RLS) may also increase the risk of death from heart-related conditions, especially in older women.

Medically reviewed by Debra Sullivan, Ph.D., MSN, R.N., CNE, COI on February 7, 2018 — Written by Adam Felman   (

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