Terminal Diseases - An Overview

Introduction:

Terminal diseases are irreversible medical conditions resulting in death or permanent unconsciousness from which one is unlikely to recover. A terminal illness is also defined as one in which an individual will die "shortly," irrespective of the medical treatment given. It is also called a life-limiting illness.

What Are the Examples of Terminal Diseases?

Individuals with terminal illnesses may have a single illness or many medical conditions. Terminal diseases are usually progressive diseases, and a few examples of terminal diseases include:

• Advanced cancer.

• Acquired immunodeficiency syndrome (AIDS).

• Dementia.

• Alzheimer's disease.

• Motor neuron disease (MND).

• Chronic lung disorders such as chronic obstructive pulmonary disease.

• Neurological diseases like Parkinson's disease.

• Advanced heart disease.

• End-stage kidney disease.

• Rheumatoid arthritis (RA).

• Schizophrenia.

• Poliomyelitis.

• Muscular dystrophy.

• Cystic fibrosis.

• Scleroderma.

• Multiple sclerosis (MS).

• Amyotrophic lateral sclerosis (ALS).

What Are the Treatment Options for Individuals With Terminal Diseases?

By definition, there is no cure or specific treatment for terminal illnesses. Therefore, the care delivered to terminally ill patients after obtaining the diagnosis includes:

• Continued Treatment: Some terminally ill patients opt for an intense, aggressive treatment approach, hoping for a miraculous cure. The unnecessary treatments with unrealistic expectations result in suffering from the side effects of the treatment, thus hampering comfort and quality of life until death.

• Medications For Terminally Ill: Terminal patients experiencing cancer-related pain are often prescribed opioids to relieve suffering. Anti-inflammatory, antidepressant, and anti-nausea medications are prescribed to alleviate symptoms of inflammation, depression, and nausea.

• Caregiving: Usually, a terminally ill needs a caregiver, who may be a nurse, licensed practical nurse, or a family member, to help in receiving medications to relieve pain and other symptoms such as nausea or vomiting, emotional and psychological support, assistance with daily activities, and meal preparation. The caregiver also acts as a link between the physician and the terminally ill and helps in coordinating care.

• Hospice Care: It provides emotional and spiritual support for patients and loved ones. Hospice care can be provided at home or in a long-term care facility. It is dedicated to nurturing the quality of life until death.

• Physician-Assisted Suicide Or Euthanasia: It is legal in only a few countries. The terminally ill opts to 'die with dignity,' which involves voluntary written and verbal consent by the individual and using lethal drugs to end life. The factors associated are avoidance from pain, suffering, life-long disability, healthcare costs, personal beliefs, spiritual beliefs, insurance coverage, impact on family, etc.

• Lifestyle interventions like radical dietary modifications.

• Psychotherapeutic interventions.

• Palliative Care: It addresses the patient's needs after the diagnosis. Palliative care addresses pain management, emotional support, and spiritual care for terminally ill patients and builds support systems to help them get through difficult times.

Palliative care also helps individuals to understand their treatment goals and helps improve comfort and quality of life. It also supports the caregiver and family members and lowers hospital admission costs.

• In a few cases, all debilitating treatments are stopped to reduce unwanted side effects, whereas others may continue intense and aggressive treatments in the hope of an unexpected miraculous cure.

• Complementary Treatment: Treatment approaches such as acupuncture, relaxation therapy, and massage help relieve some pain symptoms and other causes of suffering.

What Are the Symptoms of Terminal Diseases?

Symptoms include:

• Fatigue.

• Nausea.

• Vomiting.

• Constipation.

• Depression.

• Dyspnea.

• Anorexia.

• Congestion.

• Anxiety.

• Seizures.

• Restlessness.

• Agitation.

• Confusion.

What Are the Stages of a Terminal Disease?

Various changes in responsiveness and functioning are observed in these stages. The onset of each stage and the symptoms experienced may vary from person to person. There are three main stages of dying:

• The Early Stage: It is characterized by markedly less eating and drinking and lasts from a few weeks to months.

• The Middle Stage: It is marked by changes in the physical appearance that could last for a few hours or several days.

• The Last Stage: During the final stage of terminal disease, disorientation, restlessness, and changes in the terminally ill patient’s breathing and continence are seen.

Elisabeth Kubler Ross introduced the five phases of dying in 1969 are:

• Denial: This stage is marked by the initial shock of the diagnosis. The terminal disease diagnosis is received with disbelief and outright denial. The patient may seek second opinions or distract themselves with busy schedules and tasks as a coping mechanism. Signs of denial include confusion, anxiety, fear, or numbness.

• Anger: Anger is followed by denial and acceptance of the diagnosis. Awareness of the unsuccessful prognosis of their medical condition causes anger, rage, and frustration in them.

• Bargaining: In this stage, the terminally ill patients strive to postpone death by making negotiations with making vows to god, or may revolve around treatment or lifestyle interventions. It is a way the person copes with grief.

• Depression: In this stage, the terminally ill realizes that bargaining does not resolve his medical condition and may feel hopeless. A lack of appetite, social interactions, sleep disturbances, eating issues, depression, and altered mental status mark this stage.

• Acceptance: In this stage, the terminally ill accepts his health status and prognosis and seeks medical supervision and assistance from a caregiver, hospice care, palliative care, complementary medicine, or family members to relieve symptoms of pain and discomfort and improve the quality of life.

What Is the Life-Expectancy of Someone Who Is Terminally Ill?

There is no life expectancy, although terminally ill patients may only survive for a few days or weeks after they have been diagnosed. In contrast, others can live months or potentially years. The survival rate of a terminally ill person is a rough estimate given by the physician based on previous data and the progression of the disease. Still, it only partially reflects the exact span of longevity.

Can a Terminal Illness Get Better?

A terminal disease will not get better as it cannot be cured. But some terminal diseases can be treated to help ease symptoms such as pain, nausea, constipation, depression, etc., or improve quality of life.

Conclusion:

Terminal or end-stage disease is an incurable illness with no specific treatment approach and is expected to result in the death of an individual.