Hospice care : Things to know

Hospice care is for people who are nearing the end of life. Hospice care services are provided by a team of health care professionals who maximize comfort for a person who is terminally ill by reducing pain and addressing physical, psychological, social and spiritual needs. To help families, hospice care also provides counseling, respite care and practical support.

Unlike other medical care, the focus of hospice care isn’t to cure the underlying disease. The goal of hospice care is to support the highest quality of life possible for whatever time remains.
Target group 
Hospice care is for a terminally ill person who’s expected to have six months or less to live. This doesn’t mean that hospice care will be provided only for six months, however. Hospice care can be provided for as long as the person’s doctor and hospice care team certify that the condition remains life-limiting.

Hospice care isn’t just for people who have cancer. Many people who receive hospice care have cancer, while others have heart disease, dementia, kidney failure or chronic obstructive pulmonary disease.

Enrolling in hospice care early helps patients live better and live longer. Hospice care decreases the burden on the family, decreases the family’s likelihood of having a complicated bereavement and prepares family members for their loved one’s death.

In addition, there is a unique benefit of hospice that 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 rest in order to continue to care for his or her loved one. This is known as respite care.

Where Hospice care is provided 

Most hospice care is provided at home — with a family member typically serving as the primary caregiver. However, hospice care is also available at hospitals, nursing homes, assisted living facilities and dedicated hospice facilities.

Keep in mind that no matter where hospice care is provided, sometimes it’s necessary to be admitted to a hospital. For instance, if a symptom can’t be adequately managed by the hospice care team in a home setting, a hospital stay might be needed.

If you or a loved one has a terminal illness and you’ve exhausted all treatment options, you might consider hospice care

Managing Aging Related Problems in Your Parents

One day, our parents may not be able to drive, to climb stairs, or maybe not even change their own clothes or feed themselves. Our parents could one day be fine and then suddenly the next day need a great amount of care, so the more prepared  we are in advance, the less stressful this might be for our whole family.


Physical Activity in old age:

Regular exercise and physical activity can have a direct impact on your parent’s everyday life. The benefits they provide can help them to stay strong and fit enough to perform their daily activities, so promote them to get around and maintain their independence.


Some exercises and their benefits:

1. To enhance their endurance they may go for aerobic, activities like brisk walking or swimming, increase their breathing, heart rate and improve the health of their heart, lungs and circulatory system. Some easy house hold tasks can also help them in this regard:

  • push your grandchildren on the swings
  • work in the garden
  • rake leaves
  • play a sport

2. Strength exercises like lifting weights and using resistance bands can increase muscle strength. Lower-body strength exercises also will improve their balance. Increased muscle strength can maintain their ability to:

  •  Climb Stairs
  • Carry Groceries
  • Open Jars
  • Carry A Full Laundry Basket From The Basement To The Second Floor
  • Carry Your Smaller Grandchildren
  • Lift Bags Of Mulch In The Garden

3. Balance exercises like tai chi can improve their ability to control and maintain their body’s position, whether they are moving or  still. Good balance is important to help them to prevent falls and avoid the disability that may result from falling. Improving their  balance can help them to:

  • Prevent falls
  • Stand on tiptoe to reach something on the top shelf
  • Walk up and down the stairs
  • Walk on an uneven sidewalk without falling

4. Flexibility or stretching exercises can help them to stay flexible and limber, which gives your parents more freedom of movement for their  regular physical activity as well as for   everyday activities. Stretching exercises can improve their flexibility but will not improve their endurance or strength. Improving their flexibility makes it easier for them to:

  • Look over your? shoulder to see what’s behind you as you back the car out of the driveway
  • Make the bed
  • Bend over to tie your shoes
  • Reach for a food item on a kitchen shelf
  • Pull a sweater on over your head
  • Swing a golf club



General health related problems in Old age:


1. Balance Disorders 

So many times you find out that your parents may not able to walk properly not able to listen what are you saying or they may feel unsteady or dizzy, as if they are moving, spinning, or floating, even though you are standing still or lying down. Balance disorders can be caused by certain health conditions, medications, or a problem in the inner ear or the brain.


2. Problem with taste

Taste disorders can weaken or remove an early warning system that most of us take for granted. Taste helps us to detect spoiled food or liquids and for some people, the presence of ingredients to which they are allergic

Many of us take our sense of taste for granted, but a taste disorder can have a negative effect on our   health and quality of life. If your parents are having a problem with their sense of taste they need a doctor as soon as possible.


3. Sleep and ageing 

Sleep pattern changes according to our age. Children and adolescents need more sleep than adults. Interestingly, older adults  need about the same amount of sleep as younger adults — seven to nine hours of sleep per night. Unfortunately, many older adults often get less sleep than they need. One reason is that they often have more trouble falling asleep. A study of adults over 65 found that 13 percent of men and 36 percent of women take more than 30 minutes to fall asleep. This disorder is known as Insomnia.


 Health check up, Screening and Immunization:

  •  Periodical health check up for management of chronic diseases and screening for early detection of disease includes:
  •  Care of the problems due to ageing process as senile cataract, glaucoma, nerve deafness, osteoporosis and osteoarthritis affecting mobility, failure of special senses, and change in mental outlook.
  • Care of the problems associated with long term illness-certain chronic diseases are more frequent among the older people such as cardiovascular diseases, cancer, accidents, disease of locomotors system, respiratory illnesses as chronic bronchitis, asthma, emphysema, diseases of genitourinary system.
  • Care for psychological problems


Recommended Immunisations:

  • Immunisation recommendations are based on age, health status, location, risk factors and other factors therefore talk to healthcare professional to see which vaccine is needed.
  • Flu vaccine every year.
  • Vaccine for tetanus, diphtheria and whooping cough and a tetanus booster if it has been more than 10 years since their last vaccine.
  • If your parents are 60 or older, get a vaccine to prevent shingles. Even if they had shingles, you can still get the shingles vaccine to help prevent future occurrences of the disease.
  • If your parents are 65 or older, get a pneumonia vaccine (also known as a pneumococcal vaccine).


Aging is a natural process. Sir James Sterling Ross commented: You do not heal old age. You protect it, you promote it and you extend it”.




  • http://health.usnews.com/health-news/articles/2007/11/02/taking-care-of-your-parents-keeping-them-socially-connected
  • http://lifehacker.com/how-to-care-for-your-aging-parents-1688333666
  • http://www.pbs.org/newshour/updates/options-want-stay-home-age/
  • http://www.mayoclinic.org/healthy-lifestyle/caregivers/in-depth/aging-parents/art-20044126?pg=2

Bad Effects of tobacco on Health

Tobacco is extracted from around 65 known species of the tobacco plant of which the one that is grown commercially and widely as a source of tobacco is Nicotiana tobaccum. The growing use of tobacco is a cause of great concern around the world due to its serious effects on health.

Non-communicable diseases (NCDs) like ischemic heart diseases, cancers, diabetes, chronic respiratory diseases are the leading causes of death globally and associated with tobacco use. Available data from WHO demonstrate that thirty-eight million people die each year from NCDs, of which nearly 85% of NCD deaths occur in low- and middle-income countries.

Composition of Tobacco

Tobacco products contains around 5000 toxic substances. Most important and dangerous constituents are:

  1. Nicotine
  2. Carbon Monoxide
  3. Tar

Nicotine is the major cause of the predominant behavioral effects of tobacco. It is a poisonous substance leads to addiction. Nicotine influences and reinforces all tobacco-use behavior. After absorption, nicotine travels rapidly to the brain, in a matter of seconds, therefore, the psycho-active rewards associated with smoking occur quickly and these rewards are highly reinforced. Nicotine binds to the receptors in the brain where it influences the cerebral metabolism. Nicotine is then distributed throughout the body, mostly to skeletal muscles. Development of tolerance to its own actions is similar to that produced by other addictive drugs.

Carbon mono-oxide reduces the amount of oxygen blood can carry and causes shortness of breath.

Tar is a sticky residue which contains benzopyrene, one of the deadliest cancer causing agents known.

Other compounds are carbon dioxide, nitrogen oxides, ammonia, volatile nitrosamines, hydrogen cyanide, volatile sulfur containing compounds, volatile hydrocarbons, alcohols, aldehydes and ketones. Some of these compounds are known to cause cancers of various organs of the body.

Mechanism of action

Nicotine has structural similarity to a body neuro-transmitter acetylcholine (Ach) which conveys information from one neuron to another. Acetylcholine is an important neurotransmitter involved in systems concerned with mental and physical arousal, learning and memory, and several aspects of emotion. There are also other receptors for acetylcholine in the body, apart from the ones at synapses. They are also found at the junction of nerve and muscles and nerves and certain glands. Acetylcholine receptors throughout the body are traditionally classified as nicotine receptors (those that respond to nicotine) and muscarine receptors (those that respond to muscarine). The ability of nicotine to combine with acetylcholine-receptors means that it can exert actions like acetylcholine at all synapses where nicotine acetylcholine-receptors (nAChRs) are present and can trigger impulses.

Forms of tobacco intake

  1. Cigarette – Most common and most harmful
  2. Bidi – most commonly used form in India
  3. Cigar –
  4. Hookah (Hubble bubble)
  5. Sheesha
  6. Tobacco chewing
  7. Kreteks (clove cigarettes)
  8. Snuff – Moist & Dry
  9. E-cigarette – recent intruder in the list

When non-smokers are exposed to smoke containing nicotine and toxic chemicals emitted by smokers it is called passive smoking or exposure to second hand smoke.

Risk factors for tobacco initiation

Following factors influence the predilection for tobacco use:


  • Developmental aspects of adolescent age group include (a) establishing independence and autonomy, (b) forming a coherent self-identity and (c) adjusting to psycho-social changes associated with physical maturation.
  • Gender: tobacco use is more common among males in India.


Low emotional stability and risk taking behavior are more common in tobacco users. Existence of some mental disorders also increases the risk of tobacco use.

3.Social and Environmental:

Parental influence, lower education status, attraction towards role models, cultural practices, etc.

Consequences of tobacco use
Various effects of tobacco use are as follows:

  1. Economic loss
  2. Health loss
  3. Environmental loss

Tobacco is considered as a major behavioral risk factor for non-communicable diseases one of the leading causes of death. Treatment of cardiovascular diseases and cancer imposes maximum financial burden on the individual and family. For cultivation of tobacco crop forests are destroyed. Burning of tobacco produces number of toxicants in environment. Manufacturing, packaging and transportation also cause environmental pollution.

Cancers associated with tobacco
Tobacco is also associated with cancer of respiratory tract, lung, upper gastrointestinal tract, liver, pancreas, kidney, urinary bladder, oral cavity, nasal cavity, cervix, etc. Smokeless tobacco (chew tobacco, snuff etc.) is a major cause of cancer of the oral cavity.
Risk of developing cancer increases with:

  1. Duration of use of tobacco
  2. Number of tobacco product use per day
  3. Degree of inhalation

Cardiovascular diseases

  1. Stroke is vascular disease of the brain where tobacco causes either constrict of blood vessels or rupture leading to loss of consciousness and paralysis.
  2. Tobacco affects coronary vessels of the heart leading decrease of blood supply or death of heart muscles which is known as ischemic or coronary heart disease. This in turn causes cardiac arrest.
  3. Smoking acts synergistically with other risk factors like high cholesterol and blood pressure to increase the risk of Coronary Heart Diseases (CHD).

Respiratory Diseases

  1. Chronic Obstructive Pulmonary Disease: It includes chronic bronchitis and emphysema
  2. Asthma: Smoking is associated with acute attacks of asthma
  3. Tuberculosis

Effect on pregnancy and its outcome

  1. Bleeding during pregnancy
  2. Ectopic pregnancy
  3. Miscarriage/abortion
  4. Premature delivery of baby
  5. Stillbirth
  6. Abnormalities of the placenta

Effects on newborns and childhood
Maternal tobacco use during pregnancy and exposure of child to second hand smoke in childhood is known to be a risk factor for following conditions:

  1. Maternal smoking is associated with congenital malformations in baby like orofacial clefts, clubfoot and atrial-septal defects.
  2. Increased risk of allergies
  3. Higher blood pressure in childhood
  4. Increased likelihood of obesity
  5. Stunted growth
  6. Poorer lung function
  7. Increased likelihood of developing asthma


Following conditions are known to worsen if case of tobacco use:

  1. Rheumatologic conditions: Rheumatoid arthritis
  2. Kidney damage
  3. Eye Disease: Age-Related Macular Degeneration
  4. Dental Disease like caries
  5. Diabetes
  6. Inflammatory bowel diseases
  7. Erectile dysfunction


  1. WHO. Non-communicable Diseases Country Profiles.  2014. Available from  http://apps.who.int/iris/bitstream/10665/128038/1/9789241507509_eng.pdf.
  2. WHO. NCDs country profile. 2010. Available from http://www.who.int/nmh/countries/ind_en.pdf.
  3. WHO. Available from http://who.int/mediacentre/factsheets/fs339/en/.
  4. Talhout R, Schulz T, Florek E , Benthem J, Wester P, Opperhuizen A. Hazardous Compounds in Tobacco Smoke. Int. J. Environ. Res. Public Health 2011;8:613-28.
  5. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014