Background: Lifestyle medicine interventions have the potential to improve symptom management, daily function, and quality of life (QOL) in patients with advanced or terminal disease receiving palliative or hospice care. The goal of this review is to summarize the current state of the literature on this subject. Methods: The authors used a broad search strategy to identify relevant studies, reviews, and expert opinions, followed by narrative summary of available information. Results: Four main categories of lifestyle interventions feature prominently in the palliative care literature: exercise, nutrition, stress management, and substance use. High-quality studies in this vulnerable population are relatively sparse. Some interventions show promise. However, most show mixed results or inadequate evidence. For some interventions, risks in this generally frail population outweigh the benefits. Clinical decision making involves balancing research findings, including the risks and benefits of interventions, with a clear understanding of patients’ prognosis, goals of care, and current physical, emotional, and spiritual state. Achieving optimum QOL, safety, and ethical care are emphasized. Conclusions: The use of lifestyle interventions in patients receiving palliative or hospice care is a complex undertaking, requiring tailoring recommendations to individual patients. There is potential for considerable benefits; however, more research is needed.
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Urosepsis" was the diagnosis for the small-framed gaunt man who lay motionless as a mummy in the white sheets. Mr. Williams, 90 years old, had been in an assisted living facility because vascular dementia had left him unable to care for himself. "He's full code," my colleague told me during sign out. "Despite all the antibiotics we've given him, he's just not showing any improvement-he can't even raise his hand. I talked with Junior, his son, about life-saving measures and asked him to discuss them with the team today. To me, DNR is the right choice at this point."I reviewed Mr. Williams's labs-abysmal. He was somnolent, his thin eyelids fluttering but never opening. He did not respond to questions or to stimuli. Nasogastric tube placement had been attempted three times, without success. A swallow evaluation was impossible."You just want to give up on him?" Junior Williams asked plaintively. "I'm not the one to decide. Mama is the one needs to give permission. Pop and Mama been married 68 years. She's been riding 35 minutes each way on the bus to visit with him an hour or two and has not missed one single day in two years. She's pretty salty about this virus, too. Hospital won't let her in, seeing as how she's 95." He chuckled a little. "Yeah, when I say 'talk to Mama,' that really means 'listen to Mama.' That's the Williams family rule."The COVID-19 pandemic meant that "listening to Mama" would have to be by telephone, and I called Mrs. Williams as soon as I could. I introduced myself and explained her husband's condition and our concerns."You put James on the phone," a thin, but firm voice instructed. She doesn't understand that's impossible, I thought. Maybe I wasn't clear."But Mrs. Williams," I said, "he can't talk. He isn't responding and we haven't been able to wake him up."Funding: None. Conflicts of Interest: None.
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