The family’s expectation of prognosis is sometimes incongruent with reality. Especially with older patients in the nursing home:
It still amazes me how some families are so in tune with reality and some have no clue about reality. 87 year olds with multiple chronic medical conditions do not start dialysis and get better, and go home. They do not live out their lives in painless bliss. They suffer. Their years of smoking, immobility, obesity, alcohol abuse and noncompliance catch up. And now they live with the consequences. Some families refuse to accept reality. Some have never been explained the current reality. Some bounce from doctor to doctor with ignorance, believing there is an end of the tunnel.
Educating families and reining in expectations can help in decreasing the amount of expensive, futile care.
