Seniors With Terminal Illness: Crucial Info for Patients and Loved Ones About Dealing With End-Stage Medical Conditions

What Is a Terminal Illness?

Persistent, irreversible medical conditions come in two varieties: chronic and terminal. The main difference is that a chronic illness, in and of itself, isn't considered to be fatal. With treatment, many people who have chronic diseases live their full lives. In contrast, terminal conditions directly cut many people's lives short.

So, what is terminal disease? Here's a common terminal illness definition: a progressive, incurable medical condition that typically leads to death within a relatively short amount of time. Depending on the particular factors involved, terminal illnesses (also called end-stage or life-limiting diseases) can bring about the end of patients' lives days, weeks, months, or, in some cases, years after diagnosis.

Some of the most common terminal illnesses are:

• Late-stage cancers
• Advanced heart and circulatory conditions
• Dementia
• Advanced respiratory diseases
• Irreversible damage from stroke
• Advanced kidney disease
• Advanced liver disease

Additional medical conditions that merit inclusion on a terminal illness list are amyotrophic lateral sclerosis (also known as ALS or Lou Gehrig's disease), certain other neurodegenerative disorders, and some kinds of drug-resistant bacterial infections. Some viruses, such as Ebola, can also cause terminal illness.

Complications That Become Terminal

Having a combination of multiple medical conditions and/or complications that will likely lead to death in a short amount of time also qualifies as "terminally ill." In fact, someone with a progressive chronic illness may eventually experience complications that endanger his or her life. So even though a chronic illness itself is not a terminal disease, complications arising from it (such as infections) may lead to a terminal condition.

That's why Alzheimer's is a terminal illness, but Parkinson's disease is not. Alzheimer's always leads to death as a result of the disease itself, often at an earlier age than would otherwise be expected. In contrast, Parkinson's progresses in a way that, slowly, over time, reduces a person's movements until he or she can eventually no longer stand or walk. With late-stage Parkinson's, a patient becomes more vulnerable to potentially fatal complications like infection, blood clots, and falls. But Parkinson's is considered a chronic illness because the disease itself doesn't directly lead to death, and advances in treatment have greatly extended patients' life expectancies.

Similarly, Crohn's disease is not terminal, but some people eventually develop life-threatening complications from it. Diabetes is not a terminal illness, but it can cause fatal secondary conditions if it isn't managed well. And multiple sclerosis (MS) is not a terminal illness, but some patients at the advanced stage of the disease can pass away from infections or other complications.

What It All Means

Basically, a terminal medical condition is a single illness or combination of medical problems that will directly lead to death in a relatively short period of time. There are no cures for conditions like dementia or terminal cancer, meaning that people who are diagnosed with them will generally pass away a lot sooner than they would if they were healthy.

Of course, not all cancers are fatal. Many early-stage cancers can be successfully treated and put into remission. But many stage 4 (IV) cancers are terminal because they have metastasized (i.e., spread) to other regions of the body, making treatment much more difficult, ineffective, or even impossible. Any type of cancer can progress to a late stage and become fatal.

By the same token, heart disease is fatal for many older adults when it advances to a point at which effective treatment options no longer exist. That's also true for a lot of patients with other advanced organ diseases. For them, being terminally ill means not having options like organ transplants or other potentially life-saving treatments or procedures.

How Long Can a Terminally Ill Senior Live?

This can be hard to predict—even for doctors. It depends on all kinds of different factors, including the person's age, his or her particular diagnosis and treatments, the stage of the illness, and his or her other physical and/or mental conditions. In the elderly, terminal illness often leads to death in six months or less. In younger seniors, terminal diseases sometimes last longer than expected—sometimes for years. But no two terminally ill patients are exactly the same. Survival times vary for everyone.

The Trouble With Predictions

Physicians often make inaccurate predictions about their patients' survival time. In fact, numerous studies have shown that physicians tend to be too optimistic when estimating how long their terminally ill patients have to live. They frequently overestimate, which can make their prognoses unreliable.

On the other hand, some doctors are accurate in their estimates, and some are even too pessimistic. So any prognosis you receive is only an educated guess, not a precise determination of your actual longevity. Doctors try to know how much time you have to live by:

• Looking at the median survival time of people your age, with your illness
• Judging the progression and stage of your illness
• Evaluating the potential impacts of other conditions you may have
• Weighing your family history
• Determining whether you can handle proposed treatments
• Analyzing whether treatments may extend your survival time
• Using intuition based on clinical experiences with similar patients

A study in the Journal of Palliative Medicine found that about 13.4 percent of terminally ill patients survive more than six months after beginning hospice care. But, like physicians, hospice teams are often inaccurate at predicting death within a specified period of time, especially when it comes to stroke and dementia patients.

According to the National Hospice and Palliative Care Organization, the median length of hospice care in the U.S. is 18 days. That means half of all hospice patients survive longer than that and half survive for less time. The median length of hospice care also varies by the type of terminal illness, as highlighted in the following examples:

• Kidney disease: 8 days
• Cancer: 18 days
• Respiratory illness: 21 days
• Stroke: 26 days
• Heart or circulatory disease: 31 days
• Alzheimer's, Dementia, and Parkinson's: 55 days

Survival

It's true that many terminally ill patients are able to live for a while before requiring hospice or end-of-life care. With some illnesses, it can take several months or even years to reach that point. But regardless of how long it lasts, you cannot survive a terminal illness if it was accurately diagnosed.

By definition, terminal cancer is incurable (as are other terminal medical conditions). Depending on the particular circumstances, a person can survive stage 4 cancer for five years or longer. However, you cannot recover from terminal cancer if it is truly incurable and/or untreatable.

After age 65, the life expectancy of a person with stage 4 cancer is often two years or less at the time of diagnosis, according to survival statistics from the National Cancer Institute. In fact, only 43.8 percent of all American seniors with late-stage cancer would be expected to survive at least one year. And only about 20 percent would be expected to live at least five years. However, those numbers are for all cancers in general. Certain cancers come with significantly better or worse expectations.

For example, data from the National Cancer Institute shows that the one-year survival rate for seniors with metastatic lung cancer is 24.6 percent. And only about 4.3 percent would be expected to live five years. For late-stage pancreatic cancer (one of the deadliest types), the numbers are even worse: Only 13.6 percent of seniors would be expected to live one year, and only 1.8 percent would be expected to live five years.

So-called "medical miracles" have certainly been reported. These are cases in which patients diagnosed with terminal illnesses seem to have recovered without any logical explanation. But those types of cases are rare; they are extreme outliers. And many of them may just be the result of mistaken diagnoses, meaning that the physicians involved were wrong in their assessments. (Their patients may not have been terminally ill to begin with.)

What Are the Main Stages of Terminal Illness?

Most terminal diseases are experienced as a progression of various emotions and physical changes. But terminal illness stages can look very different from one patient to another. Each disease progresses in its own way, and not all patients experience exactly the same symptoms and changes.

For example, certain terminal illnesses are painful for some patients but not for others. And each terminal patient experiences a unique range and intensity of emotions, which can change quickly and fluctuate over time.

Mental and Emotional Stages

People respond in different ways after learning they are terminally ill. But nearly every feeling is normal. So there isn't one universal set of mental and emotional phases; they can come and go without any apparent rhyme or reason. However, most terminally ill patients do experience at least some of the following mental or emotional states, though not necessarily in this order:

• Shock: After being diagnosed with a terminal illness, it's common to feel surprised and disturbed. Getting that kind of news is upsetting, and it can feel very sudden, even if you thought it was a possibility beforehand.
• Confusion: Knowing that you're terminally ill can make you feel disoriented, kind of like being lost in time and space. You might have trouble concentrating. And some seniors experience temporary hallucinations or say or do things that are confusing to other people.
• Denial: You may not be able to acknowledge the uncomfortable truth of your terminal illness, at least for a little while. Denial is a natural defense mechanism when we're faced with what we deem to be an unacceptable reality.
• Fear: The change and uncertainty that comes with having a terminal medical condition can definitely be scary. After all, you might be afraid of what will happen to you physically, whether you'll be in pain, how your illness will affect your family, what death will be like, and more. Your fear may trigger feelings of anxiety, distress, restlessness, and agitation as you ponder your future.
• Anger: Some terminally ill patients look for people or things to blame for their conditions. They may even resent the healthy people around them or feel irritated by having to disrupt their plans, hobbies, lifestyles, or relationships in order to deal with their illnesses.
• Hope: Many seniors with terminal illnesses eventually feel a sense of optimism about their future, which can certainly be a positive way of coping. But for some patients, hope can manifest as bargaining; that is, they would give or do anything in exchange for a cure or extra time, even when all of the evidence points to that not being a realistic possibility.
• Frustration: Knowing that you can't change the reality of your terminal medical condition can create a significant amount of inner tension, making you feel annoyed. That can be especially true when you have to cancel plans or do things in a different way than you ordinarily would.
• Guilt: Terminally ill seniors often feel like they are a burden on their families and caregivers, blaming themselves for the adversity experienced by others due to their conditions.
• Helplessness: You might have days when you feel powerless or extra vulnerable, without a sense of control over your life.
• Sadness or depression: It's common to feel down in the dumps when you have a terminal disease. But some patients feel sad or disinterested in their daily activities for more than two weeks at a time, which can mean they have clinical depression.
• Detachment: Feeling a general sense of indifference, some terminally ill seniors stop pursuing social engagements or try to avoid even simple interpersonal interactions.
• Loneliness: Some patients think that nobody could truly understand what they are experiencing, so they avoid socializing or sharing their feelings with others. Or they may feel isolated, even if they have the support of people who care about them.
• Reflectiveness: Confronted with your mortality, you may ponder the meaning and purpose of your life. That might involve thinking about cherished memories and all of the people, events, and achievements that have mattered most to you. You might also begin to question your personal philosophies or spiritual beliefs.
• Regret: Reflection can lead to many positive feelings, but it can also lead to feelings of remorse, disappointment, or dissatisfaction. For example, you might regret personal conflicts that haven't been resolved or major goals that you haven't fulfilled.
• Acceptance: Eventually, some terminally ill seniors are able to fully acknowledge their mortality and embrace their approaching deaths. Once they do, they often feel more positive, at peace, and in greater control of their circumstances.

Combined with a terminally ill senior's spiritual convictions, intense emotions can sometimes play a role in bringing about dreams or visions that seem to have deep meaning. Often, such experiences are comforting. But having confusing or upsetting dreams or visions is sometimes a side effect of medication or a sign of a new, underlying medical complication that needs attention.

Physical Changes

The physical experiences of terminally ill patients vary widely. Each circumstance is different. Some people have a relatively smooth transition to the end of life; others have challenging complications. But with proper care, most challenges can be managed in a way that greatly improves a patient's level of comfort.

Still, it's helpful to know what you might experience. That way, you aren't caught off guard by physical changes that you weren't expecting.

For example, terminal cancer symptoms are often wide-ranging, but many patients experience worsening pain and fatigue as their conditions progress. They also may experience fatal complications. That's because cancer can cause death in a variety of ways. Depending on where it has spread in your body, terminal cancer kills you by triggering irreversible complications like:

• Anemia
• Infections
• Brain impairment
• Severe dehydration
• Uncontrolled bleeding
• Severe malnutrition
• Organ failure (such as of the heart, lungs, or liver)
• Blood clots that cause stroke or obstruction of an artery

Other terminal diseases can cause the same or similar complications, especially as patients get closer to passing away. But most of the physical changes caused by terminal conditions aren't directly fatal; they may just be indications that the body is compensating as best as it can. For example, in the final months, weeks, or days of life, a terminally ill senior might experience or display symptoms such as:

• Pain
• Nausea
• Constipation
• Fatigue
• Dry mouth
• Loss of bladder control
• Difficulty swallowing
• Weight loss
• Swelling and puffiness
• Noisy breathing
• Weakness
• Shortness of breath
• Loss of appetite
• Feeling too hot or cold

Pain isn't experienced by all terminally ill patients. But it can come about in a lot of different ways. For instance, it may come on suddenly and dissipate in a matter of weeks, days, or hours. Or it may come on gradually or intermittently and last for the length of a patient's remaining life.

Pain can be caused by inflammation or damage to nerves, bones, or organs. It can also "break through" when a patient is on painkillers. And pain can be felt in one area of the body even though the root cause is in a different area. But regardless of a person's condition, pain and other symptoms can often be managed through proper treatment and care.

When it comes to a terminally ill senior's last hours or minutes of life, loved ones and caregivers may notice changes such as:

• Cold hands and feet
• Blotchy or pale-blue skin
• Loud, "rattly" breathing
• Unconsciousness
• Slow, shallow, inconsistent breathing
• Delirium or out-of-character behavior

What Should I Do After Being Diagnosed With a Terminal Illness?

It's normal to wonder how to move forward when presented with the unpleasant revelation of your terminal condition. You might feel stuck in time, unsure of the actions to take next. But take heart; you can reclaim a sense of control. Your goal should be to eliminate as much uncertainty as possible while drawing upon the strength of others. That way, you can make room for greater comfort and peace of mind for you and your loved ones. Here's how to achieve that:

1. Get a second opinion.

Doctors and other medical professionals aren't perfect. Sometimes they get things wrong. And this is your life we're talking about. So you shouldn't have to wonder about your diagnosis.

By getting a second opinion from a doctor at a different institution, you'll either get your diagnosis confirmed or learn that your medical condition might be something else. If your terminal illness is confirmed, you'll know for sure—eliminating some of your doubts. And if the second opinion includes roughly the same prognosis, you'll probably have a better idea of how much time you have left.

2. Ask for honesty.

The truth isn't always easy to hear. Even so, the vast majority of patients with advanced cancer want accurate and honest communication about their prognosis, according to an article in the Annals of Palliative Medicine. (The same is probably true of other terminally ill patients.)

Yet, according to a study in the Journal of Clinical Oncology, very few patients fully understand their prognosis unless it is discussed with the appropriate physicians on an ongoing basis. In part, that's because many doctors lean too heavily in the direction of optimism (at least initially), sometimes sugarcoating what a prognosis actually means. They're afraid to crush their patients' hopes.

When discussing terminal diagnoses, doctors do tell patients they are dying. But they don't always say it so bluntly or directly. For instance, instead of telling a patient that he or she will likely pass away in under a year, a doctor might say that the illness probably isn't curable. Unfortunately, that can provide a patient with just enough hope to move him or her in a direction that is more destructive than beneficial.

For example, without a candid prognosis, a patient may decide to pursue costly or risky treatments that aren't supported with scientific evidence or that greatly reduce his or her remaining quality of life. Or a patient might not take the time to consider or plan for the kind of end-of-life care that he or she would really want—and deserve.

According to the Stanford ML Group, about 80 percent of Americans want to live their last days at home, yet as many as 60 percent of all deaths occur in acute-care hospitals. And most of those hospital patients receive aggressive treatments in their last days. Such treatments often do little to extend patients' lives by any significant margin. Instead, they frequently prolong the suffering in an environment that is anything but peaceful.

So as a terminally ill patient, it may be in your best interests to insist on honesty from your physicians. Get them to tell it to you straight, no matter how difficult the news will be to hear. Ask about the full range of potential outcomes. Or at least specify how much knowledge you want your doctors to share with you.

That way, you'll be more grounded when considering your next steps. And you'll likely have more of an opportunity to make arrangements, such as for palliative care, that can maximize your quality of life going forward.

(Many terminally ill patients and families that are driven by unjustified hope and the potential of alternative, experimental, or aggressive treatments try to schedule palliative care when it's too late. That can result in medical crises, distressing visits to the hospital, and unpeaceful death.)

3. Discuss your care and treatment options.

After the initial shock of your diagnosis wears off, schedule appointments with your doctors in order to have conversations about the courses of action that are available and realistic for you. Depending on your condition, you may have the option of pursuing treatments to extend your life or shifting your focus entirely to the management of your symptoms. (You also may have the option of pursuing both symptom management and ongoing treatment concurrently.)

But in order to make that kind of decision, you should learn all you can about what to expect from your particular illness as it progresses. Your doctors can talk to you about subjects like:

• Continuing treatment: Being terminally ill means not having access to curative treatments. At best, certain treatments might extend your life a little, potentially giving you some extra weeks, months, or years. But there is often a tradeoff for that extra time: lower quality of life. That's because many treatments come with negative side effects that can make it difficult or impossible to carry out normal daily activities or have any fun. For some patients, clinical trials for experimental treatments are an option. But a lot of clinical trials come with low odds of success. Some clinical trial patients die even sooner than they would without the experimental treatment.
• Potential care environments: Your residential and caregiving options may be limited by the type of illness and symptoms you have. For example, certain kinds of pain can only be managed effectively in hospitals, nursing homes, or other settings with skilled nurses on hand. But if you have the option, you might prefer to receive care at home or in an assisted living facility that feels more comfortable and familiar to you. As your illness progresses, however, your options may change.
• Palliative care: This type of care is all about soothing, managing, or alleviating the symptoms of terminally ill patients so that they can have the best quality of life possible during their remaining time. Palliative care professionals can also help connect terminally ill seniors and their families with spiritual, psychological, and social assistance. Patients can schedule palliative care right after they're diagnosed if they want, and they can receive it while also undergoing treatments. Plus, receiving palliative care makes it less likely that you'll need to be hospitalized or visit the emergency room.
• Hospice care: With this type of care, the emphasis is also on palliative support and quality of life. But patients don't receive it until they have stopped treatments and are expected to pass away in a matter of months, weeks, or days. The focus is solely on providing compassion, peace, and comfort, rather than pursuing any potential cures or life extensions. Depending on a patient's needs and wishes, hospice care can take place in a special hospice facility, in a skilled-nursing environment, or even at home. A hospice team often includes a variety of health and support professionals, such as doctors, nurses, counselors, social workers, aides, and volunteers.
• Physician-assisted dying: Currently, this option is only available in a few states. Also known as "death with dignity," it stirs a lot of controversy, even in the states where it is legal. In fact, many doctors are totally against this option. But some terminally ill seniors view physician-assisted dying as a compassionate and desirable choice, enabling them to pass away where and when they want—before their symptoms make it impossible to decide things for themselves or to have the minimum quality of life that they find acceptable.

4. Figure out what matters most to you going forward.

Some people are fighters all the way to the end, doing anything possible to extend their lives. Others seek to maximize the quality of their remaining time, even if it means they might die a little sooner. And a lot of people choose a path somewhere in the middle—pursuing reasonable treatments up until a certain point, then shifting their focus toward having a "good death."

Remember: You probably can't predict how much time you really have left. And not all "life-extending" treatments work. Sometimes, they do the opposite of what they're meant to do and make patients feel worse on a day-to-day basis. On the other hand, some terminally ill seniors live much longer than anyone expects without pursuing any extra treatments. A focus on quality of life can sometimes have positive, life-extending impacts on people's minds and bodies.

So, after talking about the various options with your doctors, it's really important to prioritize what you want. How do the potential benefits and downsides of each possible course of action align with what you envision for your remaining time? Will they aid or obstruct your deepest wishes? Your priorities may differ from other terminally ill adults you've known. And that's OK. For example, different patients have top priorities as diverse as:

• Proving that they're fighters
• Staying alive long enough for particular events or milestones
• Nurturing their relationships
• Being mentally present for and with the people they love
• Resolving conflicts
• Having fun
• Finishing major creative projects
• Traveling to places they've always wanted to see
• Crossing off items on their bucket lists
• Achieving other long-held goals
• Enjoying an ordinary day-to-day routine
• Helping others do what they love
• Living as comfortably and privately as possible

Many terminally ill seniors find that it helps to talk about all of this with a mental health professional. A licensed counselor or therapist can help you sort out your feelings and imagine a path forward.

5. Make a care plan.

With your top priorities figured out, you can start supporting them. Whether that means getting treatment, scheduling palliative care, or doing a combination of both, taking action to cope with your terminal illness will help ground you. Plus, the plans you make now don't have to be set in stone. As you move forward, you might change your mind or discover that you need types of support that you hadn't considered before.

When making your plan, think about where and how you want to be cared for, especially as your illness progresses and makes you less independent. Be realistic about your options, reflecting on your discussions with your doctors. And consider who you want to be around, what kind of spiritual support you'll need (if any), and who might be able to carry some of the burden on your behalf.

Also, remember that there may come a point at which you no longer have the physical and/or mental ability to inform people of your wishes or to handle your own affairs. That's why it's a good idea to explore giving someone you trust power of attorney (POA). It's also smart to prepare advance directives so that there are no questions about your wishes when it comes to end-of-life medical decisions.

Planning all of this stuff now will help you and your family; things will just feel a little easier for everyone. And if you have the financial resources to afford it, you can even hire a care manager to help arrange and coordinate all aspects of your care going forward. A care manager can act as your advocate, interacting with you, your loved ones, your doctors, and other people who are part of your support team.

6. Decide who to tell.

Mortality isn't an easy subject to discuss. In fact, according to a survey by The Conversation Project, even though more than 90 percent of people believe it's important to discuss end-of-life care with loved ones, only about a third of people actually ever have. But, of course, being diagnosed with a terminal illness kind of forces the issue.

So it's normal to feel apprehensive about sharing your news with others. But even though telling people that you're terminally ill can be hard, it can also provide some comfort. After all, it can relieve you of some of the mental burden you've been carrying around, and it can deepen your connections with the people who care about you.

Keep in mind that you don't necessarily have to tell everybody all at once. You may decide that, at least initially, you only want your closest friends and family members to know about your terminal illness. Over time, you can share the news with others, or you can ask one of your friends or loved ones to share the information with other people who may need or deserve to know.

How you tell people is up to you. Just remember that each person may respond to the news a little differently. So depending on the personalities involved, it might make sense to tell people about your illness either as a group or individually.

Share only the facts that you feel comfortable disclosing. But aim for honesty, and remember that it's OK to show your feelings. Don't worry if you're unable to answer all the questions you receive.

Some terminally ill seniors find it beneficial to have a counselor or care manager present when telling friends and loved ones about their conditions and the plans they've started making. It can also help to discuss your end-of-life options with people you love and trust before finalizing any plans. The Conversation Project offers a conversation starter guide that provides a useful framework for preparing to have this kind of discussion.

7. Prepare advance directives.

Also known as a living will, an advance directive is a legal document that expresses what you want to happen in the event that end-of-life decisions need to be made when you're unable to speak for yourself. Combined with a durable power of attorney for medical care, advance directives help ensure that your wishes will be adhered to.

For example, you may or may not want to be resuscitated in the event that your heart stops beating or you stop breathing. You may or may not want to be hooked up to a ventilator or other forms of life support under various circumstances. Or you may or may not want a feeding tube or certain interventions for failing organs, such as dialysis for kidney failure.

Discuss various scenarios with your doctors (and loved ones if you want). Then, complete the appropriate advance directive forms for your state and make sure all the important people in your life know about them.

Alternatively, in some states, you have the option of completing much more comprehensive orders for your end-of-life care. Known as Physician Orders for Life-Sustaining Treatment (POLST) or by similar names, this option can offer clear guidance to doctors and family members when medical situations aren't as well defined, such as whether to hospitalize you or provide certain treatments in the event that you get a serious infection like pneumonia.

Having advance directives can make things easier for your loved ones, lessening the guilt they feel and minimizing conflicts with each other. It can also help maximize the quality of your end-of-life care.

8. Enlist support.

If and when you feel comfortable enough to share your news with a wider audience, don't hesitate to ask for help. People are often eager to provide any support they can to those they know with terminal medical conditions. Even simple or routine tasks like doing laundry, getting groceries, caring for a pet, or cooking meals can make the people in your circle feel valued and useful. And soliciting that kind of support can enhance and maintain your social well-being as your illness progresses.

Social media platforms like Facebook can help you reach out and keep your friends, acquaintances, and loved ones informed and connected. Or you can set up a free private website through CaringBridge for sharing updates, making requests, and receiving messages of encouragement.

9. Get everything else in order.

In addition to your care plans and medical directives, you need to start thinking about a variety of other practical issues. For example, what do you want to happen after you pass away? Consider questions such as:

• Do I want a traditional funeral or memorial service?
• Do I prefer burial or cremation?
• Should I make my own funeral arrangements?
• Am I covered by life or final expense insurance?
• Have I drawn up my will? Does it need any updates?
• Do I have the financial resources to pay for any out-of-pocket care expenses?
• Who should get my pets when I'm gone?
• How should I handle my social media accounts?
• Should I name a digital executor who can manage my online accounts when I'm gone?

The more you get in order now, the greater peace of mind you can enjoy during the rest of your remaining time. So it's wise to consult with a trusted attorney, financial planner, and any other professional who can help sort out your affairs.

For instance, maybe you have questions about your life insurance or long-term care (LTC) insurance coverage. A trusted legal or financial professional can examine your existing policies and help you understand them. As an example, you can learn more about how, in term insurance, "terminal illness" is generally defined as one of the life-ending situations that is covered if you were diagnosed with it after activating your policy.

Or maybe you have critical illness insurance that you can tap into in order to help pay for various expenses that aren't covered through Medicare, Medicaid, or other means. Generally, critical illness covers most life-altering medical conditions, including terminal diseases. However, like most insurance policies, critical illness plans often come with some exclusions, so you need to read the fine print in order to make sure that your particular illness is one of the covered conditions.

Of course, some terminally ill seniors are still part of the workforce when they're diagnosed with their conditions. If you're one of them, you may wonder about things like your pension or employee disability benefits. Depending on your employer's particular plan, you can get your pension if you are terminally ill and already at retirement age. Some pension programs also allow employees to access their funds early if they have a terminal illness and haven't yet reached their plan's defined retirement age.

Terminally ill seniors with employee disability benefits can often receive funds if they are unable to continue working for the remainder of their lives, a condition often termed "total permanent disability" (TPD). Usually, TPD covers cancer (at the late stages), dementia, advanced heart disease, and many other types of terminal medical conditions when they become debilitating and effective treatments are no longer available.

10. Stay active and engaged.

Having fun and staying socially connected—as much as possible—is essential for enhancing your quality of life. Regardless of whether you're getting treatments or just managing your symptoms, staying engaged in life's daily activities will help you feel like you still matter. A lot of seniors with terminal illnesses go about this by:

• Playing games
• Doing crafts
• Finding old friends
• Traveling while they're still able to
• Playing with their dogs
• Taking up yoga
• Gardening
• Bird-watching
• Learning new hobbies
• Writing letters or making videos for their friends and family
• Attending social gatherings
• Finishing creative projects

Incidentally, you can get travel insurance if you have terminal cancer or another terminal illness. However, under most policies, you generally can't make a claim for anything that is a direct result of your condition. For instance, you may not be covered for any costs arising from being treated or hospitalized for your terminal illness when traveling.

On another note, it can be useful to maintain a daily diary of your pain and other symptoms. That way, you and your doctors will be able to more accurately assess how quickly or slowly your illness is progressing. The practice of keeping a diary may also help you stay more mindful of the present moment and less inclined to look too far ahead.

How Can I Cope Emotionally With My Terminal Illness?

Following the 10 steps above will go a long way toward helping you cope. Just keep in mind that it's normal and healthy to experience a full range of emotions, even the uncomfortable ones. In fact, effectively coping with terminal illness may require fully embracing the difficult emotions (at least temporarily) instead of trying to push them away.

When you're living with a terminal illness, inspirational words can certainly be nice to hear or read. But for some patients, a kind of "inspiration fatigue" can set in and eventually do more to lower their spirits than raise them. After all, with so much positivity coming at you, it can start to feel like you're doing things wrong—especially if your experience doesn't match the stories you read or see on TV about the most upbeat patients, some of whom have seemingly even cheated death.

All of the inspiring and cheerful portrayals of terminally ill patients in the media can also make you feel like you have to constantly show a positive and hopeful attitude in order to get any sympathy. As a result, you may feel tempted to pretend that you're upbeat and optimistic, even when you don't feel that way.

But, in most situations, your job isn't to prevent other people's uncomfortable feelings about your illness. Your job is to be fully you. Whether positive, negative, or somewhere in between, your emotions can help you and other people better understand your current reality.

Pretending that your difficult emotions don't exist can become exhausting and lead to problems like depression. "Thinking positive" and "faking it 'til you make it" may work for some people, but you shouldn't feel bad if it doesn't work for you. We're all different.

A lot of terminally ill seniors do best when they utilize a variety of coping tactics. For example, you might try:

• Listening to your favorite music: The songs and compositions you love most can provide a lot of comfort and therapeutic benefit. According to Harvard Health Publishing, research has shown that music therapy can benefit patients both physically and emotionally. So it may be worthwhile to find a certified music therapist in your area.
• Getting acceptance and commitment therapy (ACT): With this type of therapy, the emphasis is on helping you learn how to lessen the impact of your distressing emotions and troubling thoughts. Rather than trying to change or challenge them, you learn how to observe and accept them, as well as commit to actions that serve your values and best interests. You may be able to find an ACT therapist near you.
• Having deep conversations with close friends and family: Sometimes, you might just need to cry on the shoulder of a loved one or have an open, honest, and generous discussion with a friend in which you both listen intently and share your most intimate feelings. The more you help your loved ones understand what you're going through, the better they can comfort you and support your coping strategies.
• Talking to your caregivers and/or a counselor: When talking to your friends or loved ones feels too challenging, it can help to ask other people in your sphere of support to listen to your thoughts and share their own. Some of your nurses, care aides, doctors, or other people on your care team are likely good candidates for this. You may also want to ask for a referral to a good geriatric counselor who specializes in helping seniors cope with the emotional difficulties of medical problems.
• Speaking with a spiritual advisor: Having conversations with a clergyperson or leader of your faith can be very comforting, especially if you're feeling scared or confused about death or the purpose or meaning of your life. But you don't necessarily have to be a follower of any particular religion to benefit from this kind of discussion. If you want, you can simply take what sounds wise or useful to you and ignore the parts that don't align with your own spirituality.
• Joining support groups: For many terminally ill older adults, talking to other people who are in the same kind of situation is a powerful way to feel a little more normal and a lot less isolated. That's why, when you're trying to cope with a terminal illness, support groups can be invaluable. Some hospitals, charities, hospice organizations, and community centers offer in-person and/or online support groups. Your doctors, nurses, caregivers, counselor, or therapist should be able to recommend some options based on your particular situation.
• Getting pet therapy: You don't necessarily need a full-time animal companion in order to reap the emotional benefits of having one. If any of your friends or family have friendly, cuddly pets, see whether you can arrange to visit them or have them come to you. Or ask around for a local volunteer organization that can bring trained therapy animals to your home or care setting.
• Maintaining a normal routine: You might benefit from focusing on creating as much day-to-day stability as possible. Give yourself simple tasks that you can do at the same times each day. Combine practical tasks (such as making a basic breakfast) with some things you'll look forward to (such as playing a game, reading a book, or having a favorite drink). These simple pleasures will help remind you that every day that you're still alive can be a true gift.
• Resolving personal conflicts: Maybe you need to free yourself of the burdensome feelings that come from having unresolved problems with people from your past and/or present. By making an effort to forgive or apologize to those you've cared about, you may be able to lighten the emotional load you've been carrying.
• Thinking about your best memories: Your most positive experiences can still resonate and have a profound impact on your current feelings. You may just need a little help resurrecting them. For example, try looking through old photos, reading personal letters you've received, talking with old friends, or even traveling to some of the places that have a lot of significance for you.
• Sharing your stories and the wisdom you've acquired: Your younger friends and family members will likely appreciate learning more about your life and what you have learned along the way. But reflecting on your life and sharing your experiences and insights can benefit you as well by giving you a comforting sense of purpose, meaning, and satisfaction.
• Reading profound or uplifting books: The world is full of amazing writers, many of whom have shared their own truths, experiences, and insights in heartfelt memoirs or other books of wisdom. Plus, some books are available in audio format, which is useful if you have poor eyesight, have trouble focusing while reading, or simply prefer to listen to someone else's voice. Here are some of the books that are often recommended for terminally ill patients and their loved ones:
  • Can't We Talk About Something More Pleasant? by Roz Chast
  • Everything Happens for a Reason: And Other Lies I've Loved by Kate Bowler
  • Final Gifts: Understanding the Special Awareness, Needs, and Communications of the Dying by Maggie Callanan and Patricia Kelley
  • Finish Strong: Putting Your Priorities First at Life's End by Barbara Coombs Lee
  • Marrow: Love, Loss, and What Matters Most by Elizabeth Lesser
  • Saying Goodbye: A Guide to Coping with a Loved One's Terminal Illness by Barbara Okun and Joseph Nowinski
  • Stitches: A Handbook on Meaning, Hope and Repair by Anne Lamott
  • The End of Your Life Book Club by Will Schwalbe
  • The Last Lecture by Randy Pausch
  • The Year of Magical Thinking by Joan Didion
  • Tuesdays with Morrie: An Old Man, a Young Man, and Life's Greatest Lesson by Mitch Albom
  • When Breath Becomes Air by Paul Kalanithi
  • Who Dies? An Investigation of Conscious Living and Conscious Dying by Stephen Levine

What Should I Do If My Friend or Loved One Is Terminally Ill?

First, don't panic. You can get through this. Many people like you are going through the same thing as they face the unwanted reality of their friends' or family members' terminal illnesses. In fact, it's a fairly common experience, especially among adult children of terminally ill seniors. So you aren't alone if you don't quite know how to talk to a parent with terminal cancer or any other kind of terminal condition.

Nobody wants the people they care about to die. Yet, in at least one way, a diagnosis of a terminal illness can be a gift for patients and their loved ones. After all, it gives you a little time to prepare yourselves and say goodbye in the way you both want. By contrast, a sudden, unexpected death would give you no chance at all to do that.

Still, this is not an easy experience. Even though your friend or family member is the one with the terminal illness, you'll likely be profoundly impacted. So it's essential to know how to navigate the experience in a way that helps foster the greatest possible well-being for you and the terminally ill person you care about. Here are some of the approaches that often work best:

1. Show up and just listen.

Your presence may be all that's necessary to comfort the person you love. You may not have to say or do anything except provide hugs and listen without judgment. You don't have to ask questions or offer advice or go out of your way to demonstrate your love or usefulness. And you don't have to play the role of therapist or spiritual counselor.

Let your friend or loved one choose when to share his or her thoughts and feelings with you. You can invite that kind of sharing, but don't try to force it. When the sharing does happen, stay open and allow it to take whatever form it wants to.

Even if a flood of confusing or distressing thoughts and emotions are being shared—such as fear or denial—let them come, without interrupting the flow or trying to offer solutions or a sunnier perspective. Simply provide a safe space for the person you care about to release and process those feelings.

2. Learn about the kind of care and support your friend or loved one needs.

By showing that you're open, nonjudgmental, and happy to listen, you create an atmosphere of trust in which the other person feels comfortable talking about what he or she really wants and needs. That's when you can discover how to best lend your support going forward.

Some terminally ill seniors want help deciding what to do about their treatments, care, or other affairs. But many others simply want to be supported in what they have already decided to do. Listen, learn, and figure out how to define your role in a way that aligns with your friend or family member's wishes.

It could be that you simply need to be present or help foster a sense of normalcy. Or, on the other end of the spectrum, perhaps you need to be more involved in handling practical matters or advocating for the best care possible on behalf of the person you love. Just remember that it's usually better to let him or her make that decision.

3. Nurture the best qualities of your relationship while keeping an open mind to potential changes.

Every relationship has its own special dynamics. In the face of a terminal illness, the most positive points of connection are needed more than ever. It's a time to build upon your existing bond with the other person, creating more bridges while finding gentle ways of working around any obstacles.

Through it all, remember that his or her personality may seem to change in ways that alter the relationship dynamic. But if you accept those changes, you might have the opportunity to deepen the relationship and make it stronger.

4. Find healthy ways to cope with your own grief.

There's no question about it: You will experience a range of emotions that may challenge your ability to handle the circumstances. But many of the tips above for coping emotionally with a terminal illness can help you just as much as your friend or loved one. It's vital to prioritize your own self-care so that you can provide the best support possible to the terminally ill senior in your life.

Remember that it's normal to feel guilt, worry, sadness, and other troubling emotions in this situation. But if the stress starts to feel overwhelming or you find it difficult to carry out your own day-to-day activities, it's imperative that you seek help from a professional counselor or therapist. Otherwise, you run the risk of becoming depressed or even physically unwell.

Prioritize getting enough sleep, eating healthy, and staying physically active. Daily exercise can help lower your stress and elevate your mood.

5. Seek unity with your family.

When someone is diagnosed with a terminal illness, the impact on his or her entire family can be immense. In fact, it can reignite long-held conflicts or resentments, causing extra turmoil at a time when the opposite is needed. After all, family members often have to work out who will take on various financial and caregiving issues. Plus, when everyone is feeling heightened stress and emotion, communication can break down, patience can wear thin, and misunderstandings can reign supreme.

That's why it can be useful to hire an objective third party, such as a family therapist and/or geriatric care manager—someone to help the family navigate the grieving process and any practical matters that must be handled. But even without the help of a professional, it's possible to work toward family unity.

Focus on communicating openly and honestly. Listen attentively. Remind each other that your loved one needs all of you to come together. And look at this time as an opportunity to heal old wounds and move forward in a generous spirit of unconditional love, perhaps in new or redefined roles.

6. Speak with care and compassion while avoiding common pitfalls.

Knowing what to say to someone with terminal cancer or another terminal illness can definitely be challenging. As previously mentioned, you may not have to say anything at all. But when you do speak, it's often essential to pay special attention to how you're saying something. Give your friend or loved one your full attention and keep your body language open and relaxed so that you don't appear defensive or aggressive.

In terms of what you say, always remember that the person you care about is going through a unique experience. Trying to relay a story about someone else's similar situation can make you seem uncaring or out of touch. Your friend or loved one wants you to understand his or her distinctive experience. By the same token, try to avoid implying that the person's terminal illness was somehow caused by his or her choices or brought about as part of some grand cosmic plan.

Sometimes, the best things to talk about are joyful memories or funny or fascinating current events, movies, or TV shows. Try to share some laughs. And if you want to offer words of hope and encouragement, always be sensitive to the reality of the situation. (Don't push the belief that a miracle will happen.)

7. Don't intervene or offer solutions unless it's requested or becomes absolutely necessary.

Your friend or family member may already have a solid plan in place. Respect it. You may not agree with all of his or her choices, but it isn't your life that's coming to an end.

You don't need to actively research potential cures or treatments. In fact, it's better if you don't—unless you're asked to. The person you care about may be putting a lot of effort toward accepting the reality of the situation and probably already knows about the various options. Allow the terminally ill senior you care about to choose his or her own final journey.

Only consider intervening if essential responsibilities aren't being handled or you see clear signs of self-neglect or elder abuse that run counter to your friend or loved one's wishes or that unnecessarily harm his or her remaining quality of life.

For instance, some terminally ill people (and/or well-meaning family members) fall victim to costly scams and misleading marketing for so-called "miracle" cures or treatments that aren't actually supported with substantial peer-reviewed scientific evidence. That's because the hope for a miracle can make terminally ill people and their loved ones more gullible than they otherwise would be.

Such scams can not only drain financial resources, but also cause medical harm that shortens a terminally ill patient's life even more or leads to new symptoms or complications that must be managed. For example, a lot of unproven treatments are related to things like essential oils, supplements, special diets, and energy-based therapies.

8. Ask about your friend or loved one's end-of-life preferences.

Don't assume that the person you care about will want you to be present at the time of his or her death. Some people prefer to pass away in private. So it's best to discuss this subject ahead of time, keeping in mind that terminally ill people sometimes change their minds as they get closer to the end.

9. Accept that the moment of death is out of your control.

Even if your friend or loved one wants you present at the end, it is unrealistic to be at his or her side on a constant basis. You'll need to take care of yourself, which includes eating, getting enough sleep, going for short walks, and taking care of your own basic bodily functions.

It's perfectly OK to take breaks and let other people maintain a presence in your place. Simply say "I love you" each time you take a break and leave the room.

Embrace the reality that the person you love may pass away while you're gone. If that's what happens, don't beat yourself up. You haven't let your friend or family member down. It's beyond your control.

But if you do happen to be present for the end, remember that the actual moment of death isn't always easy to detect. It may require confirmation from a nurse or physician.

10. Give your friend or loved one the space, comfort, and permission to let go.

Some terminally ill patients try to hang on as long as possible for the sake of their loved ones. They often don't feel right about giving up the struggle while those they care about are still hanging around and supporting them. That's why you and your family might need to give your terminally ill loved one the permission to move on.

Even if he or she is unconscious, your words may be heard, and your presence may be felt. So it doesn't hurt to say that it's OK to let go, perhaps while gently stroking your loved one's arm and holding his or her hand. And if you think or know that your loved one wants privacy in order to feel comfortable passing on, go ahead and provide it.

11. Get support when your friend or family member passes on.

If you're present for the moment of death, take the time you need to sit with your loved one. You don't have to notify anyone right away. But as soon as you're ready, be sure to let the appropriate professionals know so that the death can be medically confirmed.

You've likely done a lot of grieving up to this point, but you still may not feel prepared for the moment your friend or loved one actually passes on. So don't hesitate to reach out to others for emotional support. Many people find it helpful to talk with a grief counselor.

How Do I Make Difficult Decisions About End-of-Life Care?

The answer to this question usually comes down to the potential amount of additional suffering involved. However, a lot of people don't give this subject the deep consideration it deserves—until it's too late. In fact, in a survey by Pew Research Center, nearly a third of Americans said that "everything possible" should always be done to save someone's life. Yet, in a lot of situations, "everything possible" can greatly reduce a terminally ill patient's remaining quality of life.

That's why it helps to ask questions that can provide more clarity, such as:

• Should painful or uncomfortable medical interventions be carried out if they aren't likely to extend a person's life for any significant period of time?
• Might quality of life be more important than quantity of life?

Here's something you may not know: A lot of physicians who become terminally ill choose to forgo the kind of aggressive end-of-life care that many of their own patients expect to receive. They view a lot of treatments as futile, costly, excessive, and likely to cause unnecessary suffering and a less-than-peaceful death. For example, consider these common situations that are often caused by a "do everything possible" approach:

• When breathing stops: A tube may be put down a patient's windpipe and attached to a ventilator in order to force his or her lungs to function. But since having a tube down your throat can be a miserable experience when you're awake, sedation is often needed. And many patients need to have their arms restrained so that they don't try to rip the tube out.
• When the heart stops: If a defibrillator isn't immediately available, then CPR (cardiopulmonary resuscitation) might be performed. But the amount of effort that is required to perform effective chest compressions can cause painful injuries such as collapsed lungs or broken ribs. Plus, CPR is often unsuccessful when performed on seniors who are already battling other medical conditions.
• When eating or drinking stops: A feeding tube may be inserted in order to supply nutrition. But one kind of feeding tube comes with risks like nausea, infection, and pneumonia. And the other type of feeding tube can be so uncomfortable that restraints are required.

The most aggressive end-of-life interventions tend to take place in hospitals. That's why, on average, it costs about $32,000 to keep a terminally ill patient alive in a hospital during his or her final month, according to Arcadia. In a nursing home, it costs about $21,000. In contrast, care in a hospice facility costs less than $20,000, and home care costs less than $5,000. Choosing palliative care at home or in a hospice facility also tends to result in a more peaceful and comfortable death.

When a terminally ill patient is unconscious and put on a life-support system, such as a ventilator, decisions for his or her family members can become especially difficult. That's why it's essential to think about all of this ahead of time. If you are terminally ill, make sure you consider preparing advance directives so that you minimize the chances of your family members having to make these kinds of decisions on your behalf.

Request an open and honest conversation with your doctors about all of the potential end-of-life interventions and the benefits and drawbacks of each one. And make sure you understand what each type of advance directive covers so that you can prepare them according to your wishes, leaving as few gaps as possible. (For example, many people don't realize that a feeding tube is not included in a do-not-resuscitate (DNR) order. Typically, a DNR only covers interventions such as CPR, defibrillation, breathing tubes, and certain medications.)

You should also know that, upon admission, all medical facilities in the U.S. are required to provide patients with information about their decision-making rights. They must ask you whether you have any advance directives. And they must comply with those directives.

You have the right to refuse any kind of medical intervention. Always make sure that your physicians, nurses, and family members know your wishes when it comes to the specific kinds of end-of-life interventions you do or do not want to receive.

If you are a family member of a terminally ill patient who is incapacitated and hard decisions need to be made in the absence of appropriate advance directives, then it's important to ask good questions. For example, depending on the situation, your questions may need to center on issues like:

• What may happen if certain treatments or interventions are started, continued, or stopped
• How long a certain course of action might realistically extend the person's life without reducing the quality of it
• Whether particular interventions will cause additional suffering or introduce new risks and side effects
• What could happen if a particular intervention doesn't work

It helps to have just one person in a family act as the point of contact for the medical team. It's also important to let medical staff know about any of your distinctive family traditions, preferences, or cultural beliefs related to dying.

But here's one of the most essential tips: Don't stop with this article. This subject is so nuanced, complex, and emotionally charged that you really should learn about it in a more in-depth way, from people with deep knowledge and relevant experience in these matters. Some of the best books to read include:

• How We Die: Reflections of Life's Final Chapter by Sherwin B. Nuland
• Knocking on Heaven's Door: The Path to a Better Way of Death by Katy Butler
• Last Rights: Rescuing the End of Life From the Medical System by Stephen Kiernan
• The Best Care Possible: A Physician's Quest to Transform Care Through the End of Life by Ira Byock
• The Conversation: A Revolutionary Plan for End-of-Life Care by Angelo E. Volandes

Prioritize Your Peace of Mind

The more you know about terminal illness and the options that exist for moving forward, the easier it may be to cope with the various challenges and discover the right path. Through it all, always remember that support is widely available if you need it.