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EPIDEMIOLOGY

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In 2007, 2,423,712 individuals died in the United States (Table 32-1). Approximately 72% of all deaths occur in those >65 years of age. The epidemiology of mortality is similar in most developed countries; cardiovascular diseases and cancer are the predominant causes of death, a marked change since 1900, when heart disease caused ~8% of all deaths and cancer accounted for <4% of all deaths. In 2006, the year with the most recent available data, AIDS accounted for <1% of all U.S. deaths, although among those age 35–44 years, it remained one of the top five causes.

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TABLE 32-1TEN LEADING CAUSES OF DEATH IN THE UNITED STATES AND BRITAIN
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It is estimated that in developed countries, ~70% of all deaths are preceded by a disease or condition, making it reasonable to plan for dying in the foreseeable future. Cancer has served as the paradigm for terminal care, but it is not the only type of illness with a recognizable and predictable terminal phase. Since heart failure, chronic obstructive pulmonary disease (COPD), chronic liver failure, dementia, and many other conditions have recognizable terminal phases, a systematic approach to end-of-life care should be part of all medical specialties. Many patients with illness-related suffering also can benefit from palliative care regardless of prognosis. Ideally, palliative care should be considered part of comprehensive care for all patients. Reviews of the recent literature have found strong evidence that palliative care can be improved by coordination among caregivers, doctors, and patients for advance care planning, as well as dedicated teams of physicians, nurses, and other providers.

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The rapid increases in life expectancy in the United States over the past century have been accompanied by new difficulties facing individuals, families, and society as a whole in addressing the needs of an aging population. These challenges include both more complicated conditions and technologies to address them at the end of life. The development of technologies that can prolong life without restoring full health has led many Americans to seek out alternative end-of-life care settings and approaches that relieve suffering for those with terminal diseases. Over the past few decades in the United States, a significant ...

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