HealthMan Keith Torkelson MS Pathology: Measuring End-of-life Social and Medical Status by Keith Torkelson, MS, BS (2025)

Measuring End-of-life Social and Medical Status by Keith Torkelson, MS, BS (2025)

Requirement	Specification
Unit	Thanatology
Lesson	Mental Science – Measuring EOL related Quality of Life
Audience	General, Adults, and Older Adults
Author(s)	Keith “Buster” Torkelson, MS, BS & Magnus EMe
Blog(s)	HealthMan
Computer(s)	Sarah g6 & Student Asus
Connectivity	Wi-Fi and Hotspot
Filename	08_EOL_QOL_Quality_25070401_Notes
Measures(s)	Use reference material to generate 2 measures tools
Instrument(s)	MSE, End-of-life Social Assessment 27 Items, End-of-life Medical Assessment 18 Items & Introduction to Cognitive Assessment
Method	Desktop Publishing
Images @ the End	About 10
Publish	Friday August 22, 2025
Purpose(s)	Help with Advanced Planning & Informing Others
AI	Food for training AI systems
Compelling Evidence	People suffering should have the Right of Choice
Theme	Including Natural Supports in the Conversation
Title	Measuring End-of-life Social and Medical Status by Keith Torkelson, MS, BS (2025)
Topic(s)	End-of-life, Proof of Competency, Advanced Planning

20250808-F: Call from EOLCCA

Switzerland

Propofol

Referred me to The Final Exit Network

Options

Canada

End Of Life - 760-636-8009

End of Life Choices California
153 S. Sierra Ave #30
Solana Beach, CA 92075
(760) 636-8009

info@endoflifechoicesca.org

Switzerland and EOL Criteria

Switzerland distinguishes between end-of-life care and planning for individuals, according to Sage Journals.

Sage Journals

Sage Publishing, formerly SAGE Publications, is an American independent academic publishing company, founded in 1965 in New York City by Sara Miller McCune and now based in the Newbury Park neighborhood of Thousand Oaks, California.

End-of-life care and planning

Propofol

Propofol, a short-acting intravenous anesthetic often called the "milk of amnesia" and marketed as Diprivan, is used to induce and maintain general anesthesia, and to sedate adults in intensive care settings. It works by enhancing the inhibitory effects of GABA receptors in the brain. While effective, propofol can cause side effects like hypotension, pain on injection, and serious conditions such as allergic reactions and propofol infusion syndrome (PRIS).

Legal framework:

The Swiss Adult Protection Law, effective 2013, allows individuals to write advance care directives (ACDs) and designate a therapeutic representative to make medical decisions on their behalf if they lose their mental capacity or consciousness.

Assisted suicide vs. euthanasia:

In Switzerland, assisted suicide is legal if performed by the individual, with the assistance provided by another person who acts without selfish motives. Euthanasia (intentional killing by a third party) is illegal.

Knowledge gaps:

Studies have revealed significant knowledge gaps among older Swiss adults concerning EOL care options, including surrogate decision-making, the legal binding nature of advance directives, and palliative care. In essence, Switzerland's EOL framework for individuals emphasizes personal autonomy and advance care planning within strict legal and ethical guidelines regarding assisted suicide

Canada’s End-of-life Criteria

To qualify for Medical Assistance in Dying (MAiD) in Canada, an individual must be an adult (18+), eligible for Canadian publicly funded health services, and have a grievous and irremediable medical condition. They must experience intolerable suffering that cannot be alleviated to their satisfaction, make a voluntary request free from external pressure, and give informed consent after being informed of all available suffering-relief options. These criteria were established by Bill C-14, with further amendments in 2021 (Bill C-7) expanding eligibility to those not nearing death, but eligibility for individuals with mental illness as the sole condition has been delayed until March 17, 2027.

Eligibility Criteria (Canada)

To be eligible for MAiD, a person must meet all the following conditions:

Be at least 18 years old.
Be eligible for health services funded by a government in Canada.
Have a grievous and irremediable medical condition, which is a condition where the patient has a serious and incurable illness, disease, or disability, is in an advanced state of irreversible decline, and experiences intolerable suffering.
Have the capacity to make health care decisions.
Make a voluntary request for MAiD: that is not the result of external pressure.
Give informed consent: after being fully informed of all available means to relieve their suffering, including palliative care.

Changes to the Law

Bill C-7 (2021)

This amendment removed the requirement that a person's natural death must be reasonably foreseeable, broadening access to MAiD for individuals with chronic illnesses or disabilities.

Mental Illness Expansion Delay:

The planned inclusion of individuals with a mental illness as the sole underlying medical condition was delayed to March 17, 2027, following the federal government's passing of Bill C-62.

Final Exit Network I

Final Exit Network, Inc. is an American 501 nonprofit right to die advocacy group incorporated under Florida law. It holds that mentally competent adults who suffer from a terminal illness, intractable pain, or irreversible physical conditions have a right to voluntarily end their lives.

Final Exit Network II

https://finalexitnetwork.org/

We Support the Human Right to a Death with Dignity

We hold that mentally competent adults who suffer from a terminal illness, intractable physical pain, chronic or progressive physical disabilities, or who face loss of autonomy and selfhood through dementia, have a basic human right to choose to end their lives when they judge their quality of life to be unacceptable.

https://finalexitnetwork.org/services/exit-guide-service-plus-end-of-life-options/

Mental Competency Assessment

A mental competency assessment evaluates a person's capacity to understand information and make informed decisions, especially in legal and medical contexts. It's not about a person's overall mental health, but rather their ability to grasp the specifics of a particular situation. Assessments often involve observation, interviews, and sometimes formal psychological tests.

Testing Methods

How to Test For Mental Competency?

Mental competency is assessed through a mental status examination (MSE), which evaluates various cognitive functions and behaviors. This includes assessing appearance, behavior, mood, thought content, perception, and cognitive abilities like memory, attention, and language skills. The examination may also involve interviews with the individual and their family, as well as the use of standardized cognitive tests.

Assess_MSE_Mental_Status_Exam_Inglis_2007_25032202_Results V2025

Competence per DMV Safety - Valid CDL

To assess a driver's competence, the DMV evaluates their physical and mental skills, knowledge of traffic laws, and driving performance. If there is a question about a driver's ability to operate a vehicle safely, the DMV may require a reexamination.

In House > Metadata >

QIP_OM_MSE_Actual_11011202 V2025

20230503-W: MSE Modified Scoring

Original Brief Mental Status Exam (MSE) Form 12-Item

APS Healthcare Version (12 Items massaged into 16-Items) - Modified

Pertains to Keith “Buster” Torkelson MS on Buster

Format Bera Uses – Not reported back anymore

HSF = Higher scores are favorable | RT = Real Time | SW = Share (d) With

1.0 = Yes | 0.00 = No | 0.50 = SoSo

Mental Status Exam Score 16 Items

##	Domain	2023 0503 W-RT Self Rate SW-TF	2024 0803 SA-RT Self Rate SW-RJD	2025 0321 (F-RT) Self Rate SW-JB
01	Appropriate Appearance	1.00	0.75	1.00
02	Reasonable Attitude	1.00	0.75	1.00
03	Appropriate Behavior	1.00	1.00	1.00
04	Reasonable Speech	1.00	0.75	0.75
05	Moderated Affect	1.00	0.50	0.75
06	Favorable Mood	1.00	1.00	1.00
07	Substantial Thought Processes	1.00	0.75	0.75
08A	Thought Content (TC) No Suicide (*)	0.69	0.90	1.00
08B	TC – No Homicide (**)	0.81	0.90	1.00
08C	TC – No Delusions	0.50	0.90	0.75
08D	TC – No Phobias	0.75	0.75	0.75
08E	TC – No Obsessions / Compulsions	0.50	0.50	0.50
09	Normal Sound Perception	1.00	0.75	0.75
10	Adequate Orientation	1.00	1.00	1.00
11	Adequate Memory/Concentration	0.75	0.75	0.75
12 (16)	Good Insight/Judgement	1.00	1.00	1.00
	CALC	=14.00/16	(*) =12.95/16	=13.75/16
	Mental Status Exam Score 16 Items (HSF) =	87.5%	80.9%	85.9%

Last Reviewed: 20250822-F: (*) 20250321-F-Rescored

End of Life (EOL) > Metadata >

EOL and Quality of Life

EOL and Quality of Life (QOL) are intrinsically linked, with QOL being a primary goal of End-of-Life (EOL) care rather than simply prolonging life. EOL care emphasizes a patient-centered approach to maintain autonomy, comfort, and independence, focusing on elements like pain-free existence, achieving personal goals, and maintaining a sense of self. Factors that negatively impact QOL at the EOL include dying in a hospital or ICU, receiving aggressive treatments, and patient worry. Conversely, positive factors include hospice stays, having a strong patient-physician therapeutic alliance, and sufficient spiritual and social support.

EOL Scenario

"The end of life story" refers to the narrative of a person's death, which can be documented through personal accounts, medical narratives, or stories from caregivers and hospice workers. These stories cover experiences with dying, palliative care, and the complexities of the healthcare system surrounding death. Stories include those of individuals who have used medical aid in dying, those who focus on living with joy despite chronic illness, and accounts of deathbed visions. The goal of sharing these stories is to provide honest insights into the dying process, offer preparedness for inevitable death, and highlight how care and support systems are changing.

EOL Assessment

End-of-Life Assessments and Communication for Dying Patients and Their Families

National Institutes of Health (NIH) | (.gov)

https://pmc.ncbi.nlm.nih.gov/articles/PMC10180061/

By EK Lee · 2021 · Cited by 3

Assessments

End-of-life assessments aim to help dying patients and their families plan clinical interventions in advance and prepare them for a peaceful end of life, in which the patient accepts life and death, and the family accepts the patient’s departure. It is important to assess whether death is imminent within a few days, because critical hospice care is provided intensively during that period. The following five changes constitute objective evidence of the end of life: diminished daily living performance, decreased food intake, changes in consciousness and increased sleep quantity, worsening of respiratory distress, and end-stage delirium.

Subjective

As subjective evidence, it is suggested that sensitive perceptions of experienced nurses and the feelings of family members caring for patients should also be considered. When notifying a patient or family members that the end of life is approaching, the members of the multidisciplinary hospice team must communicate with each other, share accurate information, and provide consistent explanations. They must also listen to non-verbal communication in an empathic and supportive manner.

Keywords: Hospice care, Hospice and palliative care nursing, Terminal care, Death, Nursing assessment, Communication.

Signs and Symptoms as EOL approaches

From sources across the web (Generative AI)

Akathisia
Blood pressure decreases
Bowel and bladder functional changes
Breathing may become erratic
Change in breathing
Changes in consciousness
Confusion
Constipation
Cool and/or discolored skin
Cough
Death rattle
Decreased food intake and impaired hydration
Decreased Urine output
Delirium
Diminished daily living performance
Dysphagia
End-of-life dreams and visions (ELDVS)
End-stage delirium
Fatigue
Fever
Hallucination
Increased sleep quantity
Loss of appetite
Mottled extremities
Pain
Restlessness
Secretion
Shortness of breath
Skin changes
Urinary incontinence
Urine decrease
Worsening of respiratory distress

Dying Old Men (DOM) Assessment(s)

Metadata >

08_Population_Dying_DOMs_23112802_Assessment V2025

https://ktork46.blogspot.com/2025/08/dying-old-man-assessments-and-cut-off.html

Living Will

A living will, also known as a health care directive, is a legal document that outlines your wishes for medical treatment if you become incapacitated and unable to make decisions for yourself. It allows you to specify the types of medical care you want, or don't want, in certain situations, particularly at the end of life. You can also appoint a health care agent to make decisions on your behalf.

Specific Wishes

A Last Will and Testament template provides a structured framework for creating a legal document that outlines how a person's assets should be distributed after their death. These templates are available from various sources, including legal websites, word processing software, and even some non-profit organizations. While templates can be a helpful starting point, it's crucial to ensure the document aligns with state laws and reflects the individual's specific wishes.

Social – QSM

Scored by and for Keith Torkelson, MS, BS

End-of-life Social Assessment 27 Items

##	Variable	20250801 F-RT SW-JB SS
01	Enough food	1.00
	Enough money	1.00
	Feel valued	0.75
	Finding meaning	1.00
05	Fulfilling life goals	0.75
	Global Satisfaction (Parity)	0.80
	Have valid CDL & Car	1.00
	High on Maslow’s Hierarchy	1.00
	Meaningful social interactions	0.75
10	Peaceful Environment	1.00
	Preferences honored	1.00
	Progress of advanced care planning	0.50
	Respected	1.00
	Satisfied with history of Love	1.00
15	Satisfied with QOL (Parity)	0.80
	Satisfied with Mobility & Motility	0.75
	Sense of autonomy	0.75
	Sense of control	0.75
	Sense of dignity	1.00
20	Sense of purpose	1.00
	Sense of self	1.00
	Socially connected	1.00
	Spiritual Reflection	0.75
	Spiritual well-being	1.00
25	Support from loved ones (Family)	1.00
	Value shelter	1.00
27	Well-being (Parity)	0.80
	CALC	=24.15/27
	End-of-life Social Assessment 27 Items (HSF) =	89.4%

Medical – QSM

Scored by and for Keith Torkelson, MS, BS

End-of-life Medical Assessment 18 Items

##	Variable	20250801 F-RT SW-JB SS
01	Anxiety controlled	0.75
	Cognitively Intact	0.75
	Effective coping mechanisms	1.00
	Favorable Mental Status Exam (MSE) Results	1.00
05	Favorable I-SOFAS score (Additive = 88)	0.75
	Intelligence	1.00
	Making Informed Decisions (Parity)	0.90
	Mild Depression	0.75
	Not on LPS Conservatorship	1.00
10	Not suffering	0.75
	Very good Quality of Sleep (With medicines)	1.00
	Reality Testing Intact	1.00
	Reasonable Pain	0.75
	Satisfied as a patient	0.90
15	Reduction in Symptoms – Behavioral	0.90
	Reduction in Symptoms – Physical	0.75
	Symptoms managed	0.80
18	Years of School	1.00

	CALC	=15.75/18
	End-of-life Medical Assessment 18 Items (HSF) =	87.5%

FYI - Cognitive Assessments

FAQ – How is it we are Competent?

Code	Measures Tool
EIQ	Emotional Intelligence Quotient
IQ	Intelligence Quotient
MSE	Mental Status Exam
PRI	Perceptual Reasoning Index
SMT	Spatial Memory Test
VCI	Verbal Comprehension Index
VST	Verbal Comprehension Test
WAIS-IV	Wechsler Adult Intelligence Scale \| Fourth Edition
WISC-V	Wechsler Intelligence Scale for Children
WMI	Working Memory Index

Reality Testing Intact

Intact reality testing is the capacity to objectively assess your surroundings and distinguish between internal experiences and actual external reality, even when experiencing feelings of detachment or distress, such as in conditions like depersonalization/derealization disorder. This ability allows individuals to remain grounded in facts and avoid being influenced by emotions or false beliefs, though its impairment is a key characteristic of psychosis.

EOL and QOL

Quality of life is a crucial aspect of end-of-life (EOL) care, often prioritized over simply prolonging life. It encompasses various factors, including physical comfort, psychological well-being, spiritual needs, and maintaining a sense of purpose and dignity.

Here's a more detailed look at the relationship between EOL and quality of life:

What is quality of life at the end of life?

Physical comfort:

Managing pain and other symptoms, ensuring a peaceful environment, and promoting physical well-being.

Psychological well-being:

Addressing anxiety, depression, and other emotional needs, fostering a sense of control and autonomy, and supporting coping mechanisms.

Spiritual well-being:

Providing opportunities for spiritual reflection, connecting with religious or cultural beliefs, and finding meaning in life's experiences.

Social well-being:

Maintaining social connections, receiving support from loved ones, and engaging in meaningful social interactions.

Sense of purpose and dignity:

Fulfilling life goals, maintaining a sense of self, and feeling respected and valued as a person.

Why is quality of life important in EOL care?

Patient preferences:

Many patients prioritize quality of life over the length of life, especially when facing a terminal illness.

Patient satisfaction:

Care that focuses on quality of life can lead to greater satisfaction with the overall EOL experience.

Reduced suffering:

Effective management of physical and psychological symptoms can significantly reduce suffering at the end of life.

Improved bereavement outcomes:

When patients receive good EOL care, including attention to quality of life, their loved ones may experience less complicated grief.

How is quality of life addressed in EOL care?

Palliative care:

Palliative care focuses on improving quality of life for patients and their families facing life-limiting illnesses.

Advance care planning:

Discussions about EOL preferences, including values and goals, can help ensure that care aligns with the patient's wishes.

Symptom management:

Effective pain and symptom management is a cornerstone of EOL care, allowing patients to focus on their quality of life.

Communication:

Open and honest communication between patients, families, and healthcare professionals is essential for addressing concerns and making informed decisions.

Cultural sensitivity:

Respecting cultural and spiritual beliefs is important in providing holistic EOL care.

Caregiver support:

Providing support to caregivers is crucial, as they are also significantly impacted by the EOL experience.

Conclusion:

In conclusion, quality of life is a fundamental aspect of EOL care, encompassing physical, psychological, spiritual, and social well-being. By focusing on these aspects, healthcare professionals can help patients and their families navigate the end of life with greater comfort, dignity, and peace.