Chemical dependency in the elderly has been recognized as a serious problem since the early 1960s. Few practitioners however, have developed intervention or treatment programs for this age group. The Elders Health Program, a research demonstration project, established the fact that the problem of enabling behaviours had to be addressed. Active family and professional enablers became significant factors influencing the design of intervention and treatment programs.

Chemical dependency in the elderly has been identified by practitioners as a serious and growing problem. This article reports on the Elders Health Program, a research and demonstration project aimed at the problem of providing appropriate services for the chemically dependent senior. It describes the development of the screening process and presents the screening tools used as part of the identification strategy. In addition, it presents the results of the epidemiological data gathered using these screening tools. Finally, the article discusses the implications of the identification strategy for intervention, treatment, and further research as identified by the project research team.

Objective: To report on the case of a terminally ill patient who expresses suicidal ideation.

Methods: As this case demonstrates, suicidality at end-of-life poses numerous challenges for the palliative care team. In this case, a 49-year-old man with locally extensive head and neck cancer refused all life-prolonging treatment and expressed a desire to hasten his own death. Other issues, such as chemical dependency and lack of social supports, complicated his care.

Results: Suicidality lessened as continuity of care, with ongoing assessments and interventions, addressed sources of suffering and built relationships with health care professionals.

Significance of results: This case highlights the observation that desire for hastened death fluctuates for patients at end-of-life and may be influenced by factors under the control of the palliative care team.