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Geriatric Palliative Care

  • Jayasingham Jayamohan
  • Puma Sundaresan
  • Nages Nagaratnam
Chapter

Abstract

The aims of palliative care at the end of life are largely the relief of pain and suffering. Palliative care is not limited to end-of-life care but strives to relieve suffering at all stages of disease. Hospice focuses attention on comfort care. Palliative care must be able to provide a wide range of services and embrace the need of patients from independent to those with multiple comorbidities, frailty and drawn-out dying. Clinicians often encounter an array of ethical issues relating to palliative care and end-of-life care, such as ethically intricate decision-making, patients’ wishes regarding treatment and quality of life.

Keywords

Palliative care The end of life Hospice Comprehensive geriatric assessment Palliative sedation Terminal sedation 

References

  1. 1.
    Millennium.culmination/The-Revolutin-of-Hospice.pdf. Accessed 23 Dec 2016.Google Scholar
  2. 2.
    Amelia EJ. Geriatrics and palliative care: collaboration for quality of life until death. J Hosp Palliat Nurs. 2003;5(1): http://www.medscape.com/viewarticle/449130
  3. 3.
    Loscalzo MJ. Palliative care: An historical perspective. ASH education program book.  https://doi.org/10.1182/asheducation-2008.1.465. Accessed 23 Dec 2016.CrossRefGoogle Scholar
  4. 4.
    National Hospice and Palliative Care Organisation. History of hospice care. http://www.nhpco.org/history-hospice-care. Accessed 23 Dec 2016.
  5. 5.
  6. 6.
    Bruera E, Dev R. Overiew of managing common non-pain symptoms in palliative care. UPToDate. http:www.uptodate.com/contents/overview-of-managing-common-non-pain-symptoms-in-palliative-care?source=se_link. Accessed 23 Dec 2016.
  7. 7.
    Bailey FA, Harman SM. Palliative care: the last hours and days of life. www.update.com/contents/14241. Accessed 16 Nov 2017.
  8. 8.
    World Health Organisation. WHO definition of palliative care. http://www.who.int/cancer/palliative/definition/en/. Accessed 23 Dec 2016.
  9. 9.
    National Consensus Project for Quality Palliative Care. Clinical practice guidelines for quality palliative care. Pittsburgh. 2009.Google Scholar
  10. 10.
    Balboni MJ, Balboni TA. Influence of spirituality and religiousness on outcomes in palliative care patient. UpToDate. http://www.uptodate.com/contents/influence-of-spirituality-and-religiousness-on-outcomes-in-palliative-care-patients?source=see_link
  11. 11.
    Kite S. Palliative care for older people. Age Aging. 2006;35(5):459–60.CrossRefGoogle Scholar
  12. 12.
    Age Concern. Policy position paper: dying and death. London: Policy Unit, Age Concern England; 2005.Google Scholar
  13. 13.
    Help the Aged. Dying in older age. Reflections and experiences from an older person’s perspective. Tom Owen ed. 2005. www.helptheaged.org.uk
  14. 14.
    The National Council for Palliative Care. The palliative care needs of older people. Briefing Bulletin. No.14. www.ncpc.org.uk (January 2005).
  15. 15.
    Murphy E, Frogatt K, Connolly S, O’Shea E, Sampson EL, Casey D, et al. Palliative care interventions in advanced dementia. Cochrane Database Syst Rev. 2016;12:CD011513.  https://doi.org/10.1002/14651858.CD011513.pub2.CrossRefPubMedGoogle Scholar
  16. 16.
    Morrison RS, Meier DE. Clinical practice: palliative care. NEJM. 2004;350(25):2582–90.CrossRefGoogle Scholar
  17. 17.
    Gatto M, Zwicker De A. Palliative care. http://consultgeriin.org/topics/palliatiecare/want_to_know_more. Accessed 24 Dec 2016.
  18. 18.
    Australian Institute of Family Studies. Australia’s older population: demography and health statistics. https://aifs.gov.au/publications/eldr-abuse/4-australias-oldrr-population-demography-and-health-statistics. Accessed 7 Jan 2017.
  19. 19.
    Solichova D, Melichar B, Blaha V, Klejna M, Vavrova J, Palicka V, et al. Biochemical profile and survival in nonagenarians. Clin Biochem. 2001;34:563–9.CrossRefGoogle Scholar
  20. 20.
    Guralnik JM. Assessing the impact of comorbidity in the older population. Ann Epidemiol. 1996;6:376–80.CrossRefGoogle Scholar
  21. 21.
    Wolff JL, Starfield B, Anderson G. Prevalence, expenditures and complications of multiple chronic conditions in the elderly. Arch Intern Med. 2002;162:2269–76.CrossRefGoogle Scholar
  22. 22.
    Marengoni A, Angleman S, Melis R, Mangialasche F, Karp A, Garmen A, et al. Aging with multimorbidity: a systematic review of the literature. Aging Res Rev. 2011;10(4):430–9.CrossRefGoogle Scholar
  23. 23.
    Sousa RM, Clensa CP, Acosta D, Albanese E, Guerrn M, Huang Y, et al. Contribution of chronic diseases to disability in elderly people in countries with low and middle incomes: A 10/66 Dementia Research Group Population-Based Survey. Lancet. 2009;374(97794):1821–30.CrossRefGoogle Scholar
  24. 24.
    Blazer DG. Psychiatry and the oldest old.  https://doi.org/10.1176/1ppi.ajp.157.12.1915. Accessed 14 Feb 2017.
  25. 25.
    Australian Bureau of Statistics. Disability, aging and carers, Australia. Summary of Findings. 2012. www.abs.gov.au/ausstats/abs@nsf/Lookup/4430.0.ExplanatoryNotes.50002012
  26. 26.
    Kaye KS. Co-morbidities metabolic changes make elderly more susceptible to infection. Infectious disease news. Http://Www.Healio.Com/Infectious-Disease/News/Print/Infectious-Disease-News/%7bao…Ceb%7D/Comorbidities-Metabolic-Changes-Make-Elderly-More-Susceptible-To-Infection. Accessed 7 Jan 2017.
  27. 27.
    Murray SA, Kendall M, Boyd K, Sheikh A. Illness trajectories and palliative care. BMJ. 2005;330(7498):1007–11.CrossRefGoogle Scholar
  28. 28.
    Morrison RS. Research priorities in geriatric palliative care: an introduction to a new series. J Palliat Med. 2013;16(7):726–9.CrossRefGoogle Scholar
  29. 29.
  30. 30.
    Murtagh FE, Preston M, Higginson I. Patterns of dying: palliative care for non-malignant disease. Clin Med (Lond). 2004;4(1):39–44.CrossRefGoogle Scholar
  31. 31.
    Lunney JR, Lynn J, Foley DJ, Lipson S, Guralnik JM. Patterns of functional decline at end of life. JAMA. 2003;289(18):2387–92.CrossRefGoogle Scholar
  32. 32.
    Murad K, Kitzman DW. Frailty and multiple comorbidities in the elderly patient with heart failure: implications for management. Heart Fail Rev. 2012;17(90):581–8.CrossRefGoogle Scholar
  33. 33.
    Stokes MB, Bergin P, McGriffin D. Role of long-term mechanical circulatory support in patients with advanced heart failure. Intern Med J. 2016;46:530.  https://doi.org/10.1111/imj.12817.CrossRefPubMedGoogle Scholar
  34. 34.
    Uchmanowicz I, Loboz-Rudnicka M, Szelag P, Jankowska-Polariska B, Loboz-Grudzien K. Frailty in heart failure. Curr Heart Fail Rep. 2014;11:268–7.CrossRefGoogle Scholar
  35. 35.
    Jha SR, Ha HS, Hickman LD, Hannu M, Davidson PM, Macdonald PS, et al. Frailty in advanced heart failure: a systematic review. Heart Fail Rev. 2015;20(5):553–60.CrossRefGoogle Scholar
  36. 36.
  37. 37.
    Health Times. The future of aged care nursing in Australia. http://healthtimes.com.au/hub/aged-care/2/news/no1/the-future-of-aged-care-nursing-in-australia/495. Accessed 8 Dec 2016.
  38. 38.
    Mitchell SL, Teno JM, Kiely DK, Shaffer ML, Jones RW, Prigerson HG, et al. The clinical course of advanced dementia. NEJM. 2009;361:1529–38.CrossRefGoogle Scholar
  39. 39.
    Bruera E, Yennurajalingam S. Palliative care in advanced cancer patients: how and when? Oncologist. 2012;17(2):267–73.CrossRefGoogle Scholar
  40. 40.
    Cherry NI, Catane R. European Society of Medical Oncology Taskforce on Palliative and Supportive Care. Attitudes of medical oncologists toward palliative care for patients with advanced and incurable cancer: report on a survey by the European Society of Medical Oncology Taskforce on Palliative and Supportive Care. Cancer. 2003;98(11):2502–10.CrossRefGoogle Scholar
  41. 41.
    Hui D, Cerana MR, Park M, Hess K, Bruera E. Impact of oncologists’ attitudes toward end-of-life care on patients access to palliative care. Oncologist. 2016;21(9):1149–55.CrossRefGoogle Scholar
  42. 42.
    Temet JS, Greer JA, Muzikansky A, Gallagher ER, Admane S, Jackson VA, et al. Early palliative care for patients with metastatic non-small cell lung cancer. NEJM. 2010;363:733–42.CrossRefGoogle Scholar
  43. 43.
    O’Donnell D, Aaron S, Bourbeau J, Hernande P, Marciniuk D, Balter M. Canadian Thoracic Society recommendations for management of chronic obstructive pulmonary disease. Can Respir J. 2003;10(SupplA):11A–65A.CrossRefGoogle Scholar
  44. 44.
    Lanken P, Terry P, Delisser HM, Fahy B, Hansen-Flaschen J, Heffner JE. An official American Thoracic Society clinical policy statement: palliative care for patients with respiratory diseases and critical illnesses. Am J Respir Crit Care Med. 2008;177:912–27.CrossRefGoogle Scholar
  45. 45.
    Yohannes AM. Palliative care provision for patients with obstructive pulmonary disease. Health Qual Life Outcomes. 2007;5:17.CrossRefGoogle Scholar
  46. 46.
    Nordgren L, Sorensen S. Symptoms experienced in the last 6 months of life in patients with end stage heart failure. Eur J Cardiovasc Nurs. 2003;2:213–7.CrossRefGoogle Scholar
  47. 47.
    Modlinska A, Buss T, Lichodziejewska-Niemierko M. Palliative care in chronic pulmonary disease. Pneumonol Alergol Pol. 2007;75(4):383–8.PubMedGoogle Scholar
  48. 48.
    Tremet JS, Pirl WF, Lynch TJ. Comprehensive symptom management in patients with advanced-stage non-small-cell lung cancer. Clin Lung Cancer. 2006;7(4):241–9.CrossRefGoogle Scholar
  49. 49.
    Block S. Assessing and managing depression in the terminally ill patient. Ann Inter Med. 2000;132:209–18.CrossRefGoogle Scholar
  50. 50.
    Brietbart W, Bruera E, Chechinov H, Lynch M. M+Neuropsychiatric syndromes and psychological symptoms in patients with advanced cancer. J Pain Symptom Manage. 1995;10:131–41.CrossRefGoogle Scholar
  51. 51.
    Barraclough J. Cancer and emotion. Abingdon: Radcliffe Medical; 1994.Google Scholar
  52. 52.
    Balducci L, Beghe C. The application of the principles of geriatrics to the management of the older person with cancer. Crit Rev Oncol Haematol. 2000;35(3):147–54.CrossRefGoogle Scholar
  53. 53.
    Terret C, Albrand G, Jeanton M, Courpron P, Droz JP. What’s new in geriatric oncology? Bull Cancer. 2006;93(1):119–23.PubMedGoogle Scholar
  54. 54.
    Teno J, Bird C, Mor V. The prevalence treatment of pain in US nursing homes. Providence: The Center for Gerontology and Health Care Research, Brown University; 2002.Google Scholar
  55. 55.
    Bernabei R, Gambassi G, Lapane K, Landi F, Gatsonis C, Dunlop P, et al. Management of pain in elderly patients with cancer. SAGE Study Group. Systematic assessment of geriatric drug use via epidemiology. JAMA. 1998;279:1877–82.CrossRefGoogle Scholar
  56. 56.
    Won AB, Lapane KL, Vallow S, Schein J, Morris JN, Lipsitz LA. Persistent non-malignant pain and analgesic prescribing patterns in elderly nursing home residents. J Am Geriatr Soc. 2004;52:867–974.CrossRefGoogle Scholar
  57. 57.
    Wijk H, Grimby A. Needs of elderly patients in palliative care. Am J Hosp Palliat Care. 2008;25:106.CrossRefGoogle Scholar
  58. 58.
    O’Neill LB, Morrison RS. Palliative care: issues specific to geriatric patients. http://www.uptodate.com/contents/palliative-care-issues-spcific-to-geriatric-patienrs. Accessed 22 Dec 2016.
  59. 59.
    Tai V, Lovell MR. Pain relief and the end of life. Med Today. 2013;14(4):16–24.Google Scholar
  60. 60.
    Kinzbrunner BM. Ethical dilemmas in hospice and palliative care. Support Care Cancer. 1995;3(1):28–36.CrossRefGoogle Scholar
  61. 61.
    Quill TE, Sussman B. Physician assisted death. From Bioethics Briefings. http://www.thehastingscenter.org/briefingbook/physician-assisted-death/ Accessed 20 Feb 2017.

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Jayasingham Jayamohan
    • 1
  • Puma Sundaresan
    • 1
  • Nages Nagaratnam
    • 2
  1. 1.Crown Princess Mary Cancer CentreWestmeadAustralia
  2. 2.Sydney Medical SchoolThe University of SydneySydneyAustralia

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