Palliative Care
last authored: Jan 2010, David LaPierre
last reviewed:
Introduction
Palliative care is provided to individuals with life-limiting, progressive diseases.
is difficult to define. It emerged from care of terminal cancer patients and has grown to extend to many other diseases, such as COPD, renal failure, and dementia.
It is holistic, with the focus on symptom management. It has a high priority on psychosocial needs: emotional, social, and family needs.
The goals of care are of fundamental importance.
We need to move away from a definite threshold model to a graded entry into palliative care.
People need not be palliative; care should be.
Palliative Care and Dementia
The dementia burden.
Greater potential for complexity: co-presentation of geriatric syndromes (incontinence, falls, polypharmacy)
Impact on QoL and can make medication adjustments difficult
age-related changes alter pharmacokinetics of drugs, and liver/renal dysfunction is common
It can be very difficult to bgein contemplating declining standard or curatie treatments for acute illness, for physicians and families.
Behavioural and mood symptoms of advanced dementia can cause significant symptom burden for both patients and loved ones.
Symptom management is hindered by increasing communication barriers/assessment barriers due to a ecline of verbal skills
Atypical presentations
acute illness
high risk of social isolation and economic difficulty: psychosocial needs are often great and extend to the caregiver
multiple co-morbid diseases: prognosis and resource allocation is difficult; underutilization of supports is more common
CGA
cognition (collateral history) MMSE, delayed recall, staging
function, and mobility (head, hands, and feet)
social issues
it is good to stage chronic conditions with state variables
- COPD: FEV1, hospitalizations, goals of care to date
- CHF
- renal
dementia-related sequelae
- delusions, hallucinations
- aggression, withdrawal, disinhibition, wnadering
- mood
- swallowing, aspiration
mobility
- falls
- aids
- orthostasis/Parkinsonian symptoms
- sensory impairment
Additional Resources
Edmonton Symptom Assessment Scale is helpful for the last 24-48 hours; if the patient cannot communicate, ask their caregivers
Novel pain scales for advanced dementia needs ro be explored
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