CARE OF OLDER ADULT | NCM 114
PALLIATIVE CARE
INTRODUCTION WHO PROVIDES PALLIATIVE CARE?
• The United States is expected to experience rapid aging of the • A team approach is best
population over the next few decades. • Anyone involved in the resident’s care can provide some
• By the year 2050, the number of Americans over age 65 is aspect of palliative care
expected to grow to 88.5 million, up from 40.2 million in 2010-- o It is important that all members of the care team be
more than double. supportive of a care plan that focuses on palliative care.
• As adults age, their medical conditions become less responsive o If some members of the care team do not agree on a
to curative treatment, and they also experience significant palliative approach, it will be challenging for the other
physical and cognitive decline. members to fully deliver palliative care.
o This is often why they require long-term care. NURSE
• Most older adults who reside in a long-term care setting will • Primary palliative care provider.
die there. • Carries out most aspects of the plan of care.
o This setting presents a great opportunity to provide end of • Monitors resident’s physical condition, symptoms, and
life care that supports comfort and quality of remaining response to palliative interventions.
life.
NURSING ASSISTANT
WHAT IS PALLIATIVE CARE?
• In providing direct care, helps nurse to identify resident’s
• The World Health Organization (WHO) defines palliative care as
needs and monitor response to treatment.
an “approach that improves the quality of life of patients and
• Delivers many non-medical palliative interventions.
their families facing the problems associated with life-
threatening illness through the prevention and relief of PHYSICIAN
suffering by means of early identification and impeccable • Monitors physical response to palliative care, orders necessary
assessment and treatment of pain and other problems-- interventions, discusses prognosis with resident/family, orders
physical, psychosocial, and spiritual.” resident’s advance directives
• Palliative care differs from traditional care in that it typically SOCIAL WORKER
does not rely heavily on invasive tests or procedures or other • Helps resident/family plan for end-of-life issues like finances
diagnostic methods that are aimed at finding a cause or cure and funeral arrangements.
for a certain symptom or medical condition. • Can also provide psychological and emotional support.
• It focuses on alleviating discomfort.
DIETITIAN
• Palliative Care:
o Provides relief from pain and other distressing symptoms • Offers suggestions for liberalizing diet at the end-of-life and
o Regards dying as a normal process help families be involved in meals.
o Intends neither to hasten or postpone death CHAPLAIN
o Integrates the psychological and spiritual aspects of • Provides spiritual and emotional support to residents, families,
patient care and even staff.
o Offers a support system to help family cope during the PHYSICAL/OCCUPATIONAL THERAPIST
patient’s illness and in their own bereavement
• Provide therapies or supportive devices to maximize resident’s
o Uses a team approach to address patient and family needs
comfort.
PALLIATIVE CARE AND HOSPICE • Teach family members how to assist resident/be involved in
• Palliative care is very similar to hospice in that both share the resident’s care.
same philosophy or perspective on the type of care delivered;
RECREATION THERAPIST
there are, however, a few important differences.
o Palliative care can be delivered by anyone at any time • Provide individual recreational opportunities for residents who
over the course of care, whereas hospice is delivered may be confined to their rooms.
primarily by a hospice care team that is separate from the • Can provide music or other comfort measures for the resident.
traditional care team. DEVELOPING A PALLIATIVE PLAN OF CARE
o Hospice is a Medicare benefit, so there are regulations • For a resident’s palliative plan of care to be successful, all
regarding eligibility and treatment once a resident enrolls members of the interdisciplinary care team must be in
in the benefit. Palliative care, on the other hand, does not agreement with the plan.
have any regulatory restrictions. o While interdisciplinary, a palliative plan of care is largely
WHO BENEFITS FROM PALLIATIVE CARE? propelled by nursing.
• RESIDENT ▪ Nurses and nursing assistants have the most
o The primary person to benefit from palliative care. frequent and regular contact with residents.
• FAMILY Therefore, they are in a prime position to carry out
o Palliative care, however, is also intended to help family the plan of care and to suggest needed changes based
members. on the resident’/family member’s responses.
o Typically, a palliative plan of care:
• STAFF
▪ States the goals of care, which should be determined
o When staff members work together to provide palliative
with significant family and resident input to the
care, thereby alleviating pain and suffering for their dying
extent possible
residents, they report a greater sense of teamwork,
▪ Lists the resident’s physical symptoms and how each
purpose, and job satisfaction.
will be addressed
LAMAGON | BSN 3A
CARE OF OLDER ADULT | NCM 114
PALLIATIVE CARE
▪ Lists the resident’s psychological symptoms and how FINAL HOURS
each will be addressed • Common symptoms are distressing
▪ Addresses any spiritual needs of the resident and o Pain, noisy breathing
family • Attend to symptoms and hygiene
▪ Addresses any other particular family needs and • Limit/withhold food and fluid intake
concerns, and finally, • Maintain personhood
▪ Provides justification for liberalizing restrictions that o Talk to resident
hinder the resident’s wishes, for example, restrictions
SUPPORTING THE FAMILY
around dietary intake
• Address questions
GOALS OF CARE • Provide information
• Hold family meeting with interdisciplinary care team • Give suggestions on how to support resident
o Clarify that palliative care does not mean withdrawing • Offer comforting items
care o Chairs, tissues, drinks
o Focus on what will be done, not what will be removed • Offer interdisciplinary support
• Complete advance directives o Social work, chaplain
o Know various types
o Understand that family may be overwhelmed
• Frame plan to meet goals of care
• Revisit plan frequently with team, including family
SYMPTOMS AT END-OF-LIFE
• PAIN
o Common, complex
• RESPIRATORY SYMPTOMS
o Shortness of breath, coughing, wheezing
• GASTROINTESTINAL SYMPTOMS
o Nausea, constipation
• PSYCHOLOGICAL SYMPTOMS
o Depression, delirium, anxiety
INTERVENTIONS
• Around the clock vs. PRN medications, especially for pain
• Oxygen, nebulizers, diuretics, antitussive w. codeine,
prednisone
• Anti-nausea medications, gentle bowel stimulants
• Anti-depressants, anxiolytics
• Non-pharmacological therapies
ADDRESSING SPIRITUAL NEEDS
• Don’t wait until the last minute!
• Offer religious music and/or icons
• Arrange visit from religious leader
• Facilitate rituals
• Assist with funeral arrangements
CULTURAL CONSIDERATIONS
• Everyone has one or more cultures
• Race, ethnicity, religion, lifestyle contribute to culture
• Culture
o It is manifested through values, customs, behaviors and
beliefs
o Affects decision-making and views re: death and dying
and palliative care
PRESERVING PERSONHOOD AND DIGNITY
• Cleanliness and odor control
• Bathing and grooming
o Face, hands, and feet
• Mouth and nail care
• Clothing and bedding
• Promote a home-like environment
o Pictures, bedding, personal items
LAMAGON | BSN 3A
