Geriatric palliative care: a view of its concept, challenges and strategies

Abstract

In aging societies, the last phase of people’s lives changes profoundly, challenging traditional care provision in geriatric medicine and palliative care. Both specialties have to collaborate closely and geriatric palliative care (GPC) should be conceptualized as an interdisciplinary field of care and research based on the synergies of the two and an ethics of care.Major challenges characterizing the emerging field of GPC concern (1) the development of methodologically creative and ethically sound research to promote evidence-based care and teaching; (2) the promotion of responsible care and treatment decision making in the face of multiple complicating factors related to decisional capacity, communication and behavioural problems, extended disease trajectories and complex social contexts; (3) the implementation of coordinated, continuous care despite the increasing fragmentation, sectorization and specialization in health care.Exemplary strategies to address these challenges are presented: (1) GPC research could be enhanced by specific funding programs, specific patient registries and anticipatory consent procedures; (2) treatment decision making can be significantly improved using advance care planning programs that include adequate decision aids, including those that address proxies of patient who have lost decisional capacity; (3) care coordination and continuity require multiple approaches, such as care transition programs, electronic solutions, and professionals who act as key integrators.

Wish to Die in Older Patients: Development and Validation of Two Assessment Instruments

“…Although the CADO may rather serve as a screening tool and be applicable even for persons without any health problems, the SAHD‐Senior may help identify the intensity of a wish to die and potentially monitor an existing wish to die over time in a patient population. Both instruments could facilitate open communication about end‐of‐life issues, existential concerns, and advance care planning, eventually improving the quality of life of this population …”

End-of-Life Care

“…Older people are less likely to have a record of their care and end-of-life preferences leading to unwanted interventions (Hunt et al 2014) and limiting the opportunity for appropriate, timely, and high quality end-of-life care (Porock et al 2009). Increased attention to the provision of supports and services to meet individual's needs at the end of life, in terms of policy and planning and end-of-life care provision, is essential given the dying phase is now described as a longer period of time, characterized by difficult symptom management, psychological problems, spiritual distress, and complicated treatment decisions (Voumard et al 2018).…”

“…The obvious first step in discussing the clinical priorities for end-of-life care for older people is the nexus between geriatric medicine and palliative care. Geriatric medicine as a specialty developed as a response to the multi-morbidity in older people and is primarily concerned with the health care of older people (Voumard et al 2018). Given the complexity of need for older people with multi-morbidity, the goals of geriatric medicine are to maintain and restore functional capabilities and improve quality of life for older people (Voumard et al 2018).…”

Ageism as a Species of Bias

“…Geriatric medicine raises moral challenges such as end-of-life care, respect for autonomy, and cost containment of medical services. 1 Ageism is becoming more prevalent in society and in medicine. 2,3 For example, instead of treating an elder as a person with dignity, clinicians sometimes minimize the severity of elders' concerns, attributing them to signs of "old age."…”