New dimensions in palliative care: a palliative approach to neurodegenerative diseases and final illness in older people

Abstract

■ A palliative care approach has much to offer people in the advanced stages of neurodegenerative diseases, as well as elderly people dying from diseases other than cancer.■ Palliative care can be part of the treatment repertoire of any health worker, supported by intermittent consultation or referral to specialist palliative care services (eg, for management of neuropathic pain).■ A palliative care approach encourages a focus on pain and symptom management, and prompts more open communication about end-of-life issues.■ This approach recruits as necessary the expertise of specialists and multidisciplinary teams to encourage a flexible, responsive service.■ Home carers and healthcare providers require education to ensure a palliative approach that meets the physical, psychological, spiritual and social challenges facing patients MJA 2003; 179: S41-S43and their families, and enhances dignity and quality of life.

Hospital treatment in residential care facilities is a viable alternative to hospital admission for selected patients

“…Better delivery of palliative care support to residential care facilities, in order to respect residents' wishes for end of life care 11–13 is needed, rather than defaulting to emergency transfer to hospital. Barriers that need to be overcome include limited access to palliative medications, 14 difficulty recognizing when patients are dying and inexperience with palliative care for non‐cancer conditions 15 …”

“…Barriers that need to be overcome include limited access to palliative medications, 14 difficulty recognizing when patients are dying and inexperience with palliative care for non-cancer conditions. 15 At the Northern Hospital in Victoria, Australia, a pilot program for hospital treatment in residential care facilities (TRC) as part of the Residential Care Intervention Program for The Elderly (RECIPE) service was launched in 2008. Treatment was provided by a dedicated geriatric team.…”

Residential aged care: the last frontier for palliative care

“…Australia supports a national policy of universal healthcare coverage and the government has recently endorsed policy guidelines aimed at promoting the delivery of a palliative approach in residential aged care facilities (Australian Government Department of Health and Ageing 2004). A palliative approach aims to improve the quality of life for older people with a life-limiting illness and their families by reducing their suffering through early identification, assessment and treatment of pain, and of physical, psychological, social and spiritual needs (Kristjanson et al 2003). Adoption of a palliative approach focuses the intention of care on improving quality of life, including symptom control, on dignity and comfort for the older person, and acknowledgement of the needs of family.…”

Rapid death after hospitalisation

“…4 A palliative care approach aims to improve the quality of life of individuals facing life-threatening illness and of their families, by preventing and relieving suffering through early identification, assessment and treatment of pain and other problems -physical, psychosocial, and spiritual. 5 Rapid death after admission to hospital is not necessarily a poor outcome for patients, carers or families. There is a proportion of patients who desire their site of care to be home for as long as possible, but their site of death to be in a hospital or hospice setting.…”