Palliative Care in Older People with Multimorbidities: A Scoping Review on the Palliative Care Needs of Patients, Carers, and Health Professionals

Abstract

Although numerous studies have been conducted previously on the needs of cancer patients at the end of their life, there is a lack of studies focused on older patients with non-oncological complex chronic multipathologies. Examining these needs would help to gain a greater understanding of the profile of this specific population within the palliative care (PC) pathway and how the health and care systems can address them. The aim of this review was to identify the needs influencing PC among older patients with multimorbidities, their relatives or informal caregivers, and the health professionals who provide care for these patients. A scoping literature review guided by the Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist was carried out with literature searched in the Medline, Embase, CINAHL, WoS, Cochrane Library, PsycINFO, and Scopus databases from 2009 to 2022. Eighty-one studies were included, demonstrating a great variety of unaddressed needs for PC among chronic older patients and the complexity in detecting those needs and how to refer them to PC pathways. This review also suggested a scarcity of tools and limited pathways for professionals to satisfy their needs for these patients and their families, who often felt ignored by the system. Substantial changes will be needed in health and care systems at the institutional level, providing more specialized PC environments and systematizing PC processes.

The Experiences and Views on Palliative Care of Older People with Multimorbidities, Their Family Caregivers and Professionals in a Spanish Hospital

“…There is increasing evidence that the implementation of palliative care generates clinically significant improvements in the patient’s quality of life [ 11 ]. The findings of this study suggest that there are unmet needs of older patients with multimorbidities and their families/carers for timely palliative care, including feeling uncertain and a sense of fear, poor awareness and knowledge on palliative care in non-malignant settings and the desire for improved physical, psychosocial and financial status as suggested in previous studies [ 12 , 16 , 17 ]. It would be interesting to relate these needs to factors such as frailty in these patients.…”

“…Solid evidence on early identification, needs assessment and mapped palliative care pathways to provide symptom management and the support to patients and their families is still lacking [ 12 ]. To improve the experience of multimorbid patients receiving palliative care and their families requires us to find out what their experience has been in the health system and the gaps or needs they have identified in their care.…”

Palliative Care for Patients With Heart Failure With Preserved Ejection Fraction

“…75 In addition to management of their medical illnesses, patients with multimorbidity often have unmet emotional, informational, spiritual, cultural, social, and caregiver needs that may require specialist PC intervention. 74,76…”

The Landscape of Outpatient Palliative Care in Germany: Results from a Retrospective Analysis of 14,792 Patients

“…Matching our study’s findings, Gothe and colleagues showed an average age of patients receiving palliative care of 77 years [ 33 ]. Demographic change, accompanied by steadily increasing life expectancy, will not only bring increasing multimorbidity, but will also require greater demand for palliative care [ 34 ]. Consequently, palliative care services have to be continuously improved and expanded, especially addressing the diverse needs of the elderly population in the future.…”