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Overview of Palliative Care
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Palliative care is a specialized form of interdisciplinary care for individuals with serious and life-threatening illnesses. An overarching goal of palliative care is to enhance quality of life for patients, which often involves high-quality pain and symptom management, clear communication about medical conditions, and matching a patient’s goals of care with the appropriate treatments. This model of care is patient/family-centered, honoring patient/family values and preference through a shared decision-making process. It also recognizes and attempts to address the complex multidimensional needs of older adults and their families, including social, psychological/emotional, spiritual, and medical aspects (Figure 11–1).
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Palliative care is a fast-growing form of care across settings that can generally be delivered concurrently with life-prolonging treatments and is not prognosis dependent. Hospice is a form of palliative care given to patients who meet certain conditions formalized under the Hospice Medicare Benefit. According to Medicare eligibility criteria, hospice care is only available to individuals who: (a) agree to forgo Medicare coverage of curative treatments for their terminal disease, and (b) have an estimated prognosis of 6 months or less to live if the illness progresses as expected. Hospice care is usually delivered in the patient’s home or current place of residence, such as a nursing home or assisted-living community. Older adults with multiple chronic conditions are often not offered hospice even though it might be beneficial, because prognostication is more difficult in this population. Studies consistently demonstrate that both hospice and nonhospice palliative care can improve outcomes across diverse health care settings, including better pain management, lower rehospitalization, and greater family satisfaction.
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Psychological, Spiritual, and Social Issues
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Patients and families express a wide variety of psychological, spiritual, and social needs during the advent of serious illness. Preserving control and independence, accessing information (eg, regarding disease progression and expectations), managing anxiety and depression, dealing with financial burdens, and spiritual support are frequently cited concerns. Active collaboration with core members of the palliative care team, such as the social worker, chaplain, nurse, and nurse aide, is highly advised to help coordinate care, improve transitions between settings, and address the multidimensional needs of patients and their families. Supporting family members and informal caregivers is also a central focus of high-quality palliative care. Networks of family and friends often provide the bulk of hands-on assistance for sick and frail older adults, particularly those who are community dwelling. Thus, members of these informal care networks often require basic education about activities of daily living (ADLs) and instrumental activities of daily living (IADLs) assistance (eg, how to transfer the patient or administer medication), and knowledge of and access to community resources, ...