Addressing inequity in palliative care provision for older people living with multimorbidity. Perspectives of community-dwelling older people on their palliative care needs: A scoping review

Abstract

Background: Older people living with multimorbidity are projected to become the main recipients of palliative care in the coming decades, yet there is limited evidence regarding their expressed palliative care needs to inform person-centred care. Aim: To understand the palliative care needs of community-dwelling people aged ⩾60 living with multimorbidity in the last 2 years of life. Design: A scoping review following Arksey and O’Malley. Data sources: Three international electronic databases (CINAHL, Ovid Medline, PsycINFO) were searched from March 2018 to December 2021. Reference lists were hand searched. Eligible papers were those reporting empirical data on older people’s needs. Results: From 985 potential papers, 28 studies were included, published between 2002 and 2020; sixteen quantitative, nine qualitative and three mixed methods. Data were extracted and presented under the holistic palliative care domains of need: physical, psychological, social, spiritual, and additionally practical needs. Different measurement tools ( n = 29) were used, of which 20 were multidimensional. Primacy in reporting was given to physical needs, most commonly pain and function. Social and practical needs were often prioritised by older people themselves, including maintaining social connections and accessing and receiving individualised care. Conclusion: Identifying the palliative care needs that matter most to older people with multimorbidity requires the recognition of their concerns, as well as their symptoms, across a continuum of living and dying. Available evidence is superficial. Supporting end of life provision for this growing and underserved population necessitates a shift to tailored multidimensional tools and community focussed integrated care services.

Matters of care and the good death – rhetoric or reality?

“…However, 66% of recipients of specialist palliative care services in Australia, for example, have cancer diagnoses 17 . This is despite the often unmet and growing palliative care needs of older people with frailty, cognitive impairment and/or multimorbidity 18▪ . The EOL care needs of older people with mental health issues and intellectual disabilities also go unmet 19 .…”

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…”

“…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 Some of the current guidelines and recommendations encourage early involvement of PC in heart failure, regardless of patient prognosis. 7,77,78 However, to care for millions of Americans with heart failure (and other life-limiting illnesses), there are fewer than 10 000 PC specialists currently practicing.…”

End-of-life communication strategies for healthcare professionals: A scoping review

“…When looking at a fuller picture of end-of-life communication, further problems need to be figured out in the future. For instance, uncertain prognosis and the best timing of these communication; clinical uncertainty and its influence on communication process; and managing special patient groups like older adults, patients with low health literacy and minority groups 5,9,73,95 .…”