Palliative Care for the Older Adult

Kapo, Jennifer; Morrison, Laura; Liao, Solomon

doi:10.1089/jpm.2006.9989

Cited by 78 publications

(49 citation statements)

References 193 publications

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“…Knowledge of functional trajectories before hospice could help place this resource in the context of the broader palliative care needs of older persons. 27 The objectives of the current study were to identify distinct functional trajectories in the year before hospice, to determine how older patients with these trajectories differ according to demographic characteristics and hospice admission diagnosis, and to evaluate the association between these trajectories and subsequent disability and survival outcomes. Our ultimate goal was to inform discussions about potential unmet palliative care needs at the end of life.…”

Section: Introductionmentioning

confidence: 99%

Functional Trajectories in the Year Before Hospice

Stabenau

Morrison

Gahbauer

et al. 2015

The Annals of Family Medicine

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PURPOSE We undertook a study to identify distinct functional trajectories in the year before hospice, to determine how patients with these trajectories differ according to demographic characteristics and hospice diagnosis, and to evaluate the association between these trajectories and subsequent outcomes.METHODS From an ongoing cohort study of 754 community-living persons aged 70 years or older, we evaluated data on 213 persons who were subsequently enrolled in hospice from March 1998 to December 2011. Disability in 13 basic, instrumental, and mobility activities was assessed during monthly telephone interviews through June 2012. RESULTSIn the year before hospice, we identified 5 clinically distinct functional trajectories, representing worsening cumulative burden of disability: late decline (10.8%), accelerated (10.8%), moderate (21.1%), progressively severe (24.9%), and persistently severe (32.4%). Participants with a cancer diagnosis (34.7%) had the most favorable functional trajectories (ie, lowest burden of disability), whereas those with neurodegenerative disease (21.1%) had the worst. Median survival in hospice was only 14 days and did not differ significantly by functional trajectory. Compared with participants in the persistently severe trajectory, those in the moderate trajectory had the highest likelihood of surviving and being independent in at least 1 activity in the month after hospice admission (adjusted odds ratio = 5.5; 95% CI, 1.9-35.9). CONCLUSIONSThe course of disability in the year before hospice differs greatly among older persons but is particularly poor among those with neurodegenerative disease. Late admission to hospice (as shown by the short survival), coupled with high levels of severe disability before hospice, highlight potential unmet palliative care needs for many older persons at the end of life. INTRODUCTIONO lder persons with persistent levels of severe disability have high mortality and substantial care needs.1,2 One option for addressing these needs is palliative care, a specialized medical and interdisciplinary care approach that aims to alleviate stress, pain, and other distressing symptoms among those with serious illness, independent of prognosis or treatment being pursued, with the goal of optimizing quality of life for both patients and families.3 Hospice care, a similar approach, is a second option. In the United States, hospice is largely defined by the Medicare Hospice Benefit, which restricts services to persons who have an expected survival of 6 months or less. Because hospice also limits the pursuit of curative and most life-prolonging therapies, it is often considered only for patients who have end-stage, terminal conditions, or when death is imminent. [4][5][6][7][8][9][10][11][12][13][14][15] Palliative care is often confused with hospice and can be difficult to access. 16 Consequently, many older persons do not receive hospice or palliative care near the end of life, 17,18 which can place a high burden on caregivers 19 and result in suffering. 20Alt...

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Section: Introductionmentioning

confidence: 99%

Functional Trajectories in the Year Before Hospice

Stabenau

Morrison

Gahbauer

et al. 2015

The Annals of Family Medicine

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“…Not surprisingly, older patients may differ from younger patients both medically and psychosocially, and they have a higher likelihood of having particular syndromes such as dementia or delirium. (40) The prevalence of dementia is estimated to be 1% of persons ages 60-65 years and increases to 40% of those over 80 years of age. (41) One recent study by Evers et al compared palliative care consultations in patients over 80 years to those in younger patients.…”

Section: Quality Of Life and Burden Of Symptoms In Older Patients Witmentioning

confidence: 99%

End-of-Life Considerations in Older Patients Who Have Lung Disease

Stapleton

Curtis

2007

Clinics in Chest Medicine

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The goal of palliative care is to prevent suffering and manage symptoms, maintain quality of life, and to provide physical, emotional, and spiritual support for patients and their loved ones. Currently, palliative care measures focus largely on patients with cancer and these models have not been effectively applied to patients with chronic lung disease. Patients with lung disease have a reduced quality of life and a burden of symptoms that is at least as great, if not greater than, patients with cancer, and they commonly experience significant pain, dyspnea, and fatigue. In addition, dementia and delirium can often play a significant role in older patients. Research suggests that patients with chronic lung disease receive suboptimal palliative care due in large part to inadequate communication with their physicians. When patients have made decisions about life-sustaining therapies, physicians often either don't know the patients' wishes or misunderstand them. Additionally, depression, which is common in older patients with chronic illness, may influence patients' decisions about end-of-life care. Clinicians should realize that the vast majority of patients want more information about endof-life care and that efforts to initiate and improve communication with their patients are important. This article reviews the potential for enhanced palliative care for older patients with chronic lung disease.

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“…(1) Given this trend, the availability of hospice care in nursing homes is increasing. The overwhelming majority of hospice patients (81%) are aged 65 or greater, and while cancer still remains the most common primary diagnosis, heart disease and dementia account for nearly one quarter of the diagnoses.…”

Section: Introductionmentioning

confidence: 99%

“…Palliative care seeks to prevent, relieve, reduce, or soothe the symptoms of a disease or disorder without affecting a cure, and it does not require that a patient have a six month or less life expectancy. (1) There are studies examining the impact of hospice care on prescribing for end of life symptoms. (For example, the results are mixed with regard to the effect of hospice care on pain management in nursing homes.)…”

Section: Introductionmentioning

confidence: 99%

Impact of a Geriatric Nursing Home Palliative Care Service on Unnecessary Medication Prescribing (766)

2009

Journal of Pain and Symptom Management

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Palliative Care for the Older Adult

Cited by 78 publications

References 193 publications

Functional Trajectories in the Year Before Hospice

Functional Trajectories in the Year Before Hospice

End-of-Life Considerations in Older Patients Who Have Lung Disease

Impact of a Geriatric Nursing Home Palliative Care Service on Unnecessary Medication Prescribing (766)

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