Guidelines for a Palliative Approach in Residential Aged Care

the factor structure of the CSDD. In the interim, this scale appears preferable to the GDS,
given the reliability of the CSDD for assessing depression in older persons with dementia.
The CSDD and GDS are available as part of a kit called Challenge Depression, which aims to
reduce the level of depression in Australian RACFs. Visit www.dementia.com.au/depression.
htm for further information regarding this kit.
7.1.3 Management
Pharmacological management
The first factor that is generally considered when choosing pharmacological interventions is the
resident’s life expectancy [283] (Level EO). According to Martin and Jackson (2000) [283] (Level
EO), residents who are expected to live for more than two months may have time to respond to
antidepressants, such as SSRIs (selective serotonin re-uptake inhibitors). These medications have
fewer side effects than other antidepressants and are less sedating.
If a resident’s life expectancy is anticipated to be less than two months, it is suggested that a
psychostimulant will relieve their symptoms quicker than an antidepressant [283,284] (Level EO;
Level IV). Psychostimulants may also stimulate appetite and promote a sense of wellbeing.
Residents with psychomotor slowing, advanced dementia, dysphoric mood, debilitating
weakness or fatigue may also benefit from the ‘energising effect’ of these drugs [285] (Level EO).
Methylphenidate is considered the most appropriate of these for use in a palliative approach [284]
(Level IV).
Irrespective of which intervention is preferred, psychological changes in residents should
never be dismissed as untreatable or inevitable. Improvements in the resident’s psychological
state can be achieved in spite of deteriorating physical functioning. Failing to investigate the
resident’s psychological state would deny them appropriate treatment, thus projecting a sense
of hopelessness.
Non-pharmacological management
Counselling and psychiatric interventions can improve the psychological wellbeing of residents in
the palliative phase of their ageing or illness. Residents may need an opportunity to verbalise their
feelings, beliefs and regrets about death and dying. Emotional and social supports are important
characteristics of intervention techniques. Simply providing a listening ear can be therapeutic.
These types of interventions, combined with assessment and treatment of depression, confusion
and anxiety, are essential components of a palliative approach [64] (Level QE).
Residents and their families should be given an explanation of how the ageing or illness
process is progressing. They may also need to express their feelings without fear of censure
or abandonment. However, a recent study found that the aged care team may have difficulty
determining symptoms of depression, because residents may be reluctant to disclose their
feelings for fear of being labelled a ‘bad’ or ‘weak’ person [263] (Level QE). An open, supportive
environment can promote trust, which could help to overcome this barrier and help the
resident’s adjustment process, thus enabling them to move towards accepting their situation.
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