Guidelines for a Palliative Approach in Residential Aged Care

Education and training in communication skills for the aged care team could also help to
remedy this barrier to open communication. Knowing the resident’s previous personality and
psychological state is helpful in identifying high-risk individuals or those with developing
symptoms. The family’s observations of any recent changes in the resident’s mental state should
also be noted.
7.2 ANXIETY
Anxiety is an arousal state. People experience anxiety in different ways, but the following three
elements are considered to be common symptoms [286] (Level III-3):
1. A conscious feeling of fear and danger without the ability to identify immediate objective
threats that could account for these feelings;
2. A pattern of physiological arousal and bodily distress that may include miscellaneous
physical changes and complaints, such as heart palpitations, faintness, feeling of
suffocation, breathlessness, diarrhoea, nausea or vomiting; and
3. A disruption or disorganisation of effective problem-solving and mental control, including
difficulty in thinking clearly and coping effectively with environmental demands.
Anxiety symptoms are considered more stable than depression symptoms and it is believed
that anxiety may be related to the trait of neuroticism [286] (Level III-3). Hence, a resident’s
psychological history should be documented to determine any previous episodes of anxiety.
7.2.1 Assessment
There are various validated assessment tools for screening anxiety. This list provides summaries
of differing findings on the suitability of these tools with either older persons, recipients of a
palliative approach, or both:
• The Hospital Anxiety and Depression Scale (HADS) was used in a palliative unit for
recognition and treatment of depression and anxiety. The researchers concluded that those
administering the HADS needed time and skill to deal with the issues it raised. This was
due to a finding that an increase in the prescription of antidepressants had occurred and
that depression was being over-diagnosed. This, however, may partly be attributed to the
influence of the scales used [287] (Level IV).
• Visual Analogue Scales (VAS) is a 10-cm linear scale for use with people receiving a palliative
approach. The VAS correlated well with both the depression sub-scale and total score of
the HADS and was found to be quick and easy to complete for most people [288] (Level IV).
However, concerns have been raised regarding the VAS, particularly that people with advanced
dementia have difficulty completing this scale, so its use with this group is not recommended.
• The Hopkins Symptoms Checklist was found to provide many referenced syndrome
classifications to the Diagnostic Statisticians Manual (3rd ed) (DSM-III) when used
with older persons. Anxiety measures were the most accurate determinates of DSM-III
classifications for mental health disorders [289] (Level QE).
122 Guidelines for a Palliative Approach in Residential Aged Care