REFERENCES 1. World Health Organization. (2003). WHO def<strong>in</strong>ition of palliative care. Retrieved August 11, 2003, from World Health Organization Web site: http://www.who.<strong>in</strong>t/cancer/palliative/def<strong>in</strong>ition/en/pr<strong>in</strong>t.html 2. Carr, D. B., Fischer, D. S. & Markman, M. (1994). Cancer: when to focus on palliation. Patient <strong>Care</strong>, 28, (3), 123–126. 3. <strong>Palliative</strong> <strong>Care</strong> Council of South Australia. (1996). Good palliative care project: f<strong>in</strong>al report. Retrieved September 4, 2002, from <strong>Palliative</strong> <strong>Care</strong> Council of South Australia Inc. Web site: http://www.pallcare.asn.au/good-ndx.htm 4. Kristjanson, L. J., Toye, C. T. & Dawson, S. (2003). New dimensions <strong>in</strong> palliative care: a palliative approach to neurodegenerative diseases and f<strong>in</strong>al illness <strong>in</strong> older people. Medical Journal of Australia, 179, (Suppl. 6), S42–44. 5. Giles, L. C., Cameron, I. D. & Crotty, M. (2003). Disability <strong>in</strong> older Australians: projections <strong>for</strong> 2006–2031. Medical Journal of Australia, 179, (3), 130–133. 6. De Bellis, A. & Parker, D. (1998). Provid<strong>in</strong>g palliative care <strong>in</strong> Australian nurs<strong>in</strong>g homes: issues and challenges. Geriaction, 16, (3), 17–23. 7. Keay, T. J. (1999). <strong>Palliative</strong> care <strong>in</strong> the nurs<strong>in</strong>g home. Generations, 23, (1), 96–98. 8. Blackburn, A. M. (1989). Problems of term<strong>in</strong>al care <strong>in</strong> elderly patients. <strong>Palliative</strong> Medic<strong>in</strong>e, 3, 203–206. 9. NHMRC. (1999). A guide to the development, implementation and evaluation of cl<strong>in</strong>ical practice guidel<strong>in</strong>es. Retrieved August 18, 2002, from National Health & Medical Research Council (NHMRC) Web site: http://www.health.gov.au/nhmrc/publications/cphome.htm 10. Cochrane Collaboration. (2002). Cochrane Reviewers’ Handbook 4.2.2. Retrieved August 15, 2002, from The Cochrane Collaboration Web site: http://www.cochrane.dk/cochrane/ handbook/hbook.htm 11. Campbell Collaboration. (2002). Campbell Collaboration <strong>Guidel<strong>in</strong>es</strong>. Retrieved August 15, 2002, from the Campbell Collaboration Web site: http://www.campbellcollaboration.org/Fralibrary.html 12. Morrison, R. S. & Siu, A. L. (2000). Survival <strong>in</strong> end-stage dementia follow<strong>in</strong>g acute illness. Journal of the American Medical Association, 284, (1), 47–52. 13. Lynn, J. (2001). Perspectives on care at the close of life. Journal of the American Medical Association, 285, (7), 925–932. <strong>Guidel<strong>in</strong>es</strong> <strong>for</strong> a <strong>Palliative</strong> <strong>Approach</strong> <strong>in</strong> <strong>Residential</strong> <strong>Aged</strong> <strong>Care</strong> 185
14. S<strong>in</strong>ger, P. A., Mart<strong>in</strong>, D. K. & Kelner, M. (1999). Quality end-of-life care: patient’s perspectives. Journal of the American Medical Association, 281, (2), 163–168. 15. McWh<strong>in</strong>ney, I. R., Bass, M. J. & Donner, A. (1994). Evaluation of a palliative care service: problems and pitfalls. British Medical Journal, 309, (6965), 1340–1342. 16. Abernethy, A. P., Currow, D. & Butler, T. (2002). Search<strong>in</strong>g electronic bibliographic databases <strong>for</strong> palliative care articles. Paper presented at the meet<strong>in</strong>g of the Australian and New Zealand Society of <strong>Palliative</strong> Medic<strong>in</strong>e, Townesville, Queensland. 17. Rice, P. L. & Ezzy, D. (1999). Qualitative research methods: a health focus. South Melbourne, Victoria: Ox<strong>for</strong>d University Press. 18. O’Gorman, S. M. (1998). Death and dy<strong>in</strong>g <strong>in</strong> contemporary society: an evaluation of current attitudes and the rituals associated with death and dy<strong>in</strong>g and their relevance to recent understand<strong>in</strong>gs of health and heal<strong>in</strong>g. Journal of Advanced Nurs<strong>in</strong>g, 27, 1127–1135. 19. McGrath, P. (2001). Keep<strong>in</strong>g the hospice spirit alive <strong>in</strong> client satisfaction surveys. Journal of <strong>Palliative</strong> <strong>Care</strong>, 17, (2), 78–85. 20. Ingleton, C. (1999). The views of patients and carers on one palliative care service. International Journal of <strong>Palliative</strong> Nurs<strong>in</strong>g, 5, (4), 187–195. 21. Reynolds, K., Henderson, M., Schulman, A. & Hanson, L. C. (2002). Needs of the dy<strong>in</strong>g <strong>in</strong> nurs<strong>in</strong>g homes. Journal of <strong>Palliative</strong> Medic<strong>in</strong>e, 5, (6), 895–901. 22. Add<strong>in</strong>gton-Hall, J. M., MacDonald, L. D. & Anderson, H. R. (1990). Can the Spitzer Quality of Life Index help to reduce prognostic uncerta<strong>in</strong>ty <strong>in</strong> term<strong>in</strong>al care? British Journal of Cancer, 62, (4), 695–699. 23. Travis, S. S., Bernard, M., Dixon, S., McAuley, W. J., Lov<strong>in</strong>g, G. & McClanahan, L. (2002). Obstacles to palliation and end-of-life care <strong>in</strong> a long-term care facility. Gerontologist, 42, (3), 342–349. 24. Travis, S. S., Lov<strong>in</strong>g, G., McClanahan, L. & Bernard, M. (2001). Hospitalization patterns and palliation <strong>in</strong> the last year of life among residents <strong>in</strong> long-term care. Gerontologist, 41, (2), 153–160. 25. Komaromy, C., Sidell, M. & Katz, J. (2000). The quality of term<strong>in</strong>al care <strong>in</strong> residential and nurs<strong>in</strong>g homes. International Journal of <strong>Palliative</strong> Nurs<strong>in</strong>g, 6, (4), 192–200. 26. Teno, J., Weitzen, S., Fennell, M. & Mor, V. (2001). Dy<strong>in</strong>g trajectory <strong>in</strong> the last year of life: does cancer trajectory fit other diseases? Journal of <strong>Palliative</strong> Medic<strong>in</strong>e, 4, (4), 451–452. 27. Lo, R. S. K. & Woo, J. (2001). <strong>Palliative</strong> care <strong>in</strong> old age. Reviews <strong>in</strong> Cl<strong>in</strong>ical Gerontology, 11, (2), 149–157. 28. Bill<strong>in</strong>gs, J. A. (2000). <strong>Palliative</strong> care. British Medical Journal, 321, (7260, Suppl. 2), 555–558. 29. Stull, D. E., Cosbey, J., Bowman, K. & McNutt, W. (1997). Institutionalization: a cont<strong>in</strong>uation of family care. Journal of Applied Gerontology, 16, (4), 379–402. 30. Tilse, V. (1998). Family advocacy roles and highly dependent residents <strong>in</strong> nurs<strong>in</strong>g homes. Australian Journal on Age<strong>in</strong>g, 16, (1), 20–23. 186 <strong>Guidel<strong>in</strong>es</strong> <strong>for</strong> a <strong>Palliative</strong> <strong>Approach</strong> <strong>in</strong> <strong>Residential</strong> <strong>Aged</strong> <strong>Care</strong>
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Guidelines for a Palliative Approac
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NHMRC APPROVAL These guidelines wer
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4 ADVANCE CARE PLANNING 55 4.1 Impl
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16 MANAGEMENT’S ROLE IN IMPLEMENT
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17 Ann and Mr Wells’ family Helpi
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IMPORTANT NOTICE On 8 December 2005
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achieved for these guidelines from
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facets of a palliative approach are
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Additional levels of evidence The N
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Guidelines Ref No. Evidence level A
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Guidelines Ref No. Evidence Cachexi
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Guidelines Ref No. Evidence Anxiety
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Guidelines Ref No. Evidence 70. Und
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1.1.1 Aims The aims of the systemat
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Table 1: Search terms Terms Aborigi
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1.1.5 Exclusion Criteria Although t
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in the methodology that may invalid
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To ensure the reliability of the re
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1.2.2 Methodology When the first re
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1.4.2 Method When feedback was requ
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Several Working Party members conve
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or disagreed with each stakeholder
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All the feedback received was colla
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CHAPTER 2 A PALLIATIVE APPROACH A s
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• Profound weakness • Trouble s
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• Has the resident had a recent d
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in the RACF rather than transferrin
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palliative care teams is more appro
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or ageing progression (see Table 4)
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Table 7: A practical model of socia
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Vignette 2: Robert’s story Robert
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CHAPTER 4 ADVANCE CARE PLANNING Car
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• A change in their health status
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CHAPTER 5 ADVANCED DEMENTIA Advance
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A study was conducted to investigat
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5.3.2 Acute illness One study found
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Vignette 5: Anna’s story Anna was
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(see Fainsinger, Miller and Bruera
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Dame Cicely Saunders first describe
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Table 8: Common myths about pain ma
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6.2.4 Breakthrough pain The term
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Pain can lead to behavioural change
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Vignette 7: Mrs Harris’ story Mrs
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examined the addition of paracetamo
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provision and storage of drugs, whe
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successfully tested predominantly w
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The reasons for malnutrition in old
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The diets of residents should also
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To assist in such a discussion, a d
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appear until dehydration is far adv
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Guideline: Hydration 24. Recommenda
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6.7 NAUSEA AND VOMITING Nausea is t
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• Do you have any problem control
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6.9.1 Assessment A thorough oral as
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6.10 SKIN INTEGRITY The major skin
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Wounds can occur in residents for a
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Brocklehurst and colleagues (1999)
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medication treatment along with non
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• CAM therapies may be culturally
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word games, the present day, and fa
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CHAPTER 7 PSYCHOLOGICAL SUPPORT A r
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7.1.1 Death statements and depressi
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the factor structure of the CSDD. I
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7.2.2 Management Non-pharmacologica
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Table 17: Distinguishing delirium f
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is recognised that in many rural an
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important [305] (Level QE). Familie
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8.4 FAMILY INVOLVEMENT The role of
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APPENDIX F: Summary of the frequenc
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APPENDIX G: An example of how the g
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APPENDIX I: Resource list PALLIATIV
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Psychological Challenge Depression
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APPENDIX J: Examples of advance dir
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Schedule 1 MEDICAL POWER OF ATTORNE
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APPENDIX K An example of a Genogram
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INDEX Abbey Pain Scale 64, 71, 78 A
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evidence levels 5, 6, 20, 21, 22 ev
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andomized controlled trials 5, 21 R
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Palliative Care Australia PO Box 24