Guidelines for a Palliative Approach in Residential Aged Care

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REFERENCES 1. World Health Organization. (2003). WHO definition of palliative care. Retrieved August 11, 2003, from World Health Organization Web site: http://www.who.int/cancer/palliative/definition/en/print.html 2. Carr, D. B., Fischer, D. S. & Markman, M. (1994). Cancer: when to focus on palliation. Patient Care, 28, (3), 123–126. 3. Palliative Care Council of South Australia. (1996). Good palliative care project: final report. Retrieved September 4, 2002, from Palliative Care 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 in palliative care: a palliative approach to neurodegenerative diseases and final illness in older people. Medical Journal of Australia, 179, (Suppl. 6), S42–44. 5. Giles, L. C., Cameron, I. D. & Crotty, M. (2003). Disability in older Australians: projections for 2006–2031. Medical Journal of Australia, 179, (3), 130–133. 6. De Bellis, A. & Parker, D. (1998). Providing palliative care in Australian nursing homes: issues and challenges. Geriaction, 16, (3), 17–23. 7. Keay, T. J. (1999). Palliative care in the nursing home. Generations, 23, (1), 96–98. 8. Blackburn, A. M. (1989). Problems of terminal care in elderly patients. Palliative Medicine, 3, 203–206. 9. NHMRC. (1999). A guide to the development, implementation and evaluation of clinical practice guidelines. 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 Guidelines. 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 in end-stage dementia following 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. Guidelines for a Palliative Approach in Residential Aged Care 185
14. Singer, P. A., Martin, D. K. & Kelner, M. (1999). Quality end-of-life care: patient’s perspectives. Journal of the American Medical Association, 281, (2), 163–168. 15. McWhinney, 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). Searching electronic bibliographic databases for palliative care articles. Paper presented at the meeting of the Australian and New Zealand Society of Palliative Medicine, Townesville, Queensland. 17. Rice, P. L. & Ezzy, D. (1999). Qualitative research methods: a health focus. South Melbourne, Victoria: Oxford University Press. 18. O’Gorman, S. M. (1998). Death and dying in contemporary society: an evaluation of current attitudes and the rituals associated with death and dying and their relevance to recent understandings of health and healing. Journal of Advanced Nursing, 27, 1127–1135. 19. McGrath, P. (2001). Keeping the hospice spirit alive in client satisfaction surveys. Journal of Palliative Care, 17, (2), 78–85. 20. Ingleton, C. (1999). The views of patients and carers on one palliative care service. International Journal of Palliative Nursing, 5, (4), 187–195. 21. Reynolds, K., Henderson, M., Schulman, A. & Hanson, L. C. (2002). Needs of the dying in nursing homes. Journal of Palliative Medicine, 5, (6), 895–901. 22. Addington-Hall, J. M., MacDonald, L. D. & Anderson, H. R. (1990). Can the Spitzer Quality of Life Index help to reduce prognostic uncertainty in terminal care? British Journal of Cancer, 62, (4), 695–699. 23. Travis, S. S., Bernard, M., Dixon, S., McAuley, W. J., Loving, G. & McClanahan, L. (2002). Obstacles to palliation and end-of-life care in a long-term care facility. Gerontologist, 42, (3), 342–349. 24. Travis, S. S., Loving, G., McClanahan, L. & Bernard, M. (2001). Hospitalization patterns and palliation in the last year of life among residents in long-term care. Gerontologist, 41, (2), 153–160. 25. Komaromy, C., Sidell, M. & Katz, J. (2000). The quality of terminal care in residential and nursing homes. International Journal of Palliative Nursing, 6, (4), 192–200. 26. Teno, J., Weitzen, S., Fennell, M. & Mor, V. (2001). Dying trajectory in the last year of life: does cancer trajectory fit other diseases? Journal of Palliative Medicine, 4, (4), 451–452. 27. Lo, R. S. K. & Woo, J. (2001). Palliative care in old age. Reviews in Clinical Gerontology, 11, (2), 149–157. 28. Billings, J. A. (2000). Palliative care. British Medical Journal, 321, (7260, Suppl. 2), 555–558. 29. Stull, D. E., Cosbey, J., Bowman, K. & McNutt, W. (1997). Institutionalization: a continuation of family care. Journal of Applied Gerontology, 16, (4), 379–402. 30. Tilse, V. (1998). Family advocacy roles and highly dependent residents in nursing homes. Australian Journal on Ageing, 16, (1), 20–23. 186 Guidelines for a Palliative Approach in Residential Aged Care
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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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efore discussing the advance care p
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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
Page 148 and 149: CHAPTER 9 SOCIAL SUPPORT, INTIMACY
Page 150 and 151: Rather than denying the existence o
Page 152 and 153: 9.2.2 Management Imaginative progra
Page 154: Guideline: Social Support Social Su
Page 157 and 158: include lack of information about t
Page 160 and 161: CHAPTER 11 CULTURAL ISSUES Australi
Page 162 and 163: 11.2 Assessment The best approach t
Page 164 and 165: CHAPTER 12 SPIRITUAL SUPPORT Dein a
Page 166 and 167: Vignette 13: Jack’s story Jack wa
Page 168: Guideline: Spiritual Support 68. A
Page 171 and 172: interpersonal and leadership skills
Page 174 and 175: CHAPTER 14 END-OF-LIFE (TERMINAL) C
Page 176 and 177: mood (61%), constipation (59%) and
Page 178 and 179: e relevant, and may even worsen sym
Page 180 and 181: Treatment involves changes in posit
Page 182 and 183: 14.5 PREPARING FOR IMMINENT DEATH
Page 184: education of the aged care team and
Page 187 and 188: Table 21: Grief, loss and bereaveme
Page 189 and 190: • excessively avoiding tasks remi
Page 191 and 192: Vignette 18: Reflections When provi
Page 193 and 194: may have been able to contribute to
Page 196 and 197: CHAPTER 16 Management’s role in i
Page 200 and 201: 31. Hanson, L. C., Danis, M. & Garr
Page 202 and 203: 60. World Health Organization Quali
Page 204 and 205: 89. McCarthy, M., Addington-Hall, J
Page 206 and 207: 121. Saunders, C. M. (1998). Forewo
Page 208 and 209: 150. Sindrup, S. H. & Jensen, T. S.
Page 210 and 211: 177. Berry, E. M. & Marcus, E.-L. (
Page 212 and 213: 208. Robinson, S. B. & Rosher, R. B
Page 214 and 215: 237. Brocklehurst, J., Dickinson, E
Page 216 and 217: 265. Barraclough, J. (1997). ABC of
Page 218 and 219: 295. Brown, T. M. & Boyle, M. F. (2
Page 220 and 221: 328. Kristjanson, L. J., Leis, A.,
Page 222 and 223: 360. McGrath, P., Vun, M. & McLeod,
Page 224 and 225: 392. Saunders, C. M. & Baines, M. J
Page 226 and 227: 424. Rawlings, D. & Glynn, T. (2002
Page 228 and 229: Glossary acetaminophen Acetaminophe
Page 230 and 231: coordinator of volunteers coping A
Page 232 and 233: geropsychologist A geropsychologist
Page 234 and 235: opioids Opioid is a specific term u
Page 236: specialised palliative team A speci
Page 239 and 240: Ms Wendy Shiels Dr Jane Sims Dr Chr
Page 242: APPENDIX B The Australian Governmen
Page 245 and 246: APRAC GUIDELINES: EVIDENCE EVALUATI
Page 247 and 248: APRAC GUIDELINES: EVIDENCE EVALUATI
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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
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