Guidelines for a Palliative Approach in Residential Aged Care

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31. Hanson, L. C., Danis, M. & Garrett, J. (1997). What is wrong with end-of-life care? Opinions of bereaved family members. Journal of the American Geriatrics Society, 45, (11), 1339–1344. 32. Hines, S. C., Glover, J. J., Babrow, A. S., Holley, J. L., Badzek, L. A. & Moss, A. H. (2001). Improving advance care planning by accommodating family preferences. Journal of Palliative Medicine, 4, (4), 481–489. 33. National Health & Medical Research Council. (1998). NHMRC standards and procedures for externally developed clinical practice guidelines. Retrieved August 18, 2002, from National Health & Medical Research Council (NHMRC) Web site: http://www.health.gov.au/nhmrc 34. Teno, J. M., Casey, V. A., Welch, L. C. & Edgman-Levitan, S. (2001). Patient-focused, family-centered end-of-life medical care: views of the guidelines and bereaved family members. Journal of Pain & Symptom Management, 22, (3), 738–751. 35. Barr, F., Graham, S. & Ireland, A. W. (2002). Treatment choices in life threatening illness: attitudes and preferences of elderly Australian veterans and War Widows. Australasian Journal on Ageing, 21, (4), 178–194. 36. Maccabee, J. (1994). The effect of transfer from a palliative care unit to nursing homes— are patients’ and relatives’ needs met? Palliative Medicine, 8, (3), 211–214. 37. Palliative Care Australia. (2002). Palliative care — service provision in Australia: a planning guide. Deakin West, Australian Capital Territory: Author. 38. Glare, P. J., Virik, K., Jones, M., Hudson, M., Eychmuller, S., Simes, J. & Christakis, N. A. (2003). A systematic review of physicians’ survival predictions in terminally ill cancer patients. British Medical Journal, 327, (7408), 195–197. 39. McKinlay, E. M. (2001). Within the circle of care: patient experiences of receiving palliative care. Journal of Palliative Care, 17, (1), 22–29. 40. Lobchuk, M. M. & Stymeist, D. (1999). Symptoms as meaningful “family culture” symbols in palliative care. Journal of Palliative Care, 15, (4), 24–31. 41. Clare, J. & De Bellis, A. (1997). Palliative care in South Australian nursing homes [corrected] [published erratum appears in Australian Journal of Advanced Nursing (1997)15(1):19]. Australian Journal of Advanced Nursing, 14, (4), 20–28. 42. Avis, M., Jackson, J. G., Cox, K. & Miskella, C. (1999). Evaluation of a project providing community palliative care to nursing homes. Health & Social Care in the Community, 7, (1), 32–38. 43. Hunt, R. W., Fazekas, B. S., Luke, C. G. & Roder, D. M. (2001). Where patients with cancer die in South Australia, 1990–1999: a population-based review. Medical Journal of Australia, 175, (10), 526–529. 44. Hurley, A. C., Volicer, B. J. & Volicer, L. (1996). Effect of fever-management strategy on the progression of dementia of the Alzheimer type. Alzheimer Disease & Associated Disorders, 10, (1), 5–10. Guidelines for a Palliative Approach in Residential Aged Care 187
45. Ackermann, R. J. & Kemle, K. A. (1999). Death in a nursing home with active medical management. Annals of Long Term Care, 7, (8), 313–319. 46. Keay, T. J., Fredman, L., Taler, G. A., Datta, S. & Levenson, S. A. (1994). Indicators of quality medical care for the terminally ill in nursing homes. Journal of the American Geriatrics Society, 42, (8), 853–860. 47. Clare, J. & De Bellis, A. (1997). Palliative care is occurring in nursing homes. In S. Surguy & M. Annells (Eds.), Aged Care Monograph (pp. 51–74). Adelaide, South Australia: Australian Institute of Nursing Research. 48. Flacker, J. M., Won, A., Kiely, D. K. & IIoputaife, I. (2001). Differing perceptions of endof-life care in long-term care. Journal of Palliative Medicine, 4, (1), 9–13. 49. Hanson, L. C., Henderson, M. & Menon, M. (2002). As individual as death itself: a focus group study of terminal care in nursing homes. Journal of Palliative Medicine, 5, (1), 117–125. 50. Hurley, A., Volicer, B. J., Mahoney, M. A. & Volicer, L. (1993). Palliative fever management in Alzheimer patients: quality plus fiscal responsibility. Advances in Nursing Science, 16, (1), 21–32. 51. Mitchell, G., Bowman, J., McEniery, J. & Eastwood, H. (1999). The blue book of palliative care: evidence based clinical guidelines for primary practitioners (3rd ed.). Ipswich, Queensland: Ipswich & West Moreton Division of General Practice. 52. Hanratty, B., Hibbert, D., Mair, F., May, C., Ward, C., Capewell, S., Litva, A. & Corcoran, G. (2002). Doctor’s perceptions of palliative care for heart failure: group focus study. British Medical Journal, 325, 581–585. 53. Larson, C. E. & LeFasto, F. M. J. (1989). Teamwork: what must go right; what can go wrong. Newbury Park, CA: Sage. 54. Vachon, M. (1997). Recent research into staff stress in palliative care. European Journal of Palliative Care, 4, (3), 99–103. 55. Maddocks, I., Parker, D., McLeod, A. & Jenkin, P. (1999). Palliative care nurse practitioners in aged care facilities. Adelaide, South Australia: Flinders University of South Australia. 56. Doyle, D., Hanks, G. W. C. & MacDonald, N. (Eds.). (2003). Oxford textbook of palliative medicine. (3rd ed.). New York: Oxford University Press. 57. Turner, K., Chye, R., Aggarwal, G., Philip, J., Skells, A. & Lickis, J. N. (1996). Dignity in dying: a preliminary study of patients in the last three days of life. Journal of Palliative Care, 12, (2), 7–13. 58. Chochinov, H. M., Hack, T., Hassard, T., Kristjanson, L., McClement, S. & Harlos, M. (2002). Dignity in the terminally ill: a cross-sectional, cohort study. Lancet, 360, (9350), 2026–2030. 59. Chochinov, H. M. (2002). Dignity-conserving care — a model for palliative care. Journal of the American Medical Association, 287, (17), 2253–2260. 188 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
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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 198 and 199: REFERENCES 1. World Health Organiza
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
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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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