Guidelines for a Palliative Approach in Residential Aged Care

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177. Berry, E. M. & Marcus, E.-L. (2000). Disorders of Eating in the Elderly. Journal of Adult Development, 7, (2), 87–89. 178. Kamel, H. K., Malekgoudarzi, B. & Pahlavan, M. (2000). Inappropriate use of therapeutic diets in the nursing home. Journal of the American Geriatrics Society, 48, (7), 856–857. 179. Kayser-Jones, J., Schell, E. S., Lyons, W., Kris, A. E., Chan, J. & Beard, R. L. (2003). Factors that influence end-of-life care in nursing homes: The physical environment, inadequate staffing, and lack of supervision. The Gerontologist, 43, 76–84. 180. Allison, S. P. (2000). Malnutrition, disease, and outcome. Nutrition, 16, (7–8), 590–593. 181. Katz, I. R., Beaston-Wimmer, P., Parmelee, P. A. & Friedman, E. (1993). Failure to thrive in the elderly: exploration of the concept and delineation of psychiatric components. Journal of Geriatric Psychiatry & Neurology, 6, (Jul/Sep), 161. 182. Kumlien, S. & Axelsson, K. (2002). Stroke patients in nursing homes: eating, feeding, nutrition and related care. Journal of Clinical Nursing, 11, 498–509. 183. Abbasi, A. A. & Rudman, D. (1994). Undernutrition in the nursing home: prevalence, consequences, causes and prevention. Nutrition Review, 52, (4), 113–122. 184. Gore, J. M., Brophy, C. J. & Greenstone, M. A. (2000). How well do we care for patients with end stage chronic obstructive pulmonary disease (COPD)? A comparison of palliative care and quality of life in COPD and lung cancer. Thorax, 55, (12), 1000–1006. 185. McCann, R. M., Hall, W. J. & Groth-Juncker, A. (1994). Comfort care for terminally ill patients: the appropriate use of nutrition and hydration. Journal of the American Medical Association, 272, (16), 1263–1266. 186. Byock, I. R. (1995). Patient refusal of nutrition and hydration: walking the ever-finer line. American Journal of Hospice & Palliative Care, 12, (2), 8–13. 187. Morley, J. E. & Silver, A. J. (1995). Nutritional issues in nursing home care. Annals of Internal Medicine, 123, (11), 850–859. 188. Mitchell, S. L., Tetroe, J. & O’Connor, A. M. (2001). A decision aid for long-term tube feeding in cognitively impaired older persons. Journal of the American Geriatrics Society, 49, (3), 313–316. 189. Twycross, G. R. (1994). Attention to detail in palliative care. Progress in Palliative Care, 2, (6), 222–227. 190. Printz, L. A. (1992). Terminal dehydration, a compassionate treatment. Archives of Internal Medicine, 152, 697–700. 191. Ganzini, L., Goy, E. R., Miller, L. L., Harvath, T. A., Jackson, A. & Delorit, M. A. (2003). Nurses’ experiences with hospice patients who refuse food and fluids to hasten death. New England Journal of Medicine, 349, (4), 359. 192. Buckler, D. A., Kelber, S. T. & Goodwin, J. S. (1994). The use of dietary restrictions in malnourished nursing home patients. Journal of the American Geriatrics Society, 42, 1100–1102. Guidelines for a Palliative Approach in Residential Aged Care 197
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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
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Rather than denying the existence o
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9.2.2 Management Imaginative progra
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Guideline: Social Support Social Su
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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 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 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
Page 250 and 251: APPENDIX F: Summary of the frequenc
Page 252: APPENDIX G: An example of how the g
Page 256 and 257: APPENDIX I: Resource list PALLIATIV
Page 258 and 259: 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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