Guidelines for a Palliative Approach in Residential Aged Care

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Glossary acetaminophen Acetaminophen is a non-opioid derivative analgesic for mild pain, which is more commonly known in Australia as paracetamol. Because acetaminophen refers to paracetamol, this term does not include other non-opioids such as Aspirin, Salicylates, or Naproxen. advance care plans Advance care plans are written documents that explain to aged care team members what a resident has decided about how they want to face their own death. They are called advance care plans, because the resident lets people know his / her wishes in advance. Ideally an advance care plan involves an ongoing discussion with the resident, family, doctor and facility to ensure that the resident’s and / or family’s wishes are current. advance directives Advance directives are formal, legally endorsed documents (usually termed ‘living wills’) that state instructions for care to be implemented in the event of future decisional incapacity. advanced dementia Advanced dementia is a neurologic disease characterised by severe cognitive decline of an irreversible nature that is associated with poor prognostic factors such as swallowing disturbance, weight loss, dysphagia, anorexia, bowel and bladder incontinence, and often being bedridden.[83] This definition therefore, would include many of the residents in RACFs because of their complete dependence on others for their activities of daily living. aged care team The term ‘aged care team’ includes non-professional workers in RACFs, such as care assistants, and professional workers, such as RNs, GPs and allied health practitioners (social workers, physiotherapists, diversional therapists, podiatrists, chaplains/pastoral care workers, music therapists, etc). Volunteers may also provide aspects of care or play a role in supporting residents and / or their families and as such volunteers or the coordinator of volunteers are considered part of the aged care team. bereavement Bereavement is the total reaction to a loss and includes the process of ‘recovery’ or healing from the loss. Although there are similarities in people’s responses, there are also marked differences. Each person will grieve and ‘recover’ in her / his own way. Guidelines for a Palliative Approach in Residential Aged Care 215
cachexia Cachexia is usually associated with a serious illness, such as cancer. The symptoms include general ill health and malnutrition, marked by weakness and emaciation. care assistants When the term ‘care assistant’ is used in the guidelines, it refers to the wide range of nonprofessional workers in RACFs undertaking the direct care of residents. These workers have many titles such as ‘assistant in nursing’ (AIN), ‘personal care assistant’ (PCA) or ‘aged person carer’, depending on the State or Territory in Australia in which they are employed. care plans carers Care plans are dynamic documents that comprise a statement of the resident’s care needs determined during assessment, with the addition of resident-centred goals, together with strategies, interventions or actions that are intended to help the resident achieve or maintain those goals. [455] Carers are usually family members and sometimes friends. Their work is based on a preexisting relationship and is unpaid and often unrecognised. The primary carer is the person who has provided the most informal assistance to the resident in relation to self-care, mobility and communication. When the word ‘family’ is used in the guidelines, it also includes carers. chaplain / pastoral care worker A chaplain / pastoral care worker is a person who works within a holistic approach to health to enable individuals and groups to respond to spiritual and emotional needs, and to the experiences of life and death, illness and injury, in the context of a faith or belief system. It is considered best practice for such a person to be incorporated into the management of residents. chronic illness A chronic illness has a sudden or slow onset that is characterised by significant exacerbations and a long, drawn-out duration. cognitive behavioural intervention / therapy Cognitive behavioural intervention is a psychological therapy (often known as CBT) that is focused on changing particular thoughts or behaviour patterns, or acquiring specific coping strategies. Included in this category is muscle relaxation training, hypnotherapy, systematic desensitisation, biofeedback, and behaviour modification or reinforcement. continuity of care Continuity of care refers to the aged care team member’s maintenance of knowledge about the resident and his / her family through consistent palliative practices to ensure that optimal staff, resident and family outcomes are achieved. 216 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
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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
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CHAPTER 11 CULTURAL ISSUES Australi
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11.2 Assessment The best approach t
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CHAPTER 12 SPIRITUAL SUPPORT Dein a
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Vignette 13: Jack’s story Jack wa
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Guideline: Spiritual Support 68. A
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interpersonal and leadership skills
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CHAPTER 14 END-OF-LIFE (TERMINAL) C
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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
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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 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 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
Page 260 and 261: APPENDIX J: Examples of advance dir
Page 262 and 263: Schedule 1 MEDICAL POWER OF ATTORNE
Page 264: APPENDIX K An example of a Genogram
Page 268 and 269: INDEX Abbey Pain Scale 64, 71, 78 A
Page 270 and 271: evidence levels 5, 6, 20, 21, 22 ev
Page 272: andomized controlled trials 5, 21 R
Page 275 and 276: Palliative Care Australia PO Box 24
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Guidelines for a Palliative Approach in Residential Aged Care

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