Guidelines for a Palliative Approach in Residential Aged Care

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Psychological Challenge Depression—resource kit for meeting the challenge of depression in residential aged care. Hammond Care Group (Sydney NSW, (02) 9825 5081). NSW Health. (2000). Best practice model for the use of psychotropic medication in residential aged care facilities and guidelines on the management of challenging behaviour in residential aged care facilities in New South Wales. Available from www.health.nsw.gov.au. Spiritual Ronaldson, S. (Ed.) (1997). Spirituality: the heart of nursing. Ausmed Publications ((03) 9375 7311, ausmed@ ausmed.com.au). Hicks, T.J.J. (1999). Spirituality and the elderly: Nursing implications with nursing home residents. Geriatric Nursing, 20(3), 144–146. MacKinlay, E. (2001) Health, healing and wholeness in frail elderly people. Journal of Religious Gerontology, 13(2), 25–34. Orchard, H., & Clark, D. (2001). Tending the soul as well as the body: spiritual care in nursing and residential homes. International Journal of Palliative Nursing, 7(11), 541–546. Wound care Guidelines for Wound Care. Australian Wound Management Association ((08) 9431 2605, www.awma.com.au, prentice@cyllene.uwa.edu.au). PUBLISHERS A series of books covering various topics on palliative care: Oxford University Press GPO Box 2784Y Melbourne VIC 3001 1300 605 616 www.oup.com.au Source National Breast Cancer Centre PO Box 572 Kings Cross NSW 1340 Fax: (02) 9326 9329 www.health.gov.au/pq/cancer/nbcc.htm Palliative Supportive Care Cambridge University Press Print ISSN: 1478-9515 Electronic ISSN: 1478-9523 www.cambridge.org Insite: The Aged Care Industry Newspaper DPS Publishing 433 Goodwood Road Westbourne Park SA 5041 (08) 8272 5554 St Luke’s Innovative Resources 137 McCrae Street Bendigo VIC 3550 www.stlukes.org.au Guidelines for a Palliative Approach in Residential Aged Care 245
ENDURING POWER OF ATTORNEY AND GUARDIANSHIP AUSTRALIAN CAPITAL TERRITORY Office of the Community Advocate PO Box 1001, Civic Square Canberra ACT 2608 (02) 6207 0707 oca@act.gov.au www.oca.act.gov.au NEW SOUTH WALES Office of the Public Guardian Level 15, Piccadilly Tower 133 Castlereagh St Sydney NSW 2000 (02) 9265 3184 www.lawlink.nsw.gov.au informationsupport@opg.nsw.gov.au QUEENSLAND Department of Justice and Attorney General (07) 3239 3520 mailbox@justice.qld.gov.au www.justice.qld.gov.au/guardian TASMANIA Tasmania Department of Justice The Guardianship and Administration Board is located at: 99 Bathurst St Hobart TAS 7000 (03) 6233 3085 guardianship@justice.tas.gov.au www.justice.tas.gov.au VICTORIA Office of the Public Advocate 5th Floor, 436 Lonsdale Street Melbourne VIC 3000 (03) 9603 9500 WESTERN AUSTRALIA Department of Justice Office of the Public Advocate 1st floor, 30 Terrace Road East Perth WA 6004 (08) 9278 7300 or 1800 807 437 www.justice.wa.gov.au 246 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
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e relevant, and may even worsen sym
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Treatment involves changes in posit
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14.5 PREPARING FOR IMMINENT DEATH
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education of the aged care team and
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Table 21: Grief, loss and bereaveme
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• excessively avoiding tasks remi
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Vignette 18: Reflections When provi
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may have been able to contribute to
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CHAPTER 16 Management’s role in i
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REFERENCES 1. World Health Organiza
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31. Hanson, L. C., Danis, M. & Garr
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60. World Health Organization Quali
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89. McCarthy, M., Addington-Hall, J
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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
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 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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