Guidelines for a Palliative Approach in Residential Aged Care

CHAPTER 2
A PALLIATIVE APPROACH
A society’s philosophical beliefs and attitudes about death and dying, and a palliative approach,
will affect the provision of guidelines for this type of care. This chapter examines some of the
key beliefs and attitudes that may influence a palliative approach.
In most western societies, any discussion of death and dying creates discomfort. [18] This
distancing response to death and dying is reflected in poor communication about the topic,
limited resources directed to this specialty area, and minimal education about how to provide
supportive end-of-life care. These barriers may make it more difficult for members of the aged
care team to provide care for residents who are dying. Therefore, RACFs who try to adopt a
palliative approach to care for residents may feel challenged to overcome some of the ‘death
denying’ attitudes pervasive in the wider culture.
At the same time, people entering RACFs are increasingly frail. Authors of a recent Australian
study projected a 70% increase over the next 30 years in the number of older persons with
profound disabilities, particularly for those aged 65 years or older [5] (Level QE). The main
conditions for older persons with profound disability are neurological, musculoskeletal,
circulatory and respiratory conditions. Stroke also severely debilitates. Mild to moderate
disabilities are associated with poor vision and hearing, psychiatric disorders and cancer.
Residents are likely to have more than one of these disabilities and their management is
therefore likely to be complex. These disabilities significantly restrict daily activities such as
self care, mobility and communication. A major increase in the number of people aged 75 to
94 with a profound restriction is also projected to occur from 2011 to 2021. This increase is
expected to have major implications for care delivery.
2.1 THREE FORMS OF PALLIATIVE CARE
In considering palliative care for residents in RACFs, it is important to distinguish between a
palliative approach, specialised palliative care service provision and end-of-life (terminal) care.
The distinction among these forms of palliative care is important in care planning and clarifying
the goals for treatment for residents.
(i)
A palliative approach
When the resident’s condition is not amenable to cure and the symptoms of the disease require
effective symptom management, a palliative approach is appropriate. Providing active treatment
for the resident’s disease may also still be important and may be provided concurrently with a
palliative approach. However, the primary goal of a palliative approach is to improve the resident’s
level of comfort and function, and to address their psychological, spiritual and social needs.
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