Guidelines for a Palliative Approach in Residential Aged Care

Table 7: A practical model of social dignity-conserving interventions regarding social
considerations
Illness-ageing related
factors
Privacy boundaries
Social support
Care tenor
Burden to others
Aftermath concerns
Dignity-related questions
What is it about your privacy or
your body that is important to you?
Who are the people that are most
important to you?
Is there anything in the way you are
treated that is undermining your
sense of dignity (or that makes you
feel ‘bad’ or ‘dirty’).
Do you worry about being a burden
to others? If so, to whom and in
what ways?
What are your biggest concerns for
the people you will leave behind?
Therapeutic interventions
Ask permission to examine resident
Proper draping to safeguard and
respect privacy
Liberal policies about visitation,
rooming in
Enlist involvement of a wide support
network
Treat the resident as worthy of honour,
esteem and respect; adopt a manner
of conveying this
With the resident and/or their family,
encourage explicit discussion about
these concerns with those they fear
they are burdening
With the resident and/or their family,
encourage the settling of affairs,
preparation of an advanced care plan,
making a will, and funeral planning
(This table was adapted from the work of Chochinov and colleagues) [59]
3.2 QUALITY OF LIFE
Quality of life is similar to the notion of dignity, in that it defies clear definition and yet is
frequently described as an essential aim of a palliative approach. An appropriate definition for
quality of life pertaining to older persons requiring a palliative approach is the one devised by
the WHO Quality of Life Group:
[60, p. 153]
“Quality of life is defined as an individual’s perception of his/her position in life in the
context of the culture and value systems in which he/she lives, and in relation to his/her
goals, expectations, standards and concerns. It is a broad-ranging concept, incorporating in
a complex way, the person’s physical health, psychological state, level of independence, social
relationships, personal beliefs and relationship to salient features of the environment.”
Quality of life measures usually include questions regarding the physical, social, psychological
and spiritual domains. Other issues, such as sexual function, body image and financial
concerns, may be incorporated as well. [61] The following story indicates the need to always seek
the resident’s views on their care decisions and how they perceive their current quality of life.
Although family views should also be considered, the most important person in a palliative
approach is the resident.
50 Guidelines for a Palliative Approach in Residential Aged Care