Guidelines for a Palliative Approach in Residential Aged Care

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9 SOCIAL SUPPORT, INTIMACY AND SEXUALITY 135 9.1 Social isolation and social support 135 9.2 Intimacy and sexuality 136 9.3 Confidentiality 140 10 ABORIGINAL AND TORRES STRAIT ISLANDER ISSUES 143 10.1 Background 143 10.2 Providing appropriate support 144 11 CULTURAL ISSUES 147 11.1 Transcultural communication 148 11.2 Assessment 149 11.3 Management 149 11.4 Interpreter services 150 12 SPIRITUAL SUPPORT 151 12.1 Assessment 151 12.2 Management 153 12.3 Chaplains and pastoral care workers 154 13 VOLUNTEER SUPPORT 157 14 END - OF-LIFE (TERMINAL) CARE 161 14.1 What is optimal end-of-life care? 161 14.2 Recognising when a resident is dying 162 14.3 Medication issues 164 14.4 Management of end-of-life care 165 14.5 Preparing for imminent death — practical considerations 169 14.6 Signs of death 169 14.7 Care after the resident has died 170 14.8 Summary 170 15 BEREAVEMENT SUPPORT 173 15.1 Characteristics of grief, loss and bereavement 173 15.2 Extreme grief 175 15.3 Assessment 176 15.4 Management 176 Guidelines for a Palliative Approach in Residential Aged Care
16 MANAGEMENT’S ROLE IN IMPLEMENTING A PALLIATIVE APPROACH 183 REFERENCES 185 GLOSSARY 215 APPENDICES A Working party of the Australian Palliative Residential Aged Care Project 225 B The Australian Government Project Reference Group — Terms of reference and membership 229 C An evaluation tool for quantitative studies 231 D An evaluation tool for qualitative studies 233 E Summary of the stakeholder participant groups 235 F Summary of the frequency with which stakeholder groups participated in the guideline refinement process 237 G An example of how the Guidelines were presented to focus group participants 239 H Useability trial — participant questions 241 I Resource list 243 J Examples of advance directive documents currently used in various states 247 K An example of a Genogram 251 L An example of an Ecomap 253 LIST OF TABLES 1 Search terms 18 2 Quantitative levels of evidence 20 3 Quality criteria for quantitative levels of evidence 21 4 Qualitative levels of evidence 22 5 A practical model of dignity-maintaining interventions regarding illness and ageing considerations 48 6 A practical model of dignity-conserving interventions regarding psychological and spiritual considerations 49 7 A practical model of social dignity-conserving interventions regarding social considerations 50 8 Common myths and counter-facts regarding pain management 73 9 Pathophysiological classifications of pain, classification characteristics and examples and recommendations for referral 75 10 Common myths regarding the use of opioids 83 11 Meals on Wheels: Treatable causes of malnutrition in RACF residents 89 12 Tube feeding decision aid 92 vi Guidelines for a Palliative Approach in Residential Aged Care
Page 1 and 2: Guidelines for a Palliative Approac
Page 3 and 4: NHMRC APPROVAL These guidelines wer
Page 5: 4 ADVANCE CARE PLANNING 55 4.1 Impl
Page 9 and 10: 17 Ann and Mr Wells’ family Helpi
Page 12: IMPORTANT NOTICE On 8 December 2005
Page 15 and 16: achieved for these guidelines from
Page 17 and 18: facets of a palliative approach are
Page 19 and 20: Additional levels of evidence The N
Page 21 and 22: Guidelines Ref No. Evidence level A
Page 23 and 24: Guidelines Ref No. Evidence Cachexi
Page 25 and 26: Guidelines Ref No. Evidence Anxiety
Page 27 and 28: Guidelines Ref No. Evidence 70. Und
Page 29 and 30: 1.1.1 Aims The aims of the systemat
Page 31 and 32: Table 1: Search terms Terms Aborigi
Page 33 and 34: 1.1.5 Exclusion Criteria Although t
Page 35 and 36: in the methodology that may invalid
Page 37 and 38: To ensure the reliability of the re
Page 39 and 40: 1.2.2 Methodology When the first re
Page 41 and 42: 1.4.2 Method When feedback was requ
Page 43 and 44: Several Working Party members conve
Page 45 and 46: or disagreed with each stakeholder
Page 47 and 48: All the feedback received was colla
Page 50 and 51: CHAPTER 2 A PALLIATIVE APPROACH A s
Page 52 and 53: • Profound weakness • Trouble s
Page 54 and 55: • 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
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150. Sindrup, S. H. & Jensen, T. S.
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177. Berry, E. M. & Marcus, E.-L. (
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208. Robinson, S. B. & Rosher, R. B
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237. Brocklehurst, J., Dickinson, E
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265. Barraclough, J. (1997). ABC of
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295. Brown, T. M. & Boyle, M. F. (2
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328. Kristjanson, L. J., Leis, A.,
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360. McGrath, P., Vun, M. & McLeod,
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392. Saunders, C. M. & Baines, M. J
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424. Rawlings, D. & Glynn, T. (2002
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Glossary acetaminophen Acetaminophe
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coordinator of volunteers coping A
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geropsychologist A geropsychologist
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opioids Opioid is a specific term u
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specialised palliative team A speci
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Ms Wendy Shiels Dr Jane Sims Dr Chr
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APPENDIX B The Australian Governmen
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APRAC GUIDELINES: EVIDENCE EVALUATI
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APRAC GUIDELINES: EVIDENCE EVALUATI
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APPENDIX F: Summary of the frequenc
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APPENDIX G: An example of how the g
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APPENDIX I: Resource list PALLIATIV
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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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Guidelines for a Palliative Approach in Residential Aged Care

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