Guidelines for a Palliative Approach in Residential Aged Care

A systematic review of current best practice on physical restraint in acute care settings and
RACFs recommended that restraint-free care be provided through the Restraint Minimisation
Program [102] (Level II). The program has two components: 1) education to change the culture
of the organisation and to provide strategies to remove restraints; and 2) restraint alternatives.
The specifics of the restraint alternatives should be used with caution, as little evaluation has
been completed [102] (Level II).
In the UK, around 80% of people diagnosed with Alzheimer’s have eating difficulties so the
problem is substantial for those involved with patients with dementia. [103] It is likely that similar
figures would exist for Australian residents with Alzheimer’s disease. Despite these statistics,
there is little clear evidence on best approaches regarding handling food refusal and dysphagia
in older people with dementia. Based on a systematic review of the nursing management
of dysphagia in adults with neurological impairment, [104] (Level III-1), the Joanna Briggs
Institute [105] has developed some guidance regarding dysphagia management, which is discussed
in Section 6.8 ‘Dysphagia’.
Additionally, evidence-based parameters dealing with pharmacologic and non-pharmacologic
treatments for dementia management have been developed in the US; however, because
these parameters were not specific to the palliative population their appropriateness for this
population requires further research and guidance [106] (Level II).
5.5 FAMILY SUPPORT
Family members of residents with dementia may have unresolved emotional needs, stemming
from the illness itself and RACF placement, that may make it difficult to be involved in endof-life
treatment decisions [76,77] (Level QE; Level QE). It is the responsibility of the aged care
team to encourage and facilitate family involvement. However, the team must avoid making
negative judgements about family members whose involvement appears (to team members) to
be inadequate or if family members choose to withdraw.
Care planning meetings need to be held to protect the vulnerability of residents with advanced
dementia and to ensure that, where appropriate, families are involved in decision-making [76,77]
(Level QE; Level QE). The aged care team also needs to be aware that families and carers of a
resident with dementia are at great risk of psychological problems, due to the prolonged dying
trajectory of the resident [107] (Level QE). The following story illustrates the need for the aged
care team to be flexible in their involvement with the family, to ensure they are able to cope and
participate in the demands of decision-making.
66 Guidelines for a Palliative Approach in Residential Aged Care