Guidelines for a Palliative Approach in Residential Aged Care

Vignette 5: Anna’s story
Anna was an 82-year-old lady originally from Germany. She was admitted to the dementia
unit shortly after the death of her husband. Anna had one adult child, Helen, who found it
extremely difficult to accept her father’s death and her mother’s declining mental capacity.
Helen held legal power of attorney and was the immediate next of kin for her mother.
However, Helen evaded attempts by staff to involve her in planning for her mother’s care.
Over a short period of time Anna’s physical health began to deteriorate significantly. She
began to suffer more frequent angina attacks and became wheelchair-bound as a result
of a fall, which had fractured her right hip. Anna’s condition deteriorated when her oxygen
levels fell severely and she experienced extreme tiredness and shortness of breath.
Attempts to engage the daughter, Helen, in care planning meetings were unsuccessful.
Eventually contact was made with Anna’s adult grandson, David, who at this critical time
assisted staff to make pertinent decisions about Anna’s health needs. Despite Anna’s mental
confusion and her ill health, she recognised David and responded well to his suggestions
about her health needs and care options. With Anna and Helen’s agreement, staff members
were able to liaise directly with David about the level and type of care provided to Anna in
the final stages of her life. Through David, the aged care team was also able to explain the
physical and psychological processes Anna was going through, enabling him to more fully
support his grandmother and to keep other family members advised of her situation.
Guideline:
Advanced dementia
10. For residents with advanced dementia, the implementation of a palliative
approach that incorporates ongoing assessment, attention to distressing
symptoms, avoidance of hospitalisation and which emphasises and
promotes the resident’s quality of life and dignity will benefit the family
as well as the resident.
11. Remaining in their familiar surroundings is beneficial for residents with
advanced dementia because this helps maintain their care plans and
facilitates residents’ feelings of orientation and security.
12. Assessment of residents with advanced dementia using dementia-specific
pain assessment tools results in more attentive symptom relief for pain
and discomfort.
13. Aggressive medical treatment of infections is not recommended for
residents with advanced dementia. Instead, a palliative approach is
suggested for the resident’s comfort, which might include short-term
antibiotic therapy to ease symptoms and improve quality of life.
14. The use of restraints within RACFs is associated with adverse outcomes
for residents such as an increase in distress and the risk of injury.
Developing a policy of restraint-free care that includes strategies and
an education program to minimise restraint use can reduce residents’
distress and the risk of falls-related injuries.
Ref No. Evidence
level
86 QE
83 II
93 IV
44 III-2
50
102 II
104 III-1
Guidelines for a Palliative Approach in Residential Aged Care 67