Guidelines for a Palliative Approach in Residential Aged Care

The Edmonton Symptom Assessment Scale (ESAS) [116] (Level III-3) was derived from the
measurement of different symptoms using 0- to 10-cm visual analogue scales. The ESAS has
been validated in the cognitively intact terminally ill population and is frequently used in
clinical studies as an assessment tool. Individual symptoms evaluated in the ESAS include
pain, tiredness, nausea, depression, anxiety, drowsiness, appetite, sensation of wellbeing, and
shortness of breath. For all items, 0 is absence of the symptom or best possible status, and a
score of 10 indicates the worst possible status. An overall distress score is calculated by averaging
the individual symptom scores.
The Symptom Assessment Scale (SAS) [117] is used to assess symptoms commonly found in
individuals in palliative settings, many of whom are older and a large proportion of whom
have cancer. Participants are asked to rate each of the following symptoms according to their
intensity: insomnia, appetite problems, nausea, bowel problems, breathing problems, fatigue
and pain. Absent symptoms are assigned a 0, and symptoms that are present are rated from
1 (minimal problem) to 10 (worst possible). Scores are not generally totalled. Sometimes family
members and the aged care team sometimes provide proxy responses using the SAS when the
person is unable to respond, using their knowledge of ways in which these individuals generally
present when experiencing these symptoms.
The Abbey Pain Scale [96] (Level IV) is a new Australian tool, specifically developed for people
with advanced dementia. The scale is based on the assumption that nursing staffs’ perception of
pain severity is the gold standard for determining a resident’s pain intensity. Although further
substantiation of this scale is required, given its brevity and validity it may be a worthwhile
addition to pain assessment.
Guidelines:
Symptom Assessment
15. The development of a treatment plan that is based on a comprehensive
and ongoing assessment of a resident’s needs and wishes, which includes
early identification of the main symptoms, provides effective symptom
management in accordance with the resident’s goals for care and their
specific treatment preferences.
16. Implementation of a palliative approach that includes adequate relief of pain
and effective symptom management increases residents and their families’
satisfaction with the care that is provided.
17. A simple method for regular assessment of symptom distress is to ask
residents for their own determination of the intensity of their physical and
psychological distress. Regular assessments will improve the effectiveness of
symptom management and enhance residents’ quality of life.
Ref No. Evidence
level
112 IV
110 IV
116 III-3
6.2 PAIN MANAGEMENT
Pain is under-treated in many clinical settings. [118] Pain management requires a systemic and
holistic approach to treatment that is tailored to the individual’s physical, psychological and
spiritual needs. [119] As Dickinson stated, “Pain is a subjective sensation and therefore pain is
what the individual says it is and not what others think it should be”.
[120, p. 78]
Guidelines for a Palliative Approach in Residential Aged Care 71