Guidelines for a Palliative Approach in Residential Aged Care

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Table 9: Pathophysiological classifications of pain, classification characteristics and examples and recommendations for referral Origin of stimulus Examples Description Localisation (to site of stimulus) Nociceptive — superficial somatic • skin, subcutaneous tissue • mucosa of mouth, nose, sinuses, urethra, anus • pressure ulcers • stomatitis • hot • burning • stinging • very well defined Nociceptive — deep somatic • bone, joints, muscles, tendons, ligaments • superficial lymph nodes • organs capsules and mesothelial membranes (pleura and peritoneum) • arthritis, liver capsule distension or inflammation Movement • no effect • worsening pain (resident prefers to be still) Nociceptive — visceral • solid or hollow organs • deep tumour masses • deep lymph nodes • deep abdominal or chest masses • intestinal, biliary, ureteric colic Neuropathic • damage to nociceptive pathways • tumour-related: brachial, lumbosacral plexus or chest wall invasion, spinal cord compression • non-tumour-related: post-herpetic neuralgia, postthoracotomy syndrome, phantom pain • dull aching • dull deep • dysaesthesia, e.g. pins and needles, tingling, burning, lancinating/ shooting • allodynia • phantom pain • pain in numb area • well defined • poorly defined • nerve or dermatome distribution • may improve pain Referral • no • yes • yes • yes Local tenderness Autonomic effects • yes • yes • maybe • no • no • no • nausea, vomiting, sweating, blood pressure and heart rate changes • nerve traction provokes pain, e.g. sciatic stretch test • autonomic instability: warmth, sweating, pallor, cold, cyanosis (localised to nerve pathway). This table is reproduced with permission from the Therapeutic Guidelines: Palliative Care (2001) [109, pp. 120–121] Guidelines for a Palliative Approach in Residential Aged Care 75
6.2.4 Breakthrough pain The term ‘breakthrough pain’ (also known as ‘intermittent pain’) is generally associated with chronic cancer pain and specifically refers to when people with cancer who are already receiving opioids have intermittent episodes of increased pain. [135] However, it is important to assess the occurrence of intermittent pain in all individuals, not just those with a diagnosis of cancer. The incidence of breakthrough pain has been found to vary between 40% and 80% among individuals in various settings [135] (Level EO). No tool has been developed that specifically assesses the occurrence of breakthrough pain. However, use of a 24-hour assessment algorithm may help to categorise breakthrough pain (see Figure 2 for an example). Figure 2: Algorithm for treatment of breakthrough (episodic) pain [135] CANCER, Vol. 94, No. 3, 2002, 832–839. © American Cancer Society. Reprinted by permission of Wiley-Liss, Inc., a subsidiary of John Wiley & Sons, Inc. 76 Guidelines for a Palliative Approach in Residential Aged Care
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Guidelines for a Palliative Approac
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NHMRC APPROVAL These guidelines wer
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4 ADVANCE CARE PLANNING 55 4.1 Impl
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16 MANAGEMENT’S ROLE IN IMPLEMENT
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17 Ann and Mr Wells’ family Helpi
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IMPORTANT NOTICE On 8 December 2005
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achieved for these guidelines from
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facets of a palliative approach are
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Additional levels of evidence The N
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Guidelines Ref No. Evidence level A
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Guidelines Ref No. Evidence Cachexi
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Guidelines Ref No. Evidence Anxiety
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Guidelines Ref No. Evidence 70. Und
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1.1.1 Aims The aims of the systemat
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Table 1: Search terms Terms Aborigi
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1.1.5 Exclusion Criteria Although t
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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
Page 56 and 57: in the RACF rather than transferrin
Page 58: palliative care teams is more appro
Page 61 and 62: or ageing progression (see Table 4)
Page 63 and 64: Table 7: A practical model of socia
Page 65 and 66: Vignette 2: Robert’s story Robert
Page 68 and 69: CHAPTER 4 ADVANCE CARE PLANNING Car
Page 70 and 71: efore discussing the advance care p
Page 72 and 73: • A change in their health status
Page 74 and 75: CHAPTER 5 ADVANCED DEMENTIA Advance
Page 76 and 77: A study was conducted to investigat
Page 78 and 79: 5.3.2 Acute illness One study found
Page 80: Vignette 5: Anna’s story Anna was
Page 83 and 84: (see Fainsinger, Miller and Bruera
Page 85 and 86: Dame Cicely Saunders first describe
Page 87: Table 8: Common myths about pain ma
Page 91 and 92: Pain can lead to behavioural change
Page 93 and 94: Vignette 7: Mrs Harris’ story Mrs
Page 95 and 96: examined the addition of paracetamo
Page 97 and 98: provision and storage of drugs, whe
Page 99 and 100: successfully tested predominantly w
Page 101 and 102: The reasons for malnutrition in old
Page 103 and 104: The diets of residents should also
Page 105 and 106: To assist in such a discussion, a d
Page 107 and 108: appear until dehydration is far adv
Page 109 and 110: Guideline: Hydration 24. Recommenda
Page 111 and 112: 6.7 NAUSEA AND VOMITING Nausea is t
Page 113 and 114: • Do you have any problem control
Page 115 and 116: 6.9.1 Assessment A thorough oral as
Page 117 and 118: 6.10 SKIN INTEGRITY The major skin
Page 119 and 120: Wounds can occur in residents for a
Page 121 and 122: Brocklehurst and colleagues (1999)
Page 123 and 124: medication treatment along with non
Page 125 and 126: • CAM therapies may be culturally
Page 127 and 128: word games, the present day, and fa
Page 130 and 131: CHAPTER 7 PSYCHOLOGICAL SUPPORT A r
Page 132 and 133: 7.1.1 Death statements and depressi
Page 134 and 135: the factor structure of the CSDD. I
Page 136 and 137: 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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