Guidelines for a Palliative Approach in Residential Aged Care

successfully tested predominantly with people with cancer in the US, China, and Taiwan and its
validity and reliability were also supported when the Revised Piper Fatigue Scale (1998) [166] was
used with 199 older persons (M age = 88 years) living in a RACF [164] (Level IV).
6.3.2 Management
To enable realistic goals for the management of fatigue to be achieved in accordance with the
wishes of the resident and their family, the aged care team should initiate a discussion with
those concerned. The first step is to assess the resident and identify any other symptoms,
diseases or circumstances that may contribute to fatigue [164] (Level IV). For example, depression
and anxiety, insomnia, anorexia, pain, dehydration, and anaemia may respond to treatment,
which can improve the level of energy available.
Pharmacological management
No RCTs have been conducted to date that specifically address pharmacological interventions
for fatigue in older persons. [165]
Non-pharmacological management
Suggested non-pharmacological methods for relieving fatigue, such as exercise programs and
energy conservation, may be effective for people receiving a palliative approach [169] (Level IV).
Winningham and colleagues (1994) [167] (Level EO) in a review of the literature regarding
fatigue and cancer, found that if people are tired it is often a result of inactivity. Guidelines on
fatigue management for people with advanced cancer have been developed [172] (Level QE) and,
although these guidelines have not been tested in the aged care setting, they might offer some
useful direction for managing this difficult symptom in the aged care population.
Systematic reviews were conducted to examine the benefits of physical exercise [173] (Level II),
and cognitive behavioural interventions [174] (Level I) for sleep disturbances in adults aged over
60 years. Physical exercise was found to provide some benefits such as facilitating sleep and
improving quality of life; however, the trials had small numbers and reviewers cautioned that
exercise was not appropriate for all older persons. [173]
Cognitive behavioural therapy (CBT) was found to have a mild effect on sleep disturbances in
older persons, but the effect was not usually long-lasting (