Palliative care of geriatrics-nursing care plans: An updated review
Keywords:
Geriatric palliative care, chronic illness, nursing care plans, care coordination, elderly, end-of-life care, ethical decision-making, quality of life, multimorbidity, advanced care planningAbstract
Background: The increasing life expectancy in aging populations has highlighted the growing need for specialized care in managing chronic, life-limiting conditions. With the rising prevalence of multimorbidity, frailty, and cognitive decline in elderly populations, geriatric palliative care (GPC) has emerged as a necessary field of practice. This paper discusses the integration of geriatrics and palliative care, emphasizing the role of nursing care plans in managing the complex healthcare needs of the elderly, particularly those with chronic illnesses. Aim: To explore the role of geriatric palliative care in managing complex geriatric conditions and to identify key challenges and strategies for improving care delivery, with a focus on nursing care plans and multidisciplinary approaches. Methods: The review synthesizes current literature and evidence on geriatric palliative care, examining the intersection between geriatrics and palliative care. Theoretical foundations, ethical frameworks, and challenges within the field are discussed. Strategies for improving care coordination, patient autonomy, and research efforts are also explored. Results: The paper identifies several key geriatric conditions, such as chronic heart disease, chronic obstructive pulmonary disease (COPD), and dementia, which often require palliative care interventions. It highlights the challenges in providing comprehensive care, including decision-making difficulties, care coordination, and research gaps.
Downloads
References
Davies E. Higginson IJ, World Health Organization. Regional Office for Europe.: better palliative care for older people. Copenhagen: WHO Regional Office for Europe; 2004.
Jagger C, Weston C, Cambois E, Van Oyen H, Nusselder W, Doblhammer G, Rychtarikova J, Robine JM, Team E. Inequalities in health expectancies at older ages in the European Union: findings from the survey of health and retirement in Europe (SHARE). J Epidemiol Community Health. 2011;65(11):1030–5. DOI: https://doi.org/10.1136/jech.2010.117705
Guthrie B, Payne K, Alderson P, McMurdo ME, Mercer SW. Adapting clinical guidelines to take account of multimorbidity. BMJ. 2012;345:e6341. DOI: https://doi.org/10.1136/bmj.e6341
Van Den Block L, Albers G, Pereira SM, Onwuteaka-Philipsen B, Pasman R, Deliens L. Palliative care for older people : a public health perspective, first edition. Edn. Oxford: Oxford University Press; 2015. DOI: https://doi.org/10.1093/acprof:oso/9780198717614.001.0001
Evers MM, Meier DE, Morrison RS. Assessing differences in care needs and service utilization in geriatric palliative care patients. J Pain Symptom Manag. 2002;23(5):424–32. DOI: https://doi.org/10.1016/S0885-3924(02)00377-9
Meier DE, Back AL, Berman A, Block SD, Corrigan JM, Morrison RS. A national strategy for palliative care. Health Aff (Millwood). 2017;36(7):1265–73. DOI: https://doi.org/10.1377/hlthaff.2017.0164
Morrison RS, Meier DE, Capello C. Geriatric palliative care. 1st edition 2003. Oxford New York: Oxford University Press; 2014.
Marengoni A, Angleman S, Meinow B, Santoni G, Mangialasche F, Rizzuto D, Fastbom J, Melis R, Parker M, Johnell K, et al. Coexisting chronic conditions in the older population: variation by health indicators. Eur J Intern Med. 2016;31:29–34. DOI: https://doi.org/10.1016/j.ejim.2016.02.014
Rodriguez-Manas L, Fried LP. Frailty in the clinical scenario. Lancet. 2015;385(9968):e7–9. DOI: https://doi.org/10.1016/S0140-6736(14)61595-6
Tinetti M. Mainstream or extinction: can defining who we are save geriatrics? J Am Geriatr Soc. 2016;64(7):1400–4. DOI: https://doi.org/10.1111/jgs.14181
Kubler-Ross E. On death and dying. Bull Am Coll Surg. 1975;60(6):12 15-17.
Saunders CM, Baines M, Dunlop R. Living with dying : a guide to palliative care. 3rd ed. Oxford: Oxford University Press; 1995. DOI: https://doi.org/10.1093/acprof:oso/9780192625144.001.0001
Benaroyo L, Widdershoven G. Competence in mental health care: a hermeneutic perspective. Health Care Anal. 2004;12(4):295–306 discussion 265-272. DOI: https://doi.org/10.1007/s10728-004-6637-8
Pacala JT. Is palliative care the “new” geriatrics? Wrong question--we're better together. J Am Geriatr Soc. 2014;62(10):1968–70. DOI: https://doi.org/10.1111/jgs.13020
Meier DE. Focusing together on the needs of the sickest 5%, who drive half of all healthcare spending. J Am Geriatr Soc. 2014;62(10):1970–2. DOI: https://doi.org/10.1111/jgs.13020_1
Albers G, Froggatt K, Van den Block L, Gambassi G, Vanden Berghe P, Pautex S, Van Den Noortgate N, Euro I. A qualitative exploration of the collaborative working between palliative care and geriatric medicine: barriers and facilitators from a European perspective. BMC Palliat Care. 2016;15:47. DOI: https://doi.org/10.1186/s12904-016-0118-3
World Health Organization. Framework on integrated, people-centred health services. Geneva: WHO; 2016.
Davila JA, Ross JS, Hartronft S, Garza M, Lee S, Sanchez-Reilly S. Effectiveness of a geriatrics and palliative care consultation on symptom management and geriatric syndromes. J Palliat Care Med. 2012;2:116. DOI: https://doi.org/10.4172/2165-7386.1000116
Jox RJ, Schaider A, Marckmann G, Borasio GD. Medical futility at the end of life: the perspectives of intensive care and palliative care clinicians. J Med Ethics. 2012;38(9):540–5. DOI: https://doi.org/10.1136/medethics-2011-100479
Goldhirsch S, Chai E, Meier DE, Morris J. Geriatric palliative care : a practical guide for clinicians. New York: Oxford University Press; 2014. DOI: https://doi.org/10.1093/med/9780195389319.001.0001
Silveira MJ, Kim SY, Langa KM. Advance directives and outcomes of surrogate decision making before death. N Engl J Med. 2010;362(13):1211–8. DOI: https://doi.org/10.1056/NEJMsa0907901
Kühlmeyer K, Schuler A, Kolb C, Borasio GD, Jox RJ. Evaluating nonverbal behavior of patients with dementia during feeding: a survey of the nursing staff in residential care homes for elderly adults. J Am Geriatr Soc. 2015;62(12):2544-49. DOI: https://doi.org/10.1111/jgs.13822
Shalowitz DI, Silveira MJ. Building a better advance directive: next steps. Am J Bioeth. 2010;10(4):34–6. DOI: https://doi.org/10.1080/15265161003650502
Berwick DM, Hackbarth AD. Eliminating waste in US health care. JAMA. 2012;307(14):1513–6. DOI: https://doi.org/10.1001/jama.2012.362
Boyd CM, Darer J, Boult C, Fried LP, Boult L, Wu AW. Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: implications for pay for performance. JAMA. 2005;294(6):716–24. DOI: https://doi.org/10.1001/jama.294.6.716
Gozalo P, Teno JM, Mitchell SL, Skinner J, Bynum J, Tyler D, Mor V. End-of-life transitions among nursing home residents with cognitive issues. N Engl J Med. 2011;365(13):1212–21. DOI: https://doi.org/10.1056/NEJMsa1100347
Mitchell SL, Teno JM, Kiely DK, Shaffer ML, Jones RN, Prigerson HG, Volicer L, Givens JL, Hamel MB. The clinical course of advanced dementia. N Engl J Med. 2009;361(16):1529–38. DOI: https://doi.org/10.1056/NEJMoa0902234
Smith AK, McCarthy E, Weber E, Cenzer IS, Boscardin J, Fisher J, Covinsky K. Half of older Americans seen in emergency department in last month of life; most admitted to hospital, and many die there. Health Aff (Millwood). 2012;31(6):1277–85. DOI: https://doi.org/10.1377/hlthaff.2011.0922
Unroe KT, Meier DE. Research priorities in geriatric palliative care: policy initiatives. J Palliat Med. 2013;16(12):1503–8. DOI: https://doi.org/10.1089/jpm.2013.9464
Hofmeister M, Memedovich A, Dowsett LE, Sevick L, McCarron T, Spackman E, Stafinski T, Menon D, Noseworthy T, Clement F. Palliative care in the home: a scoping review of study quality, primary outcomes, and thematic component analysis. BMC Palliat care. 2018;17(1):41. DOI: https://doi.org/10.1186/s12904-018-0299-z
Hall S, Kolliakou A, Petkova H, Froggatt K, Higginson IJ. Interventions for improving palliative care for older people living in nursing care homes. Cochrane Database Syst Rev. 2011;16(3):Cd007132. DOI: https://doi.org/10.1002/14651858.CD007132.pub2
Murphy E, Froggatt K, Connolly S, O'Shea E, Sampson EL, Casey D, Devane D. Palliative care interventions in advanced dementia. Cochrane Database Syst Rev. 2016;12:Cd011513. DOI: https://doi.org/10.1002/14651858.CD011513.pub2
Smets T, Onwuteaka-Philipsen BBD, Miranda R, Pivodic L, Tanghe M, van Hout H, Pasman R, Oosterveld-Vlug M, Piers R, Van Den Noortgate N, et al. Integrating palliative care in long-term care facilities across Europe (PACE): protocol of a cluster randomized controlled trial of the 'PACE steps to Success' intervention in seven countries. BMC palliative care. 2018;17(1):47. DOI: https://doi.org/10.1186/s12904-018-0297-1
Kavalieratos D, Corbelli J, Zhang D, Dionne-Odom JN, Ernecoff NC, Hanmer J, Hoydich ZP, Ikejiani DZ, Klein-Fedyshin M, Zimmermann C, et al. Association between palliative care and patient and caregiver outcomes: a systematic review and meta-analysis. Jama. 2016;316(20):2104–14. DOI: https://doi.org/10.1001/jama.2016.16840
Mullick A, Martin J, Sallnow L. An introduction to advance care planning in practice. BMJ. 2013;347:f6064. DOI: https://doi.org/10.1136/bmj.f6064
Houben CH, Spruit MA, Groenen MT, Wouters EF, Janssen DJ. Efficacy of advance care planning: a systematic review and meta-analysis. J Am Med Dir Assoc. 2014;15(7):477–89. DOI: https://doi.org/10.1016/j.jamda.2014.01.008
Brinkman-Stoppelenburg A, Rietjens JA, van der Heide A. The effects of advance care planning on end-of-life care: a systematic review. Palliat Med. 2014;28(8):1000–25. DOI: https://doi.org/10.1177/0269216314526272
Volicer L, Cantor MD, Derse AR, Edwards DM, Prudhomme AM, Gregory DC, Reagan JE, Tulsky JA, Fox E. Advance care planning by proxy for residents of long-term care facilities who lack decision-making capacity. J Am Geriatr Soc. 2002;50(4):761–7. DOI: https://doi.org/10.1046/j.1532-5415.2002.50175.x
Capezuti EA, Bricoli B, Boltz MP. Nurses improving the Care of Healthsystem Elders: creating a sustainable business model to improve care of hospitalized older adults. J Am Geriatr Soc. 2013;61(8):1387–93. DOI: https://doi.org/10.1111/jgs.12324
Strijbos MJ, Steunenberg B, van der Mast RC, Inouye SK, Schuurmans MJ. Design and methods of the hospital elder life program (HELP), a multicomponent targeted intervention to prevent delirium in hospitalized older patients: efficacy and cost-effectiveness in Dutch health care. BMC Geriatr. 2013;13:78. DOI: https://doi.org/10.1186/1471-2318-13-78
Counsell SR, Callahan CM, Buttar AB, Clark DO, Frank KI. Geriatric resources for assessment and Care of Elders (GRACE): a new model of primary care for low-income seniors. J Am Geriatr Soc. 2006;54(7):1136–41. DOI: https://doi.org/10.1111/j.1532-5415.2006.00791.x
Tinetti ME, Esterson J, Ferris R, Posner P, Blaum CS. Patient priority-directed decision making and Care for Older Adults with multiple chronic conditions. Clin Geriatr Med. 2016;32(2):261–75. DOI: https://doi.org/10.1016/j.cger.2016.01.012
Section UG: Geriatrics definition. 2008.
Held V. The ethics of care. Personal, political, and global. Oxford: Oxford University press; 2006. DOI: https://doi.org/10.1093/0195180992.001.0001
Published
How to Cite
Issue
Section
Copyright (c) 2018 International journal of health sciences
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Articles published in the International Journal of Health Sciences (IJHS) are available under Creative Commons Attribution Non-Commercial No Derivatives Licence (CC BY-NC-ND 4.0). Authors retain copyright in their work and grant IJHS right of first publication under CC BY-NC-ND 4.0. Users have the right to read, download, copy, distribute, print, search, or link to the full texts of articles in this journal, and to use them for any other lawful purpose.
Articles published in IJHS can be copied, communicated and shared in their published form for non-commercial purposes provided full attribution is given to the author and the journal. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
This copyright notice applies to articles published in IJHS volumes 4 onwards. Please read about the copyright notices for previous volumes under Journal History.
