3.5 (3.4) Palliative Care in the nursing home

Question 1

Epidemiologic studies demonstrate the 6 leading causes of death in the elderly in the US are what?

Answer 1

The six leading causes of death of people aged over 65 years in the United States are heart disease (44%), cancer (29%), stroke (11%), chronic obstructive pulmonary disease (8%), influenza and pneumonia (4%), and diabetes (4%)

Question 2

Improving access of long term care residents to specialized palliative care services has shown improvement in what three areas?

Answer 2

resident’s access to palliative care expertise and care protocols,
improved pain management,
reduces hospitalization rates during the last month of life, and
reduces the number of residents who die in hospital

Question 3

A palliative approach to care has been demonstrated to improve the QOL of residents in LTC in what three areas

Answer 3

(1) evidence-based symptom management
(2) appropriate decision-making support and goal setting
(3) access to practical aid, community resource, and specialist palliative care advice or support as required
(4) collaborative and seamless end-of-life care within the nursing home

Question 4

You have been tasked with improving the palliative care at a local LTC facility. List four requirements for implementing a palliative approach to care in an LTC facility

Answer 4

• communication, with a focus on identifying residents who would benefit from a specialist palliative care referral and negotiating this with their treating doctor and family (SPECIALIST MD)
• the development of palliative care leadership teams, technical assistance meetings for team members, education in palliative care for all staff, and feedback on performance (EDUCATION)
• targeted symptom control strategies to improve discomfort.
• commitment to: (1) person-centred care; (2) creating a palliative care team for each resident based on need; (3) optimizing symptom control; (4) advance care planning; and (5) timely recognition of dying. (POLICY)

Question 5

List 3 priorities for residents nearing EOL in LTC

Answer 5

(1) being active to the very last;
(2) having one’s will respected and being allowed to die;
(3) not being in pain; and
(4) being amongst persons close to one (valediction and showing respect)

Question 6

Research on “good deaths” shows what factors are important for those with cognitive impairment and their families

Answer 6

good symptom management,
clear decision-making,
good preparation for death,
completion and affirmation of the whole person
smooth transition from usual care to terminal care

Question 7

What three characteristics increase the risk of a LTC resident not having good symptom control

Answer 7

Non malignant disease
cognitive impairment
older age

Question 8

What four issues arise in LTC residents that make the administration of symptom control meds more challenging

Answer 8

Polypharmacy and cognitive, behavioural, and swallowing problems

Question 9

Advanced care planning is often inadequate in LTC facilities. If giving a presentation on the role of a pro active ACP to the managers of a LTC facility, what four benefits of ACP would you list?

Answer 9

more likely to be enrolled in hospice within 30 days

fewer acute care admissions

Residents’ families also rated the care provided more highly than those receiving usual care

increased satisfaction of care