Palliative care for older pts

Question 1

Define palliative care

Answer 1

Palliative care improve the QUALITY OF LIFE of pts and families who face LIFE-THREATENING ILLNESS, by providing pain and symptom relief, spiritual and psychosocial support from DIAGNOSIS to the end of life and BEREAVEMENT

Question 2

What is specialist palliative care?

Answer 2

palliative care provided by health professionals who specialise and work in a multi-discipinalry specialist care team

Question 3

Give examples of staff involved in specialist palliative care

Answer 3

consultants in palliative medicine
clinical nurse specialists e.g. Macmillan nurses
Hospice nurses 
specialist social workers
dieticians
chaplains
physiotherapists

Question 4

What is generalist palliative care?

Answer 4

health professionals who have not received accredited levels of training in palliative care provision and so are not called specialists but routinely provide care for pts at the end of their lives

Question 5

Give examples of staff involved in generalist (universal/generic) palliative care

Answer 5

GPs
hospital doctors
hospital nurses
district nurses
community matrons
nursing home staff
social workers 
COPD nurses

Question 6

Give examples of the specific care needs of older pts

Answer 6

co-morbities 
greater risk of adverse drug reactions 
increased psychological distress
increased social isolation 
increased economic hardship

Question 7

Give examples of factors that cause inequalities in provision of palliative care to older people

Answer 7

socio-economic status
poverty
poor living conditions increases with age 
living alone
winter deaths

Question 8

What are the similarities between gerontology and palliative care?

Answer 8

promote QoL
promote dignity and autonomy
control symptoms, whilst avoiding use of invasive medical investigations and aggressive treatments

Question 9

Compare the older population to the younger population in terms of medical care

Answer 9

Older people are:

• less likely to be admitted to a hospice
• less likely to die in their place of preference
• less likely to receive preventative planning
• repeated hospital admissions
• less likely to be involved in advanced care planning

Question 10

Give two characteristics of COPD

Answer 10

progressive airflow obstruction

not fully reversible

Question 11

Give examples of co-morbidities that a pt may have

Answer 11

heart disease
diabetes
arthritis 
asthma
stroke
cancer
mental illness

Question 12

What are the barriers to COPD care? VIP question

Answer 12

1. Unpredictable illness trajectory
2. difficulty to get prognosis
3. poor pt understanding
   limited access to 4. specialist palliative care
   (funding
   workforce expertise)

Question 13

What problems does poor pt understanding of COPD bring?

Answer 13

anxiety and confusion regarding condition and implications
Pts unable to make advanced care planning decisions
family and carers are unprepared for death

Question 14

Compare COPD pts to lung cancer pts

Answer 14

COPD pts have:

• worse ADLs
• more depression
• less visits from district nurses
• less likely to know they will die
• more ICU visits
• no palliative care offered

Question 15

what are the NICE guidelines for COPD and palliative care?

Answer 15

COPD pts should have access to full range of services offence by palliative MDTs and hospice admission

Question 16

What improvements can be made to COPD care?

Answer 16

• More specialist palliative care offered to COPD pts, not just generalist
• more community support
• more emphasis on chronic condition care rather than acute model of care
• specialist palliative care could be offered by COPD charities instead of just cancer ones
• reduce stigma around COPD and smoking