Palliative care: Issues specific to geriatric patients
- Lynn Bunch O'Neill, MD
Lynn Bunch O'Neill, MD
- Associate Professor
- Emory University School of Medicine
- R Sean Morrison, MD
R Sean Morrison, MD
- Section Editor — Selected End Stage Conditions
- Hermann Merkin Professor of Palliative Care
- Mount Sinai School of Medicine
- Section Editors
- Kenneth E Schmader, MD
Kenneth E Schmader, MD
- Editor in Chief — Geriatric Medicine
- Section Editor — Geriatrics
- Chief, Division of Geriatrics
- Duke University
- Director, Geriatric Research Education and Clinical Center
- Durham VA Medical Centers
- Robert M Arnold, MD
Robert M Arnold, MD
- Editor-in-Chief — Palliative Care
- Section Editor — General Principles of Palliative Care
- Chief, Section of Palliative Care and Medical Ethics
- University of Pittsburgh School of Medicine
Palliative care is an interdisciplinary medical specialty that focuses on preventing and relieving suffering and on supporting the best possible quality of life for patients and their families facing serious illness. The primary tenets of palliative care are symptom management; establishing goals of care that are in keeping with the patient’s values and preferences; consistent and sustained communication between the patient and all those involved in his or her care; psychosocial, spiritual, and practical support both to patients and their family caregivers; and coordination across sites of care. Palliative care aims to relieve suffering in all stages of disease and is not limited to end of life care. Within an integrated model of medical care, palliative care is provided at the same time as curative or life-prolonging treatments. (See "Benefits, services, and models of subspecialty palliative care".)
While palliative care was once considered to be synonymous with end of life care (which was often delivered in a hospice setting), it is now recognized that palliative care can be appropriately offered to patients at any time along the trajectory of any type of life-threatening illness, even concurrent with restorative, life-prolonging therapies.
Most serious, chronic illness in the United States, Europe, and other developed countries occurs in those aged 65 years and older. These older individuals often live with and die from chronic illnesses that are preceded by long periods of physical decline and functional impairment. Thus, providing medical care for the elderly often involves medically and ethically complex decision-making, requiring consideration of patients' multiple comorbid conditions, their quality of life, and their wishes regarding treatments.
Establishing the goals of care is of the utmost importance when treating older adults with life-limiting illnesses. Depending upon the circumstances, this may be done directly with the patient or may require a surrogate decision-maker.
Issues in symptom assessment and management that are primarily applicable to the older adult will be reviewed here. General aspects of palliative care relating to decision-making that are relevant to the geriatric population (eg, decision-making capacity, advance directives) and issues relevant to assessment and management of symptoms in palliative care patients are discussed separately:
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