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Palliative care: Issues specific to geriatric patients

Lynn Bunch O'Neill, MD
R Sean Morrison, MD
Section Editors
Kenneth E Schmader, MD
Robert M Arnold, MD
Deputy Editor
Diane MF Savarese, MD


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 older adults 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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Literature review current through: Nov 2017. | This topic last updated: Aug 17, 2017.
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  1. Kapo J, Morrison LJ, Liao S. Palliative care for the older adult. J Palliat Med 2007; 10:185.
  2. Wijk H, Grimby A. Needs of elderly patients in palliative care. Am J Hosp Palliat Care 2008; 25:106.
  3. Walke LM, Gallo WT, Tinetti ME, Fried TR. The burden of symptoms among community-dwelling older persons with advanced chronic disease. Arch Intern Med 2004; 164:2321.
  4. Portenoy RK, Thaler HT, Kornblith AB, et al. The Memorial Symptom Assessment Scale: an instrument for the evaluation of symptom prevalence, characteristics and distress. Eur J Cancer 1994; 30A:1326.
  5. de Haes JC, van Knippenberg FC, Neijt JP. Measuring psychological and physical distress in cancer patients: structure and application of the Rotterdam Symptom Checklist. Br J Cancer 1990; 62:1034.
  6. Watanabe SM, Nekolaichuk C, Beaumont C, et al. A multicenter study comparing two numerical versions of the Edmonton Symptom Assessment System in palliative care patients. J Pain Symptom Manage 2011; 41:456.
  7. Ferrell BA. Pain evaluation and management in the nursing home. Ann Intern Med 1995; 123:681.
  8. Hadjistavropoulos T, Herr K, Turk DC, et al. An interdisciplinary expert consensus statement on assessment of pain in older persons. Clin J Pain 2007; 23:S1.
  9. Morrison LJ, Morrison RS. Palliative care and pain management. Med Clin North Am 2006; 90:983.
  10. Ferrell BA, Ferrell BR, Rivera L. Pain in cognitively impaired nursing home patients. J Pain Symptom Manage 1995; 10:591.
  11. Parmelee PA, Smith B, Katz IR. Pain complaints and cognitive status among elderly institution residents. J Am Geriatr Soc 1993; 41:517.
  12. Pautex S, Michon A, Guedira M, et al. Pain in severe dementia: self-assessment or observational scales? J Am Geriatr Soc 2006; 54:1040.
  13. American Geriatrics Society Panel on Pharmacological Management of Persistent Pain in Older Persons. Pharmacological management of persistent pain in older persons. J Am Geriatr Soc 2009; 57:1331.
  14. Helme RD, Gibson SJ. The epidemiology of pain in elderly people. Clin Geriatr Med 2001; 17:417.
  15. Thomas E, Peat G, Harris L, et al. The prevalence of pain and pain interference in a general population of older adults: cross-sectional findings from the North Staffordshire Osteoarthritis Project (NorStOP). Pain 2004; 110:361.
  16. Rao A, Cohen HJ. Symptom management in the elderly cancer patient: fatigue, pain, and depression. J Natl Cancer Inst Monogr 2004; :150.
  17. Potter J, Higginson IJ. Pain experienced by lung cancer patients: a review of prevalence, causes and pathophysiology. Lung Cancer 2004; 43:247.
  18. Goldstein NE, Morrison RS. Treatment of pain in older patients. Crit Rev Oncol Hematol 2005; 54:157.
  19. Barbera L, Seow H, Husain A, et al. Opioid prescription after pain assessment: a population-based cohort of elderly patients with cancer. J Clin Oncol 2012; 30:1095.
  20. Higginson IJ, Gao W. Opioid prescribing for cancer pain during the last 3 months of life: associated factors and 9-year trends in a nationwide United Kingdom cohort study. J Clin Oncol 2012; 30:4373.
  21. Solomon DH, Rassen JA, Glynn RJ, et al. The comparative safety of analgesics in older adults with arthritis. Arch Intern Med 2010; 170:1968.
  22. Bishop, TF, Morrison, RS. Geriatric palliative care—Part I: Pain and symptom management. Clinical Geriatrics 2006 (in press).
  23. Francis J. Delirium in older patients. J Am Geriatr Soc 1992; 40:829.
  24. Kiely DK, Bergmann MA, Jones RN, et al. Characteristics associated with delirium persistence among newly admitted post-acute facility patients. J Gerontol A Biol Sci Med Sci 2004; 59:344.
  25. Morrison RS, Magaziner J, Gilbert M, et al. Relationship between pain and opioid analgesics on the development of delirium following hip fracture. J Gerontol A Biol Sci Med Sci 2003; 58:76.
  26. Gapapentin. In: Hospice and Palliative Care Formulary, 2nd Edition, R Twycross and A Wilcock (Ed), Palliativedrugs.com, Nottingham 2008. p.209.
  27. Pregabalin. In: Hospice and Palliative Care Formulary, Second, R Twycross and A Wilcock (Ed), palliativedrugs.com, Nottingham 2008. p.212.
  28. Small GW. Tricyclic antidepressants for medically ill geriatric patients. J Clin Psychiatry 1989; 50 Suppl:27.
  29. Lunn MP, Hughes RA, Wiffen PJ. Duloxetine for treating painful neuropathy, chronic pain or fibromyalgia. Cochrane Database Syst Rev 2014; :CD007115.
  30. Abou-Raya S, Abou-Raya A, Helmii M. Duloxetine for the management of pain in older adults with knee osteoarthritis: randomised placebo-controlled trial. Age Ageing 2012; 41:646.
  31. Gammaitoni AR, Alvarez NA, Galer BS. Safety and tolerability of the lidocaine patch 5%, a targeted peripheral analgesic: a review of the literature. J Clin Pharmacol 2003; 43:111.