Geripal experts:
If you have to share ONE TIP with your fellow Geriatricians and Gerontologists about palliative care of older adults, what would it be?
The American Academy of Hospice and Palliative Medicine is co-sponsoring a pre-conference work shop with the American Geriatrics Society during the AGS annual meeting May 12-15th 2010.
Please share your favorite geripal tip and we will compile it and share it during the workshop with all the attendees.
13 comments:
I asked my 78 year old mother what tip she would share with professionals working with older adults. Her emailed response was a statement a poem:
We are still alive and will be until we are dead. Stop treating us as if we were already in the death process.
"Let it be a dawn of flagrant gold
"With scarlet streaks flung out across the sky
"Let there be a bitter chill to hold
"The scent of burning pines when I must die."
This is rather a "duh" statement, but true, nevertheless. Both Geriatrics and Palliative Care focus on quality of life, trying to enhance function and help patients and their families as they transition from living with a debilitating chronic disease, to dying from the effects of a chronic disease. The path from one to the other is not always smooth, nor is it predictable, but it can and should be comfortable for all involved.
Bonnie Parsons, GNP-BC
Manager, Center for Comprehensive Palliative Care
Ocala, Florida
Listen. First, last, and continuously. Don't feel compelled to talk so much.
"as you age you become more uniquely who you are" - Older adults are more different than they are alike. Care must be tailored to the those differences.
Dee Wadsworth
Church Gerontologist
PHPC
In caring for persons with dementia, use the golden rule. Dementia-related behaviors are communication of unmet need. The behavior is telling us something. It is our job to find out what it is - is the person hungry? Cold? In pain? If the behaviors are assessed and addressed and we think comfort in all that we do, we are providing interventions that support palliative care. Carol Long, PhD, RN, FPCN
I would share that PC in the elderly is one of the most overlooked elements in transitional care planning particularly for frail hospitalized patients preparing to go home.
Hope all goes great at the workshop (I'd be there myself if I weren't already part of the AAHCP meeting)!
My tip would be to listen to them. They will tell you want they want. They want their pain under control. They want spiritual support. They want their family close by. They want to get their affairs in order. Give them the dignity and respect they have earned.
Jan Walker, PA-C
Palliative Care Coordinator
VA Medical Center
Gainesville, Florida
what a great workshop idea!
I will answer a slightly different question, since I more represent someone who would be learning from your workshop rather than teaching it. Specifically, what would I want to learn from a Palliative Care expert to help me better care for my older patients?
My question uses as its context the new AGS Guideline on the management of chronic pain in the elderly. This guideline has a revolutionary recommendation: That after acetominophen has failed, that we view opiods as the primary traatment for chronic pain rather than NSAIDS. The implementation of this guideline would result in a large expansion of the number of older persons on opiods treatment, many of whom would be on opiods for many years.
So, I would want this type of workshop to teach me something about the management of opiod therapy in this context. Subquestions would include:
1) When should you start opiods for chronic pain in the elderly?
2) How should you initially dose these opiods, and how should you titrate your initial dose?
3) How should you monitor therapy? Should one have theraputic trials of dose reduction? When do you escalate the dose?
4) How do you manage the complications of long term opiod therapy, particularly constipation?
Great suggestions all. I agree with Ken that discussing the treatment of non-malignant pain in the elderly is a great place to start.
I have an even more basic tip; besure patients have their glasses on and if they use them, hearing aides in.Speak to them face to face, not from the side or behind them. I have had more than one patient remark that I am their favorite or really listen to them because I do this (little do they realize I also do it because I wear hearing aides and want to hear them). Someone without their glasses is also likely to feel slightly confused and disoriented.
Kim Carroll - It is usually best to error on the side of touch, not just for an assessment, but to touch with warmth and compassion - let that person, whom you are caring for- feel cared for.
Any neurologic injury predisposed to over response to opiates.
Thanks all for the great comments. The session on Palliative Care was completely full. It was enheartening to know that over 50 geriatricians were planning to sit for the Hospice and Palliative Medicine boards.
Many shared their favorite geriatrics tip to be shared with fellow palliators. These will be compiled and used to shape a pre-con session on geriatrics at the upcoming AAHPM/HPNA meeting in Vancouver 2011.
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