PALL8436 Palliative Care in Aged Care Settings

This topic addresses particular palliative clinical issues and clinical decision making for older people with a life limiting illness within residential aged care facilities and community settings. Palliative care in these settings typically occurs over a protracted period and involves 3 discreet forms; a palliative approach, specialised palliative care and terminal care. Rather than the inexorable decline characteristic of a person in the palliative phase of many malignancies, physical deterioration in aging typically occurs intermittently and from multiple non-malignant conditions. A crucial skill is the assessment and clinical management of each new symptom & differentiating between the irreversible progress of an already diagnosed medical condition and a potentially reversible symptom requiring acute intervention. Unique aspects of pharmacokinetics within the aging population are also explored. Issues of addressing and documenting patient wishes regarding interventions and care in the event of further deterioration in mental and physical function is introduced. Also explored is the experience of physical, social and psychological dying. Introduction to the ethical and legislative issues pertinent to this area of practice.

This topic aims to broaden student knowledge and understanding of the palliative care needs of older people across a variety of care settings.

1. Describe the philosophy and practice of palliative care in aged care settings
2. Compare and contrast the common dying trajectories of older people with a life limiting illness and differentiate between the decline in malignant and non-malignant conditions
3. Identify strategies for assessing when a palliative approach, specialist palliative care, supportive care is appropriate and articulate how are these decisions are made
4. Distinguish between the concepts of social, psychological and biological death and describe their application to patients and caregivers
5. Review the concept of advance directives and their relevance to local legislative frameworks, interpreting the implications of these for practice
6. Identify and discuss issues of advanced care planning for older people, particularly those with cognitive impairment and describe the complexity of decision making in the absence of an advanced directive
7. Describe the unique clinical aspects involved in the palliative care of older people
8. Discuss the implications of loss and grief on families, carers and staff within this population of older people