Research has revealed that the death rate in Aged Care Residential Facilities (RACF) is steadily increasing in Australia. It has resulted into the recognition that a palliative approach enhances care provided by residents and families (Church, Goodall, Norman, & Haas, 2011). Due to the residents served by the RCAFs, they experience certain unique and substantial difficulties by applying a palliative approach, these can be addressed. Most of the residents suffer from dementia and have co-morbidities that affect their physical, mental, emotional, and social issues. Therefore, they require palliative care (Church, Goodall, Norman, & Haas, 2011).
Palliative care is specialized care and support given to individuals living with a terminal illness. It also involves caring and supporting the person’s family and caregivers. The goal here is improving the quality of care for patients, their families, and caregivers by addressing their physical, emotional, social, cultural, and spiritual needs. It involves treatment of pain and other physical and psychological symptoms that might be interfering with an individual’s health and wellbeing (Watson & al, 2009)
The aim here is to provide patients with quality life, offer social and moral support for their family and caregivers, and manage patient’s illness and bereavement (Watson & al, 2009) palliative care has three principles; symptom prevention, psychosocial care, and disease management. Each principle depends on the other and requires an inter-disciplinary approach towards the provision of care (Watson & et al., 2009).
Different types of palliative care exist that are; general palliative care provided by the usual patient and family carers. Here, the need for palliative care needs ranged from low to moderate and taken as a routine clinical practice. Specialist palliative care provided to patients and their families with moderate to high complexity of the needs of palliative care. Specialist care comprises of supportive care (for cancer patients) and hospice and hospice care (a philosophy of care). Finally, there is terminal care or end-of-life care (management of patients in their last days of life) (Watson & et al., 2009)
Importance of Providing Age Appropriate Care
To provide effective patient care, one must consider the patients age and level of development. Knowing the patient’s level of development helps the professional select the most appropriate strategy for care and treatment. It involves the examination of the patient’s physical maturity and abilities, psychosocial development, cognitive development, and the issue or disease to be treated.
Different age groups have different health care needs. These needs determine the treatment interventions to be undertaken and this includes palliative care. Despite suffering from similar or different terminal illnesses, children, young adults, and aged have different needs to help them cope and accept their state (Paediatric Palliative Care Reference Group., 2010). In addition, the families and caregivers are affected differently depending on whether the affected person is a child, young adult, or an aged person. Therefore, family members require different approaches depending on the age of the person affected in the family. Finally, the age of the family member of caregiver also determines how an individual will be affected by the suffering of their family members. Adults tend not to have control of emotions compared to the children and young adults (Paediatric Palliative Care Reference Group., 2010).
For example, in developed countries, child death is rarely experienced and individuals may not be well prepared to support a family with a child having a fatal disease. Individuals feel uncomfortable and avoid contact as they fear of speaking out or doing the wrong thing (Hynson, 2009). Therefore, families may be isolated at their time of need. Therefore, a child’s palliative care needs are great and complex. Children suffer from a diverse range of rare illnesses. They most of the time affect the nervous system and slow progress to cause disability, sleeping and feeding difficulties (Hynson, 2009).
The conditions may be inherited affecting more than one child. Parents here are very involved as the primary caregivers and decision makers with difficult decisions regarding treatment to be provided (Hynson, 2009). Care for the child here is required around the clock over years and parents require familiarity with complicated equipment to take care of their child. For a child, it is a period of psychological, emotional, and psychological development. Illness affects development and in a similar manner developmental factors influence how a child perceives an illness. The way a child understands illness, communicate fears and hopes, their involvement is affected by their level of development (Hynson, 2009).
The above indicate how complex child factors are and, therefore, indicate that they require unique palliative approaches of treatment compared to the young adults and aged counterparts. Taking an age based approach allows the palliative care professional to determine the best approach to handle the patient, the patient’s family and caregivers. It is aimed at ensuring that the clients and patients attain the highest quality of life, achieve physical, social, emotional, spiritual, and psychological wellbeing. These will enable the patient and family to cope with the disease and tolerate any future outcomes including death.
Nursing Care in Old age
The human race has two stages of life; a long childhood and a long old age. It has allowed for the education and passing of values from the old to the young one and through this the survival and progress of man has been ensured throughout history. The presence of elderly people in our social lives provides an irreplaceable lesson to humanity not only by their life, but also their death.
Palliative is a vital health care issue due to the ageing population increasing number of older people in society and the insufficient attention to the needs of this aged group. Palliative care in old age in old age aims at improving symptoms of the disease, the dignity and life quality of especially for those people approaching that are almost dying, and caring for their families and friends. It is often neglected despite its relevance to the society. Palliative care was originally for cancer patients; however, it must be integrated broadly in other health services (World Health Organization, 2011).
Linkages exist between palliative care for older individuals and geriatrics, for example, frailty syndrome, elderly cancer, neurodegenerative disorders, end-stage, elderly with chronic pain, and bereaved elderly. Palliative care and geriatrics are patient-centered holistic care that emphasize on quality of life and add life to days where such days cannot be added to life. Nurses play a wide range of roles in palliative care for people in old age. In this case, they act as geriatric nurses who offer palliative geriatric care to the elderly person. In addition, they offer palliative care to by alleviating pain, ameliorating bereavement, and stress from taking care of the older person to their families.
In Australia, significant changes have been occurring over the past ten years in Residential Aged Care (RAC). These promoted a homely environment and many individuals moved into RACs due to loneliness and social isolation. However, RACs do no longer offer such care and the RACs currently homes were admitted residents have multiple comorbidities, dementia, and other complex needs that require care (Melbourne Citymission, 2011). The residents are also entering their last stages of life and, therefore, posing a challenge to the staff in terms of managing symptoms. Staff in RACs lacks the necessary skills. Nurse practitioners are able to handle such patients and are employed there to provide palliative care for the individuals in them. Therefore, aged and palliative care nurse practitioners are being introduced in the Citymission in Melbourne (Melbourne Citymission, 2011).
In addition, nurses offer palliative care in hospice settings. Hospice palliative care is a combination of active, compassionate therapies aimed at comforting and supporting families that are living with, or dying from a progressive life-limiting illness (Canadian Hospice Palliative Care Association Nursing Standards Committee, 2009). It is a holistic health care approach aimed at relieving pain and suffering and improves their quality of living and dying. Here, nurses strive to help the aged and their family; achieve physical, psychological, social, spiritual, practical, and expected associations (Canadian Hospice Palliative Care Association Nursing Standards Committee, 2009). Furthermore, they help patients prepare for and manage self-determined life closure and the dying process. Finally, they support the family and caregivers cope with loss and grieve during illness or death (Canadian Hospice Palliative Care Association Nursing Standards Committee, 2009).
Advanced Practice Nurses also play a vital role in palliative care. They have a doctorate in nursing and are specialized in different areas of nursing. Nurses who have specialized in palliative care are usually prepared to serve the roles of Clinical Nurse Specialists (CNS) or Nurse Practitioner (NP) (American Health Association & Centre to Advance Palliative Care, 2012). In addition they perform extra roles as educators, consultants, researchers, and leaders. Among all the health care professionals working to improve care at the end of life, nurses are best suited to provide such services. Nurses are uniquely are qualified to provide comprehensive, effective, compassionate, and cost-effective care. In addition, they practice in settings where patients are cared for and die. APNs are qualified to address a wide range of issues, therefore, work to provide palliative care at these levels (World Health Organization, 2011).
The population in Europe and the United States is aging and experts predicting that the position will triple or quadruple within the next 30 years. Furthermore, the number paid informal caregivers is decreasing, medical advances are increasing life expectancies, and incentives from the economy and shortage of bed capacity in acute care hospitals lead to early discharge of the chronically ill elderly. As this number of people with severe, debilitating illnesses increases, the number of those living and dying in nursing homes increases.
Many families and aged people do not view as nursing home admittance as desirable. For most of the families, admission into nursing homes means abandonment. Today many residents in nursing facilities are ill and actively die at an increasing rate. Introduction of palliative care provided by nurses can relieve suffering and support quality life for nursing home residents and their families (Palliative Care WA (Inc.), 2012).
Palliative care is an interdisciplinary approach of medicine whose focus is preventing and relieving suffering and supporting quality life for both patients and their families who have serious illnesses (O’Neill & Morrison, 2013). The main tenets of this approach are management of symptoms, establishment of goals of care that go hand-in-hand with the patient’s values and preferences, maintain consistent and sustained communication between the patient and caregivers, and coordination of sites of care. Palliative care aims at relieving suffering in all disease stages and not just for the end of life care. It is provided together with curative treatment in a medical care model of treatment (O’Neill & Morrison, 2013).
Palliative care is often synonymous with the end of life care. However, today it is recognized that it can be used on patients at any time during any life-threatening illness including with the constructive restorative treatments and therapies that are intended to prolong the life of the patient (O’Neill & Morrison, 2013). Establishment of goals of care is most important when dealing with aged adults. The setting determines whether this may be done indirectly or directly (O’Neill & Morrison, 2013). The treatment may be provided in an in-patients o out-patient setting with most of the treatments provided by nurses who have specialized in the field. For any palliative care professional, the goal should be to ensure maintenance of the tenets while considering the patient’s age in order to provide the appropriate treatment required for each client (age appropriate care).
American Health Association & Centre to Advance Palliative Care. (2012). Palliative Care Services: Solutions for Better Patient Care and Today’s Health Care Delivery Challenges. 3-19.
Canadian Hospice Palliative Care Association Nursing Standards Committee. (2009). Canadian Hospice Palliative Care Nursing Standards of Practice: Canadian Hospice Palliative Care Association Nursing Standards Committee.
Church, J., Goodall, S., Norman, R., & Haas, M. (2011). An Economic Evaluation of Community and Residential Aged Care Falls Prevention Strategies in NSW. Sydney: NSW Ministry of Health. doi: 10.1071/NB10051.
Hynson, J. (2009). Palliative Care for Children. Journal of Consumers Health Forum of Australia (4), 22-23.
Melbourne Citymission. (2011). Implementation of Aged & Palliative Care Nurse Practitioner Role Melbourne Citymission. Melbourne: Melbourne Citymission.
O’Neill, L. B., & Morrison, R. S. (2013, Oct 7). Uptodate.
Paediatric Palliative Care Reference Group. (2010). Palliative care for children and their families. About Respite, 1-12.
Palliative Care WA (Inc.). (2012). Palliative Caring at Home: Information for those Caring for a Person with Advanced and Terminal Illness. Palliative Care WA Inc.
Watson, M. S., & al, e. (2009). Oxford handbook of palliative care. Oxford; New York: Oxford University Press.
World Health Organization. (2011). Palliative care for older people: better practices. (S. Hall, H. Petkova, A. D. Tsouros, M. Costantini, & I. J. Higginson, Eds.) Copenhagen: World Health Organization.