Geriatric Palliative Care
Original Editor - Lucinda Hampton
Top Contributors - Lucinda hampton, Joey Pease, Kapil Narale and Janine van Dyk
Introduction
Geriatric palliative care (GPC) integrates the specialties of geriatrics and palliative care to provide comprehensive care for older patients in the later stages of life and their families. It combines the focus on diagnosing and treating age-specific diseases from geriatrics with the approach of improving quality of life and relieving suffering from palliative care.
The field of GPC is growing due to the global aging population and the extended later stages of life. These final life stages often involve complex medical decisions, challenges in symptom management, psychosocial concerns, and emotional distress.
In GPC, complex medicolegal and ethical issues frequently arise, particularly due to cognitive decline in older patients. This can lead to challenges with capacity assessment, advanced care planning, and end-of-life decisions, often requiring proxy decision-makers.
The boundaries between geriatrics and palliative care can be unclear, as both fields address chronic conditions and aim to enhance quality of life for older adults. Improved communication between these disciplines is necessary for comprehensive care.
Research has shown that early integration of palliative care improves quality of life, reduces hospitalizations, and leads to better overall outcomes for older patients. GPC is appropriate for any geriatric patient with a serious illness, regardless of prognosis. Home-based geriatric palliative care is becoming increasingly important, allowing elderly patients to receive support in their preferred environment.[1] [2] [3] .[4]
Physiotherapists often have a role in geriatric palliative care focusing on areas such as pain management, strength preservation, energy conservation and simplification of activities of daily living (ADLs). Physiotherapists support palliative rehabilitation efforts, helping patients and caregivers adapt daily activities to physical decline, promoting independence and comfort.[3]
See Physiotherapy in Palliative Care.
Differing Needs
Geriatric patients have distinct needs that distinguish their care from younger individuals. Evidence suggests that their palliative care needs differ in symptom patterns and intensity with older adults often experiencing more recurring neuropsychiatric challenges such as delirium and cognitive decline, complicating treatment an decision making. [5]Geriatric patients also face greater social isolation and caregiver stress, often requiring additional psychosocial support. Complex medicolegal and ethical issues often arise in geriatric care, due to the higher prevalence of cognitive decline, such as capacity assessment, advanced care planning and end-of- life decisions leading to a reliance on proxy decision-makers. This can create conflicts between the patient's autonomy and family and carer expectations. [3]
The boundaries between geriatrics and palliative care are unclear and often overlap as both address chronic conditions and aim to enhance quality of life. Better communication between the two disciplines in regard to what each discipline can offer the other is needed for comprehensive care, as they provide valuable strategies for managing the physical, emotional and social needs of older patients. [6]
Palliative care is fitting for any geriatric patient with a serious illness, regardless of prognosis.[7]Early integration improves quality of life, reduces incidence of hospitalisations, and leads to better overall outcomes.[5]
Home Based Geriatric Palliative Care
Many homebound individuals are geriatrics with multiple chronic conditions eg cognitive impairment, neurodegenerative disorders, cardiovascular disorders, or patients living with frailty. These individuals may be homebound and additionally chair- or bed-bound, and their prognosis may be quite limited. Home-based Palliative Care has an increasing amount of literature that supports the benefits of this form of palliative care. It appears beneficial to patients, families, and informal caregivers by lessening symptoms, minimising unwanted hospitalisations, and offering support at the end of life.[4]
Home based palliative care has been shown to increase patient satisfaction by allowing care to align with personal preferences, such as the desire to stay home, and improving overall quality of life and for elderly patients this is particularly valuable in promoting aging in place. [4]
Challenges and Limitations in Geriatric Palliative Care
Identifying geriatric patients who could benefit from palliative care, including physiotherapy, is often complex. Many older adults with multiple comorbidities may not be recognised early enough as needing palliative interventions, delaying their access to supportive care. Early identification is crucial for optimising quality of life .[9]
Older age can present as a barrier to accessing specialised palliative care . Evidence suggest disparities in care for older adults, highlighting inequalities in palliative care access, although the reasons remain unclear. Some healthcare professionals may assume that older individuals need less palliative care due to the perception that death is more expected at an advanced age and that older people cope better with terminal diagnoses. These beliefs could influence referral practices for geriatric palliative care.[10]
References
- ↑ Leung DY, Chan HY. Palliative and end-of-life care: More work is required. International journal of environmental research and public health. 2020 Oct;17(20):7429. BibTeXEndNoteRefManRefWorks Available:https://pmc.ncbi.nlm.nih.gov/articles/PMC7599788/#sec1-ijerph-17-07429 (accessed 27.3.2025)
- ↑ Chai E, Meier D, Morris J, Goldhirsch S. Geriatric palliative care: a practical guide for clinicians. (No Title). 2014.
- ↑ 3.0 3.1 3.2 Voumard R, Rubli Truchard E, Benaroyo L, Borasio GD, Büla C, Jox RJ. Geriatric palliative care: a view of its concept, challenges and strategies. BMC geriatrics. 2018 Dec;18:1-6.
- ↑ 4.0 4.1 4.2 Roberts B, Robertson M, Ojukwu EI, Wu DS. Home based palliative care: Known benefits and future directions. Current Geriatrics Reports. 2021 Dec:1-7.Available:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8614075/ (accessed 2.11.2023)
- ↑ 5.0 5.1 Goldhirsch S, Chai E, Meier DE, Morris J. Geriatric palliative care : a practical guide for clinicians. New York: Oxford University Press; 2014.Available:https://books.google.com.au/books?hl=en&lr=&id=8LkoAwAAQBAJ&oi=fnd&pg=PP1&ots=-GCakpu4E5&sig=Os1dHsFLLybUGTgoANzbb26og6M&redir_esc=y#v=onepage&q&f=false (accessed 2.1.2023)
- ↑ Visser R, Borgstrom E, Holti R. The overlap between geriatric medicine and palliative care: A scoping literature review. Journal of Applied Gerontology. 2021 Apr;40(4):355-64. Available: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7961659/Accessed 2.11.2023
- ↑ Santivasi WL, Partain DK, Whitford KJ. The role of geriatric palliative care in hospitalized older adults. Hospital Practice. 2020 Mar 31;48(sup1):37-47.Available: https://www.tandfonline.com/doi/full/10.1080/21548331.2019.1703707 (accessed 2.11.2023)
- ↑ CAPC Palliative. Home-Based Palliative Care: Getting Started. Available from https://www.youtube.com/watch?v=_V5l52rfLic
- ↑ Kochems K, de Graaf E, Hesselmann GM, Ausems MJ, Teunissen SC. Healthcare professionals’ perceived barriers in providing palliative care in primary care and nursing homes: a survey study. Palliative Care and Social Practice. 2023 Dec;17:26323524231216994.
- ↑ Gardiner C, Cobb M, Gott M, Ingleton C. Barriers to providing palliative care for older people in acute hospitals. Age and ageing. 2011 Mar 1;40(2):233-8.