Dare to Understand and Ask for Palliative Care

Friday, November 19th, 2010 by American Senior Fitness Association   View This Issue of Experience!

Today we are pleased to present the following article by Terry F. Katz, MD. Dr. Katz is medical director of The Center for Healthy Living in Teaneck, New Jersey. An internist specializing in the care of the elderly, Dr. Katz is associated with PMR, the Physical Medicine and Rehabilitation Center, PA, of Englewood, New Jersey. PMR is devoted to the diagnosis and treatment of medical problems related to pain and disability, and its multidisciplinary treatment teams provide comprehensive care for sports, spine, orthopedic, and neuromuscular conditions. For more information, click on www.Rehabmed.net.

The primary purpose of palliative care is to alleviate suffering and enhance the quality of life. The concept of medical palliation in its inception conjured up images of dying patients with a similar set of physical symptoms that required relief. As older people began living longer with incurable chronic disease, the concept of palliative care took on a broader meaning. Palliative care now includes providing care that addresses the physical, emotional, cultural, and spiritual issues that affect a patient and their family during the final phase of life. This stage may last days to weeks when associated with an acute event, or may last months to years as in chronic illness with progressive debility.

Providing quality palliative care requires a multifaceted approach that achieves best results when a team of nurses, social workers, physical therapists, religious counselors, and other therapists supply care under the supervision of a physician team leader. The expertise and involvement by all these individuals is important to identify and address the "whole person." Members of the palliative care team conduct their own evaluations over a period of time talking to the patient, family, and care providers to obtain the complete picture. The evaluation will elucidate team members as to social needs such as financial concerns, need for closeness, care-giving needs, and access to care; spiritual needs such as the degree of distress, role of spirituality, and the extent to which one has settled relationships; medical needs such as the role of further diagnostic evaluation and treatment of physical and mental symptoms; and finally therapeutic issues that illuminate the goals of care.

The evaluation is a constant process. Goals of care and treatment priorities shift with increasing disease burden, but treating physical symptoms is always paramount. Symptom management includes nondrug interventions such as physical therapy modalities and acupuncture, and pharmacological management with both traditional and alternative choices. Typically treatment is a combination that minimizes potential adverse reactions. After therapy is initiated, regular patient follow-up is important to assess relief of symptoms, effect of treatment on abilities to maintain usual activities, and measure whether the identified goals are being met.

The concept of a "good death" is central to the modern palliative care movement, but watching the diminishing physical capabilities and the death of someone close is never easy. The truth is: no one can escape the experience. We all feel the fragility of life and worry about our own future end-of-life experience. Embracing palliative care allows better management of symptoms and prevents unnecessary suffering for the patient, bolsters the family and care-givers with skills to adapt to the transitions and face the losses, and, in creating a more positive outlook on end-of-life care, can help so many groups of people.

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