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Introduction to palliative medicine and care of the elderly Introduction to palliative medicine and care of the elderly
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Epidemiology of ageing Epidemiology of ageing
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Assessing the needs of older people Assessing the needs of older people
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A palliative approach A palliative approach
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Rethinking goal setting in the context of chronic illness in older adults: maximizing well-being and partnering with others Rethinking goal setting in the context of chronic illness in older adults: maximizing well-being and partnering with others
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Palliative care needs assessment Palliative care needs assessment
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Establishing care partnerships Establishing care partnerships
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Advance care planning Advance care planning
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Managing older peoples’ care transitions Managing older peoples’ care transitions
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Palliative care in the home setting Palliative care in the home setting
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Living alone Living alone
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Palliative care in hospitals Palliative care in hospitals
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Emergency departments Emergency departments
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Palliative care in nursing homes Palliative care in nursing homes
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Supporting caregivers Supporting caregivers
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Elements of a palliative approach model of care for community dwelling older people Elements of a palliative approach model of care for community dwelling older people
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Palliative care for specific diagnoses and geriatric syndromes Palliative care for specific diagnoses and geriatric syndromes
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Dementia Dementia
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Delirium Delirium
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Pain Pain
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Constipation Constipation
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Falls Falls
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Frailty Frailty
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Depression Depression
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Managing multimorbidity Managing multimorbidity
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Physiological changes with ageing Physiological changes with ageing
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Hearing and vision changes Hearing and vision changes
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Dry mouth, dysphagia, and tooth loss Dry mouth, dysphagia, and tooth loss
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Dermatological changes associated with ageing, pressure ulcers, and wound healing Dermatological changes associated with ageing, pressure ulcers, and wound healing
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Pharmacokinetics and pharmacodynamics and impacts on prescribing Pharmacokinetics and pharmacodynamics and impacts on prescribing
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Conclusion Conclusion
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References References
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Online references Online references
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16.3 Palliative medicine and care of the elderly
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Published:March 2015
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Abstract
Palliative care in the older person occurs in the context of chronic disease and multimorbidity. Coexisting conditions include musculoskeletal, psychiatric, cognitive, and chronic pain-related problems, each associated with substantive symptomatology and disability. Most crucial is to avoid management within disease ‘silos’ and the risks associated with polypharmacy, which both contribute to adverse outcomes. The complexity of older people’s care demands the formation of a collaborative partnership between primary care, geriatric, and palliative care services, together with other health-care providers in accordance with need. The caregiver of the older person warrants specific mention, often an older spouse with their own medical problems or an adult child juggling other life and work commitments. Planning for care in advance is crucial to avoid decisions being made in crisis, and is particularly crucial if cognitive decline is predicted. Physiological changes, and the frequency of falls, frailty, depression, and delirium are important when planning care and prescribing.
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