Geriatric Palliative Care

625 Pages·2014·8.96 MB·English

by  Suzanne Goldhirsch et al.

Geriatric Palliative c are

Geriatric
Palliative c are
A Practical Guide for Clinicians
EditEd by:
Emily ChAi, md
Associate Professor, Geriatrics and Palliative Medicine
Icahn School of Medicine at Mount Sinai
New York, New York
diAnE mEiEr, md , FACP
Professor, Geriatrics and Palliative Medicine
Icahn School of Medicine at Mount Sinai
New York, New York
JAnE morris, ms , rn , AChPn
Clinical Coordinator, Palliative Care
New York Hospital
Queens, New York
suzAnnE GoldhirsCh, mA, ms Ed
Program Coordinator, Geriatrics and Palliative Medicine
Icahn School of Medicine at Mount Sinai
New York, New York
1
1

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Library of Congress Cataloging-in-Publication Data
Geriatric palliative care : a practical guide for clinicians / edited by Emily Chai . . . [et al.].
p. ; cm.
Includes bibliographical references and index.
ISBN 978–0–19–538931–9 (alk. paper) — ISBN 978–0–19–987489–7 (alk. paper)
I. Chai, Emily.
[DNLM: 1. Palliative Care. 2. Aged. 3. Hospice Care. 4. Patient Care Team. WB 310]
616.02′9—dc23
2012046220
This material is not intended to be, and should not be considered, a substitute for medical or other professional advice.
Treatment for the conditions described in this material is highly dependent on the individual circumstances. And, while
this material is designed to offer accurate information with respect to the subject matter covered and to be current as of the
time it was written, research and knowledge about medical and health issues are constantly evolving and dose schedules
for medications are being revised continually, with new side effects recognized and accounted for regularly. Readers must
therefore always check the product information and clinical procedures with the most up-to-date published product
information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulation.
The publisher and the authors make no representations or warranties to readers, express or implied, as to the accuracy
or completeness of this material. Without limiting the foregoing, the publisher and the authors make no representations
or warranties as to the accuracy or efficacy of the drug dosages mentioned in the material. The authors and the publisher
do not accept, and expressly disclaim, any responsibility for any liability, loss, or risk that may be claimed or incurred as a
consequence of the use and/or application of any of the contents of this material.
9 8 7 6 5 4 3 2 1
Printed in the United States of America
on acid-free paper
This book is dedicated to the late Dr. Robert Butler, pioneer in the field
of Geriatrics, founding Chair of our Department, and early advocate of
palliative care.
Emily Chai
Diane Meier
Jane Morris
Suzanne Goldhirsch

contentS
Preface xi 19. Last Hours of Living 101
Contributors xiii 20. Grief and Bereavement 107
21. Spirituality 112
Section i: overview 22. Palliative Sedation 116
1. Introduction to Geriatric Palliative Care 3 23. Responding to Requests for
2. Principles of Geriatric Palliative Care 10 Hastened Death 122
3. Medication Management in 24. Assistive Aids and Devices 126
Older Adults 16 25. Rehabilitation 131
4. Special Issues in Caregiving 21 26. Mechanical Ventilation 136
5. Financing Hospice and Palliative Care 26 27. Artificial Nutrition and Hydration 143
6. Ethical Decision-Making 30
7. Prognostication 35 Section iii: Caregivers
8. Advance Care Planning 40
28. Caregivers 149
9. Communication Skills 46
10. Managing Conflict 53
Section iv: symptoms
11. Care Transitions 58
29. Management of Pain in Older Adults 159
12. The Hospice Model of Palliative Care 63
30. Fatigue 170
13. Health Insurance 67
31. Failure to Thrive 175
32. Fever and Sweating 179
Section ii: special issues in Geriatric
Palliative Care 33. Behavioral Disorders in Dementia 182
14. Palliative Care Emergencies 75 34. Delirium 190
15. Dying at Home 80 35. Terminal Delirium 196
16. Cultural Considerations 85 36. Sleep Disorders 200
17. Complementary and Alternative 37. Dizziness 204
Medicine 90 38. Headache 209
18. Clinician Self-Care 95 39. Myoclonus 213
viii Contents
40. Cough and Secretions 218 74. Aspiration Pneumonia 387
41. Dyspnea 224 75. Colonic Diverticulitis 393
42. Anorexia/Cachexia 230 76. Mesenteric Ischemia 398
43. Ascites 232 77. End-Stage Liver Disease 405
44. Bowel Obstruction 236 78. Feeding Tube Management 411
45. Constipation 239 79. End-Stage Renal Disease 416
46. Diarrhea and Fecal Incontinence 244 80. Recurrent Urinary Tract Infections
(RUTI) 423
47. Xerostomia and Oral Mucositis 248
81. Diabetic Management in
48. Dyspepsia 253
Advanced Illness 428
49. Dysphagia 256
82. End-Stage Heart Failure 434
50. Hepatic Encephalopathy 259
83. Arrhythmias 442
51. Gastroparesis 263
84. Valvular Heart Disease 448
52. Hiccups 267
85. Peripheral Arterial Disease 453
53. Nausea and Vomiting 271
86. Hip Fracture Management 458
54. Urinary Retention 275
87. Osteoarthritis 461
55. Urinary Incontinence 280
88. Lumbar Spinal Stenosis 467
56. Bleeding 288
89. Osteoporotic Fracture 471
57. Thrombosis 291
90. Polymyalgia Rheumatica 477
58. Lymphedema 296
91. Rheumatoid Arthritis in Older Adults 480
59. Pressure Ulcers 301
92. Osteomyelitis in Older Adults 484
60. Pruritus 307
93. Herpes Zoster in Older Adults 489
61. Malodorous Wounds 311
94. HIV/AIDS 493
95. Skin Cancer 499
Section v: diseases and syndromes
96. Colorectal Cancer 509
62. Frailty 317
97. Head and Neck Cancer 515
63. Falls 321
98. Breast Cancer 521
64. Depression 325
99. Prostate Cancer 533
65. Anxiety 333
100. Lung Cancer 538
66. Alcohol Abuse and Dependence 338
101. Leukemia 546
67. Dementia 344
102. Non-Hodgkin’s Lymphoma 554
68. Seizure 352
103. Intracranial Malignancies 559
69. Stroke 357
70. Parkinson’s Disease 362
Section vi: the interdisciplinary team
71. Essential Tremor 370
104. Clinical/Counseling Psychologist 567
72. Malignant Spinal Cord Compression 373
105. Complementary and Alternative
73. Chronic Obstructive Pulmonary Disease 376 Practitioners 569
Contents ix
106. Registered Dietitian 570 112. Physician 586
107. Licensed Massage Therapist 572 113. Social Work 589
108. Music Therapist 574 114. Speech-Language Pathologist 591
109. Nursing 576 115. Chaplain 593
110. Rehabilitation Therapist 581
111. Pharmacist 584 Index 595