Palliative care in the ambulatory geriatric practice

Thomas E Finucane; Olivia Nirmalasari; Antonio Graham

doi:10.1016/j.cger.2015.01.008

Palliative care in the ambulatory geriatric practice

Clin Geriatr Med. 2015 May;31(2):193-206. doi: 10.1016/j.cger.2015.01.008. Epub 2015 Feb 20.

Authors

Thomas E Finucane¹, Olivia Nirmalasari², Antonio Graham²

Affiliations

¹ Division of Gerontology and Geriatric Medicine, Johns Hopkins University School of Medicine, Beacham Ambulatory Care Clinic, Johns Hopkins Bayview Medical Center, 5505 Hopkins Bayview Circle, John R. Burton Pavilion, Baltimore, MD 21224, USA. Electronic address: tfinucan@jhmi.edu.
² Division of Gerontology and Geriatric Medicine, Johns Hopkins University School of Medicine, Beacham Ambulatory Care Clinic, Johns Hopkins Bayview Medical Center, 5505 Hopkins Bayview Circle, John R. Burton Pavilion, Baltimore, MD 21224, USA.

PMID: 25920055
DOI: 10.1016/j.cger.2015.01.008

Abstract

Geriatrics and palliative care often overlap. This article focuses on 2 areas where the disciplines may differ in their approach. The first is planning for extreme illness and death, with explicit acknowledgment that limiting therapy might be a good idea. This situation is likely to have a different impact in the course of a routine geriatrics visit than in a palliative care context. The second is pain management, especially chronic pain. In patients with sharply limited life expectancy, the risk/benefit equation tilts easily toward narcotic use. In frail elders working to remain independent, the calculus may be quite different.

Keywords: Advance care planning; Elderly; Geriatrics; Pain management.

Publication types

Review

MeSH terms

Advance Care Planning
Aged
Chronic Pain* / psychology
Chronic Pain* / therapy
Frail Elderly / psychology*
Geriatric Assessment
Health Services for the Aged
Humans
Life Expectancy
Pain Management / methods*
Palliative Care* / methods
Palliative Care* / psychology
Quality of Life*