Complementary and Integrative Medicine for Older Adults in Palliative Care

A large portion of adults in the United States use some form of complementary and integrative medicine, but while these therapies are offered in many hospice and palliative care programs, few patients end up accessing the therapies. Studies show that patients who receive these services are more satisfied with their care. Additionally, surveys show that nurses are often the critical factor is assessing a patient’s appropriateness for integrative care and making the referrals. This chapter reviews therapies and supplements that can be used for specific conditions, and it ends with a list of resources to help put ideas into practice.

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Traditional, Complementary and Integrative Medicine as Self-Care in Chronic Illness: A Focus Upon Stroke and Older Adults

Public Health and Health Services Research in Traditional, Complementary and Integrative Health Care ◽

10.1142/9781786346797_0010 ◽

2019 ◽

pp. 163-178

Author(s):

Jon Adams ◽

Wenbo Peng ◽

Jason Prior ◽

Roger Dunston ◽

Erica McIntyre ◽

...

Keyword(s):

Older Adults ◽

Chronic Illness ◽

Integrative Medicine ◽

Self Care ◽

Complementary And Integrative Medicine

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Characteristics of Provider-Focused Research on Complementary and Integrative Medicine in Palliative Care: A Scoping Review

American Journal of Hospice and Palliative Medicine® ◽

10.1177/10499091211011708 ◽

2021 ◽

pp. 104990912110117

Author(s):

Anurag Ratan Goel ◽

Hana Elhassan ◽

Melissa Patterson ◽

M. Carrington Reid

Keyword(s):

Palliative Care ◽

Integrative Medicine ◽

Scoping Review ◽

Care Setting ◽

Symptom Relief ◽

Palliative Care Setting ◽

The Us ◽

Complementary And Integrative Medicine ◽

Study Population ◽

Population Concept

Background: The use of complementary and integrative medicine (CIM) continues to grow in palliative care. While research supports the use of many CIM therapies for symptom relief, the scope of provider-focused research on CIM remains poorly characterized. Objectives: We conducted a scoping review to characterize provider-focused research on CIM in palliative care in order to map existing evidence and identify knowledge gaps. Methods: We developed a protocol outlining the study population, concept, and context; then used a validated approach per the JBI manual and searched MEDLINE, EMBASE, CINAHL, and AMED. Results: We identified 34 studies that were conducted primarily in the US (n = 9) and UK (n = 6), focused mostly on nurse (n = 29) and physician (n = 22) providers, and employed questionnaires (n = 16) or qualitative (n = 15) methods. Studies investigated 58 CIM modalities, including massage (n = 13), music therapy (n = 12), and aromatherapy (n = 10), to address common symptoms including pain (n = 17), fatigue (n = 6), and nausea/vomiting (n = 6). Study outcomes included perceived benefits of CIM (n = 17) and types of CIM modalities that providers offer (n = 15). Uncommonly studied phenomena included referral patterns (n = 4), facilitators of provider recommendation of CIM (n = 3), and rates of CIM use (n = 3). Conclusion: Provider-focused research on CIM in palliative care can expand its scope by addressing perspectives of interdisciplinary providers, examining CIM modalities that patients report using, addressing symptoms commonly encountered in palliative care, and researching provider-use-focused outcomes. We identify these possibilities for future studies in addition to opportunities for systematic investigations to enhance the safe and efficacious delivery of CIM in the palliative care setting.

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Gynecologists´ attitude towards their use of complementary and integrative medicine approaches: results of a nationwide AGO IMed survey

10.1055/s-0040-1718073 ◽

2020 ◽

Author(s):

D. Grimm ◽

D. Paepke ◽

P. Voiss ◽

H. Cramer ◽

S. Kuemmel ◽

...

Keyword(s):

Integrative Medicine ◽

Complementary And Integrative Medicine

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Emergency Medicine Palliative Care Access (EMPallA): protocol for a multicentre randomised controlled trial comparing the effectiveness of specialty outpatient versus nurse-led telephonic palliative care of older adults with advanced illness

BMJ Open ◽

10.1136/bmjopen-2018-025692 ◽

2019 ◽

Vol 9 (1) ◽

pp. e025692 ◽

Cited By ~ 3

Author(s):

Corita R Grudzen ◽

Deborah J Shim ◽

Abigail M Schmucker ◽

Jeanne Cho ◽

Keith S Goldfeld

Keyword(s):

Quality Of Life ◽

Older Adults ◽

Palliative Care ◽

Randomised Controlled Trial ◽

Case Management ◽

Controlled Trial ◽

Chronic Obstructive ◽

Randomised Controlled ◽

End Stage

IntroductionEmergency department (ED)-initiated palliative care has been shown to improve patient-centred outcomes in older adults with serious, life-limiting illnesses. However, the optimal modality for providing such interventions is unknown. This study aims to compare nurse-led telephonic case management to specialty outpatient palliative care for older adults with serious, life-limiting illness on: (1) quality of life in patients; (2) healthcare utilisation; (3) loneliness and symptom burden and (4) caregiver strain, caregiver quality of life and bereavement.Methods and analysisThis is a protocol for a pragmatic, multicentre, parallel, two-arm randomised controlled trial in ED patients comparing two established models of palliative care: nurse-led telephonic case management and specialty, outpatient palliative care. We will enrol 1350 patients aged 50+ years and 675 of their caregivers across nine EDs. Eligible patients: (1) have advanced cancer (metastatic solid tumour) or end-stage organ failure (New York Heart Association class III or IV heart failure, end-stage renal disease with glomerular filtration rate <15 mL/min/m2, or global initiative for chronic obstructive lung disease stage III, IV or oxygen-dependent chronic obstructive pulmonary disease); (2) speak English; (3) are scheduled for ED discharge or observation status; (4) reside locally; (5) have a working telephone and (6) are insured. Patients will be excluded if they: (1) have dementia; (2) have received hospice care or two or more palliative care visits in the last 6 months or (3) reside in a long-term care facility. We will use patient-level block randomisation, stratified by ED site and disease. Effectiveness will be compared by measuring the impact of each intervention on the specified outcomes. The primary outcome will measure change in patient quality of life.Ethics and disseminationInstitutional Review Board approval was obtained at all study sites. Trial results will be submitted for publication in a peer-reviewed journal.Trial registration numberNCT03325985; Pre-results.

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Educational intervention to improve palliative care knowledge among informal caregivers of cognitively impaired older adults

Palliative & Supportive Care ◽

10.1017/s1478951520001200 ◽

2020 ◽

pp. 1-9

Author(s):

Hyunjin Noh ◽

Lewis H. Lee ◽

Chorong Won

Keyword(s):

Older Adults ◽

Palliative Care ◽

Cognitive Impairment ◽

Educational Intervention ◽

Test Scores ◽

Informal Caregivers ◽

Cognitively Impaired ◽

Significant Difference ◽

Post Test ◽

Seriously Ill

Abstract Objective Lack of palliative care knowledge among caregivers may pose an access barrier for cognitively impaired older adults, who may benefit from the specialized care. Therefore, this study aims to examine the effectiveness of an educational intervention in improving palliative care knowledge among informal caregivers of cognitively impaired older adults. Method Using a one-group, pre- and post-test intervention design, this study implemented an individual, face-to-face educational intervention with an informational brochure for 43 informal caregivers of chronically or seriously ill older adults (50+) with cognitive impairment, recruited from communities in West Alabama. Their level of knowledge about palliative care was assessed by the Palliative Care Knowledge Scale (PaCKS). The pre- and post-test scores were compared by the Wilcoxon signed-ranks test, and the racial subgroup (Whites vs. Blacks) comparison was made by the Mann–Whitney U test. Results There was a statistically significant difference between the pre- and post-test scores (z = 5.38, p < 0.001), indicating a statistically significant effect of the educational intervention in improving palliative care knowledge among participants. There was a significant difference (U = 143, p < 0.05) between Whites and Blacks in the pre-test, which, however, disappeared in the post-test (U = 173.50, p > 0.05), suggesting that the amount of increased PaCKS scores were significantly greater for Blacks (Mdn = 9.50) than for Whites (Mdn = 4.00, U = 130.50, p < 0.05). Significance of results This study demonstrated that a one-time educational intervention can improve the level of palliative care knowledge among informal caregivers of chronically or seriously ill older adults with cognitive impairment, particularly among Black caregivers. Therefore, further educational efforts can be made to promote palliative care knowledge and reduce racial disparities in palliative care knowledge and its use.

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