Anorexia and Cachexia

2019 ◽  
pp. 140-148
Author(s):  
Elizabeth E. Schack ◽  
Dorothy Wholihan
Keyword(s):  
Palliative Care ◽  
Health Professionals ◽  
Terminal Illness ◽  
Multidisciplinary Approach ◽  
Management Strategies ◽  
Clinical Syndrome ◽  
Care Providers ◽  
Knowledge Deficits ◽  
Cachexia Syndrome

Anorexia/cachexia syndrome (ACS) is being progressively recognized as a serious aspect of advanced or terminal illness. This chapter focuses on its management, which is complicated by numerous obstacles. These include a lack of clear definitions and guidelines, inconsistency in assessment and management strategies, and knowledge deficits regarding this complex clinical syndrome in health professionals and caregiving families. This chapter highlights this challenge, compounded by the interwoven emotional symbolism of food and nurturance. It focuses on the inherent role of palliative care providers as leaders striving to support, understand, and translate the developing evidence that guides our care. The complex and potentially devastating impact of this problem demands a holistic response. Palliative care nurses are optimally situated to coordinate and administer the necessary multidisciplinary approach to address anorexia and cachexia in advanced, progressive disease.

Anorexia and cachexia

2015 ◽  
pp. 167-174 ◽  
Author(s):  
Dorothy Wholihan
Keyword(s):  
Palliative Care ◽  
Health Professionals ◽  
Terminal Illness ◽  
Multidisciplinary Approach ◽  
Progressive Disease ◽  
Treatment Options ◽  
Management Strategies ◽  
Clinical Syndrome ◽  
Knowledge Deficits ◽  
Cachexia Syndrome

Anorexia/cachexia syndrome (ACS) is recognized as a serious aspect of advanced or terminal illness and as an area requiring further research with respect to its pathophysiology and treatment options. The management of ACS is complicated by numerous obstacles, including lack of clear definitions and guidelines, inconsistency in assessment and management strategies, and knowledge deficits about this complex clinical syndrome in health professionals and caregiving families. The challenge is compounded by the interwoven emotional symbolism of food and nurturance. Palliative care nurses are optimally situated to coordinate and drive the necessary multidisciplinary approach to address anorexia and cachexia in advanced, progressive disease.

The Role of PT, OT, and Other Therapies in Palliative Care for Seriously Ill Patients

2019 ◽  
pp. 682-689
Author(s):  
Dennis Lin ◽  
Megan Borjan ◽  
Seanell D. San Andres ◽  
Christina Kelly
Keyword(s):  
Palliative Care ◽  
Terminal Illness ◽  
Symptom Burden ◽  
Speech Language Pathology ◽  
Functional Impairments ◽  
Recreation Therapy ◽  
Rehabilitation Team ◽  
Language Pathology ◽  
Seriously Ill Patients

This chapter describes the roles of physical therapy, occupational therapy, speech language pathology, and recreation therapy in providing rehabilitation for patients receiving palliative care. Palliative rehabilitation should be included as part of a comprehensive interdisciplinary effort to support patients who experience functional impairments or symptoms that impact daily life and that result from terminal illness. Palliative rehabilitation focuses on creating collaborative goals that address disability and easing symptom burden to maximize or maintain function throughout every stage of disease. Patients receiving the appropriate rehabilitative interventions can adapt to the changes and foster an optimal quality of life. Nurses collaborate with the rehabilitation team so that patients and their caregivers can achieve a greater benefit from their palliative care.

scholarly journals Palliative Care and Advance Care Planning in Pulmonary Hypertension

2018 ◽  
Vol 17 (1) ◽  
pp. 15-19 ◽  
Author(s):  
Charles L. Rhee ◽  
Michael Cuttica
Keyword(s):  
Palliative Care ◽  
Pulmonary Hypertension ◽  
Advance Care Planning ◽  
End Of Life Care ◽  
Progressive Disease ◽  
Care Planning ◽  
Care Providers ◽  
Advance Care

Pulmonary hypertension (PH) is a progressive disease with high associated morbidity and mortality despite the development of novel therapies. Palliative care is a multidisciplinary field focused on optimization of quality of life and overall supportive care for patients and their families in the setting of life-limiting illness. Although the benefits of palliative care in oncology are well described, there are few studies regarding the timing and involvement of palliative care in PH patients. In this paper, we describe the importance of longitudinal advance care planning, including suggestions for addressing difficult topics such as end-of-life care, and the role of palliative care providers in helping guide these discussions throughout the course of the illness.

Best Practices, Enduring Challenges, and Opportunities for VSED

2021 ◽  
pp. 126-130
Author(s):  
Timothy E. Quill ◽  
Paul T. Menzel ◽  
Thaddeus M. Pope ◽  
Judith K. Schwarz
Keyword(s):  
Decision Making ◽  
Palliative Care ◽  
Best Practices ◽  
Advance Directives ◽  
Symptom Management ◽  
Early Phase ◽  
Terminal Illness ◽  
Care Providers ◽  
Decision Making Capacity ◽  
Challenges And Opportunities

VSED begins with excellent symptom management supported by experienced clinicians. VSED is largely patient controlled, but involvement of experienced palliative care providers and family is strongly recommended. Decision making capacity is frequently lost late in the process as death nears, so written advance directives to continue withholding food and fluids should be completed prior to initiating VSED to forestall any misunderstandings of the patient’s wishes. Challenges associated with VSED include its two week duration before death, the personal determination required, and the possibility of delirium in the latter stages that potentially compromises the commitment to forgo fluids. These challenges should be anticipated and planned for. The primary advantages of VSED include: 1) predictable two week duration from initiation to death; 2) alertness for the early phase, 3) no terminal illness requirement, 4) largely under the patient’s control, and 5) awareness of the possibility of VSED can provide comfort to those worried about unacceptable future suffering.

Dementia and frailty

2019 ◽  
pp. 579-618
Keyword(s):  
Palliative Care ◽  
Hospital Admissions ◽  
Advanced Disease ◽  
Psychological Symptoms ◽  
Management Strategies ◽  
People With Dementia ◽  
Diagnosis Of Dementia ◽  
The Uk ◽  
End Stage

This chapter outlines the symptoms, epidemiology, aetiology, and differential diagnosis of dementia, with emphasis on advanced disease. It discusses the role of dementia treatments, the challenges faced with advanced disease, and guides to recognition and treatment of common symptoms, including behavioural and psychological symptoms of dementia and pain. The chapter also discusses pharmacological and non-pharmacological approaches to management of dementia symptoms, highlighting the role of palliative care, when it is appropriate to refer, and terminal care. The chapter illustrates some of the controversial aspects of care. At the current rate there will be 850,000 people with dementia in the UK by 2015, and this number is forecast to increase to over 1 million by 2025 and over 2 million by 2051.This is contributing to one in four hospital admissions, with the health and social costs of dementia estimated to be more than stroke, heart disease, and cancer combined. Along with these worrying progressive epidemiological figures, we need to take into account the immense caring burden for families, carers, and society. End-stage dementia often falls between the cracks of specialization, with professionals feeling under-prepared for the intricacies of end-stage dementia management strategies. Palliative care has been slow in its involvement for multiple reasons, but primarily because dementia has a much slower disease trajectory than cancer, with an unclear prognosis.

The Role of Home Care in Palliative Care Services

2004 ◽  
Vol 5 (3) ◽  
pp. 151-157 ◽  
Author(s):  
Eileen Hanley
Keyword(s):  
Palliative Care ◽  
Staff Development ◽  
Home Care ◽  
End Of Life Care ◽  
Care Providers ◽  
Care Services ◽  
Palliative Care Services ◽  
Key Topics ◽  
Home Care Providers

This article addresses the increasing interest in end of life care and the need for improving access to palliative care services in patients/families served by the home care industry. The author discusses factors leading to this growing demand as well as some of the recent research conducted in the field of palliative care. The benefits of and underutilization of hospice services are discussed. The author addresses a variety of options for home care providers to consider expanding access to palliative care services including recent changes in regulation that allow for collaboration with Medicare certified hospice programs. A discussion of key topics to include in staff development initiatives related to palliative care is included as are education and clinical practice resources.

The Management of Terminal Illness: Opinions of the Medical and Nursing Staff in a Paris University Hospital

1997 ◽  
Vol 13 (1) ◽  
pp. 40-47 ◽  
Author(s):  
Gwenaëlle Vidal-Trécan ◽  
Jean Luc Fouilladieu ◽  
Geneviève Petitgas ◽  
Aliette Chassepoux ◽  
Geneviève Ladegaillerie ◽  
...  
Keyword(s):  
Palliative Care ◽  
Terminal Care ◽  
Terminal Illness ◽  
Planning Process ◽  
University Hospital ◽  
Department Heads ◽  
Care Providers ◽  
Hospital Data ◽  
Psychological Burden ◽  
Care Training

The views of French physicians and nurses of the organization of palliative care have not been previously analyzed. We surveyed opinion on the care of the terminally ill in a 1000-bed Paris university hospital. Data were obtained in 1992 by non-directed interviews of leading physicians and semi-directed interviews of nurses. Most physicians wished to manage terminal care in their departments. Patient and family preferences were considered in choosing the place for care. Treatment of hospitalized patients should be limited to relieving symptoms. Department heads and senior nurses agreed on most problems encountered in the management of care. The psychological burden borne by nurses was emphasized. Terminal care training and the possibility of consulting experts in palliative care were the main suggestions for improvement cited by both department heads and senior nurses. Integrating this knowledge into the planning process should result in improved care and in increased satisfaction for the care providers.

scholarly journals Psychiatry and Terminal Illness

2000 ◽  
Vol 45 (2) ◽  
pp. 143-150 ◽  
Author(s):  
Harvey Max Chochinov
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Health Care Providers ◽  
End Of Life Care ◽  
Terminal Illness ◽  
Empirical Studies ◽  
Life Care ◽  
Care Providers ◽  
Psychological Issues ◽  
Dying Patients

Objective: To provide an overview of the palliative care literature salient to the psychiatric aspect of end-of-life care. Method: A literature review was conducted, targeting primarily empirical studies that addressed the following topics: 1) psychological issues pertaining to life-threatening conditions; 2) family issues in the context of palliative care; 3) psychological issues and challenges faced by end-of-life health care providers; and 4) psychiatric disorders, including depression, anxiety, and organic mental disorders, in people with terminal illness. Results: There is a small but emerging literature that can guide psychiatrists in their role of providing care to dying patients. Conclusions: While psychiatry has made tremendous inroads toward providing care to patients throughout the life cycle, its presence is only just beginning to be felt in end-of-life care. Within the domain of palliative care, psychiatry has an expanded and important role to play.

scholarly journals Insights from the Northern Territory on factors that facilitate effective palliative care for Aboriginal peoples

2009 ◽  
Vol 33 (4) ◽  
pp. 636 ◽  
Author(s):  
Emma L Phillips ◽  
Pam D McGrath
Keyword(s):  
Palliative Care ◽  
Health Care Providers ◽  
Health Professionals ◽  
Traditional Healers ◽  
Cultural Safety ◽  
Aboriginal Peoples ◽  
Care Providers ◽  
Remote Communities ◽  
Care Services ◽  
Palliative Care Services

This article aims to assist remote communities to develop their own palliative care services by providing findings on successful strategies identified through a 2-year research project which developed an innovative model for Indigenous palliative care. The discussion is set in the context of an understanding of the notion of cultural safety and discusses the positive experiences of the benefits of palliative care from the perspectives of both consumers and health professionals. The findings show that successful outcomes are derived from generic factors associated with palliative care philosophy and practice and from more specific factors, including the provision of pragmatic support to overcome practical problems, and community visits by health professionals. Factors specific to cultural respect are important, including familiarity and continuity of health care providers, cultural respect for grieving practices, provision of comfort food and bush tucker, development of culturally appropriate built environments, use of traditional healers and respect for spiritual practices.

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