Symptom burden at the end of life in older people

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Symptom burden at the end of life in older people

• Lynne Partington
• Senior Lecturer/Researcher
• Cheshire Hospices Education
• St Lukes Hospice

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• The challenges in assessing and managing symptoms
  in older people
• Common symptoms at the end of life
• Effective management of symptoms

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What are the challenges in practice re assessing
and managing symptom burden at the end of life in
older people?
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What are the challenges in practice re assessing
and managing symptom burden at the end of life in
older people?

• Older people more commonly affected by multiple
  medical problems which may be much greater than
  any individual disease
• Older people are at greater risk of adverse drug
  reactions
• Problems of acute illness may be superimposed on
  physical or mental impairment, economic hardship
  and social isolation
• Lack of knowledge of aspects of palliative care
  as related to older people
• Lack of standardized assessment tools for older
  people
• How does knowledge translate into practice across
  different care settings?
• (Better Palliative Care for Older People, 2004)
• Is guidance always helpful? (British Geriatrics
  Society, 2009)
• Prognostication

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Prognostication - identifying the end
The three trajectories of illness. (Lynn
Adamson, 2003)
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Prevalence of symptoms at the end of life?
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What do you think are the common symptoms and
their prevalence?
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Symptoms at the end of life mixed messages?

• Symptoms at end of life in care homes
• Prevalence of burdensome symptoms at 48 hours
  before death was 51.3 (Brandt, 2006)
• In last month of life, 47 had pain, 48 had
  dyspnoea (Hanson et al, 2008)
• At time of death, 86 had pain, 75 had dyspnoea
  (Reynolds et al, 2002)
• In last 72 hours, 66.7 had analgesics
  administered, 33.3 had anxiety reported
  (Goodridge et al, 2005)

M Connelly, 2006
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A prospective descriptive study to examine the
incidence of end of life symptoms in care home
residents (first 50 data sets)
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A prospective descriptive study to examine the
incidence of end of life symptoms in care home
residents (x50)
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A prospective descriptive study to examine the
incidence of end of life symptoms in care home
residents (x50)
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Effective management of symptoms
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Effective management of symptoms

• Use of appropriate assessment tools
• The Modified Edmonton Symptom Assessment Scale
  (ESAS)
• Doloplus 2
• Improved LCP guidelines version 12 (currently
  under consultation)
• Appropriate management of symptoms
• What do older people want (collectively and
  individually)?

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Effective management of symptoms
The real challenge is putting the knowledge into
practice...!

• Use of appropriate assessment tools
• The Modified Edmonton Symptom Assessment Scale
  (ESAS)
• Doloplus 2
• Improved LCP guidelines version 12 (currently
  under consultation)
• Appropriate management of symptoms
• What do older people want (collectively and
  individually)?

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Modified Edmonton Symptom Assessment Scale (ESAS)
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Definition of terms used
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Doloplus 2 (Lefebvre-Chapiro, 2001)
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Liverpool Care Pathway Draft version 12
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