PalliativeCareasaCoreComponentofGeriatricMedicin.ppt

Palliative Care as a Core Component of Geriatric Medicine American Geriatrics Society May 17, 2004 Las Vegas Diane E. Meier, MD Professor, Departments of Geriatrics and Medicine Mount Sinai School of Medicine Director, Center to Advance Palliative Care in Hospitals and Health Systems a Robert Wood Johnson Foundation - Mount Sinai School of Medicine initiative 051704 Palliative Care Interdisciplinary care that aims to relieve suffering and improve quality of life for patients with advanced illness and their families. It is offered simultaneously with all other appropriate medical treatment. The Cure - Care Model: The Old System Palliative Care and Geriatrics Median age of death in U.S. 78 and rising Chronic degenerative disease accounts for 77% of causes of death Evidence of preventable suffering across settings and diagnoses in elderly Evidence of improved clinical, functional, satisfaction, and utilization outcomes with expert symptom management/palliative care Palliative Care and Geriatric Medicine:The 5 Main Arguments Clinical care quality Patient and family preferences Demographics Education Finances Why palliative care? 1. Clinical imperative: The need for a better quality of care for persons with serious and complex illnesses Site of Death Hospitals: 53% Nursing homes: 24% Home: 23% Teno et al, Brown Site of Death Atlas of the U.S: /dying/usa_statistics.htm 1997 and National Mortality Followback Survey Everybody with serious illness spends at least some time in a hospital... 98% of Medicare decedents spent at least some time in a hospital in the year before death. 15-55% of decedents had at least one stay in an ICU in the 6 months before death. Dartmouth Atlas of Health Care 1999 The Nature of Suffering and the Goals of Medicine The relief of suffering and the cure of disease must be seen as twin obligations of a medical profession that is truly dedicated to the care of the sick. Physicians’ failure to understand the nature of suffering can