Depression in the Hospitalized Older Patient住院老年患者抑郁.pptVIP

CHAMPHow to Approach Palliative Carein the Older Patient Déon Cox Hayley, DO University of Chicago Objectives of session 1. To understand and be able to apply the concept of gradual implementation of palliative care. 2. Teach others Continuum of Care Model Gradual implementation of end of life care Curative measures: go all out toward prolonging life Hospice and palliative care: go all out toward symptom relief Challenge? to sensitively negotiate between those extremes with patients families Outline Who? What? Where? When? Prognostication How? Who? For patients who have serious or life-threatening disease(s). Many appropriate conditions Not just cancer Don’t even have to have a traditional “diagnosis” What is palliative care? Care with focus on quality of life. Symptom management Decision-making Decisions in palliative care Will it help the patient? In their remaining life? Within their goals of care? If it will help, what are the burdens? Pain or other symptoms Physical limitations Risk of adverse events Cost Is it worth it? Where? Hospital Home Outpatient Nursing home When? Prognostication Would you be surprised if this person died within the next year? Other prognostic markers Age Co-morbidities Function Many elderly are near the end of their lives as indicated by the following markers: Limited life expectancy Decreased reserve Co-morbidities and geriatrics syndromes Functional impairments Functional Impairment Percent of Persons Reporting Problems with Two or More Activities of Daily Living (ADLs), By Age 1994-1995 Percent* Total 65+ 6.0 Age Group (yrs) 65-74 3.1 75-84 7.8 85+