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COE Lecture: EOL Care in Frail Elderly
Transcript of COE Lecture: EOL Care in Frail Elderly
in Frail Older Adults Why is now the time? Frailty:
The Devil is in the Details Population Aging
The byproduct of advancing medical knowledge and technology = frailty
Unprecedented levels of poor functional outcomes
We are at the beginning of a new age in geriatric medicine: the age of frailty Humans are complex systems Clinically, complex systems fail with their highest order functions first The highest order functions
of humans are:
Use of tools (function)
Social graces Delirium Falls Functional
Decline Behavioral issues,
Incontinence Frailty can be measured Frailty predicts outcomes Failures of highest order functions
lead to the geriatric giants Comprehensive
Geriatric Assessment (CGA) How does this model differ from traditional Palliative Care Model?
Emphasis on provision of information as primary determinant of decision making
Aim to reduce "burden" of decision making
Provide recommendations when asked
Endpoint is the process, not the decision Volandes AE, Paasche-Orlow MK, Barry MJ, et al. Video decision support tool for advance care planning in dementia: randomised controlled trial. BMJ. 2009;338:b2159. for more information: pathclinic.ca In summary... During this session, we will review Knowledge synthesis and Knowledge Translation
Partnering with DEANS
Synthesis of existing guidelines, limitations of evidence in frail older adults
Goal is to avoid overtreatment and undertreatment
Creation of guidelines for treatment of common diseases in LTC (mod-sev frail)
DM and HTN complete
Academic detailing for GPs Cases: Tales from the PATH Theme 1: Baseline QoL as a tool for decision making Theme 2: Bringing frailty into focus for crisis decision making Theme 3: Clarity of language Theme 4: Activating the care plan Paige Moorhouse MD MPH FRCPC The story of that person's health Your assessment is successful when:
1. You are able to describe that person to another health care provider in a way that they feel they have met them
2. You've taken the time to ensure your information is accurate: ie you've relied on the collateral historian
3. You've used the information to change the care plan. Use your staff person to help you! The communication part is hard, but it's not rocket science The PATH Clinic can help! Discussion Interested in Research?
Lots of opportunity for summer reserach students to make a mark! Take home messages:
Most of what we do is not curative
Sometimes the most effective intervention is communication
No amount of compassionate care makes up for missing a potentially remediable diagnosis
This is a skill-- it requires practice Thinking through the care plan
What issues are not easily curable?
What issues are potentially curable?
What would be the effect of investigation/treatment on cognition, function and mobility?
Based on this, what are the goals of care? Take a step back-- see the big picture to protect your patients