Zeitschrift für Palliativmedizin 2014; 15(06): 266-275
DOI: 10.1055/s-0034-1387411
CME-Fortbildung
© Georg Thieme Verlag KG Stuttgart · New York

Palliativmedizin in der Geriatrie

Geriatric Palliative Medicine
H. Frohnhofen
1   Kliniken Essen Mitte, Knappschaftskrankenhaus, Akademisches Lehrkrankenhaus der Universität Essen-Duisburg, Essen
2   Department Humanmedizin, Fakultät für Gesundheit, Universität Witten-Herdecke, Witten
,
T. Pianta
3   Klinik für Geriatrie, St. Marien-Hospital, Akademisches Lehrkrankenhaus der Universität zu Köln
,
G. Röhrig
3   Klinik für Geriatrie, St. Marien-Hospital, Akademisches Lehrkrankenhaus der Universität zu Köln
4   Klinikum der Universität zu Köln
,
R. J. Schulz
3   Klinik für Geriatrie, St. Marien-Hospital, Akademisches Lehrkrankenhaus der Universität zu Köln
› Author Affiliations
Further Information

Publication History

Publication Date:
27 November 2014 (online)

Zusammenfassung

Die Geriatrie konzentriert sich auf die Ressourcennutzung älterer Patienten zur Wiederherstellung der Alltagstauglichkeit und Selbstständigkeit sowie auf die Symptombehandlung, während die Palliativmedizin sich auf die Symptomlinderung, den Erhalt und die Steigerung der Lebensqualität am Lebensende erkrankter Patienten jeden Alters fokussiert.

Die palliative Geriatrie stellt sich nun der Herausforderung, in der Therapie die Ressourcen der älteren Patienten zu nutzen und andererseits eine frühe Integration der palliativen Versorgung zu gewährleisten, um die persönlichen Ziele und Bedürfnisse des Einzelnen wahrzunehmen und bis zum Lebensende zu verfolgen. Dies gelingt nur im Prozess, im stetigen Austausch und Diskurs mit dem Patienten, den Angehörigen und dem gesamten Behandlungsteam.

Es ist die Aufgabe der palliativen Geriatrie, die Patienten und ihr Umfeld zu begleiten und den Prozess zu erkennen, wann die Ressourcen erschöpfen und die Fokussierung auf Symptomlinderung bis zur Sterbebegleitung beginnt.

Abstract

While geriatric medicine focuses on elderly patients resources for leading them back into everyday life, palliative care concentrates on the control of symptoms during patients’ terminal and dying phase.

Palliative geriatric medicine is the challenging intersection area between the two fields by using the elderly patient’s resources and initiating early palliative care with respect to individual needs and desires regarding end of life. To overcome this challenge constant communication is needed between medical staff, patients and relatives.

The leading aim of palliative geriatric medicine is to recognize when a patient’s exhaustion of resources demands a switch from geriatric to palliative care.

 
  • Literatur

  • 1 Fortin M, Hudon C, Dubois M et al. Comparative assessment of three different indices of multimorbidity for studies on health-related quality of life. Health Qual Life Outcomes 2005; 3: 74
  • 2 Covinsky KE, Palmer RM, Fortinsky RH et al. Loss of independence in activities of daily living in older adults hospitalized with medical illnesses: increased vulnerability with age. J Am Geriatr Soc 2003; 51: 451-458
  • 3 Anderson RT, James MK, Miller ME et al. The timing of change: patterns in transitions in functional status among elderly persons. J Gerontol B Psychol Sci Soc Sci 1998; 53: S17-27
  • 4 Goldstein NE, Morrison RS. The intersection between geriatrics and palliative care: a call for a new research agenda. J Am Geriatr Soc 2005; 53: 1593-1598
  • 5 Hamel MB, Phillips RS, Teno JM et al. Seriously ill hospitalized adults: do we spend less on older patients? Support Investigators. Study to Understand Prognoses and Preference for Outcomes and Risks of Treatments. J Am Geriatr Soc 1996; 44: 1043-1048
  • 6 Phillips RS, Hamel MB, Teno JM et al. Race, resource use, and survival in seriously ill hospitalized adults. The SUPPORT Investigators. J Gen Intern Med 1996; 11: 387-396
  • 7 Hamel MB, Teno JM, Goldman L et al. Patient age and decisions to withhold life-sustaining treatments from seriously ill, hospitalized adults. SUPPORT Investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment. Ann Intern Med 1999; 130: 116-125
  • 8 Somogyi-Zalud E, Zhong Z, Lynn J et al. Elderly persons’ last six months of life: findings from the Hospitalized Elderly Longitudinal Project. J Am Geriatr Soc 2000; 48 (Suppl. 05) S131-139
  • 9 Dale W. International geriatrics perspectives. J Geriatr Oncol 2014; 5 (Suppl. 01) S5
  • 10 Gunten CF von, Camden B, Neely KJ et al. Prospective evaluation of referrals to a hospice/palliative medicine consultation service. J Palliat Med 1998; 1: 45-53
  • 11 Weissman DE, Griffie J. The Palliative Care Consultation Service of the Medical College of Wisconsin. J Pain Symptom Manage 1994; 9: 474-479
  • 12 Evers MM, Meier DE, Morrison RS. Assessing differences in care needs and service utilization in geriatric palliative care patients. J Pain Symptom Manage 2002; 23: 424-432
  • 13 Frohnhofen H, Hagen O, Heuer HC et al. The terminal phase of life as a team-based clinical global judgment: prevalence and associations in an acute geriatric unit. Z Gerontol Geriatr 2011; 44: 329-335
  • 14 Morrison RS, Siu AL. Survival in end-stage dementia following acute illness. JAMA 2000; 284: 47-52
  • 15 Parmelee PA, Smith B, Katz IR. Pain complaints and cognitive status among elderly institution residents. J Am Geriatr Soc 1993; 41: 517-522
  • 16 Sengstaken EA, King SA. The problems of pain and its detection among geriatric nursing home residents. J Am Geriatr Soc 1993; 41: 541-544
  • 17 Leventhal EA, Prohaska TR. Age, symptom interpretation, and health behavior. J Am Geriatr Soc 1986; 34: 185-191
  • 18 Brockopp D, Warden S, Colclough G et al. Elderly people’s knowledge of and attitudes to pain management. Br J Nurs 1996; 5: 556-558, 560-562
  • 19 Müller-Mundt G, Bleidorn J, Geiger K et al. End of life care for frail older patients in family practice (ELFOP) – protocol of a longitudinal qualitative study on needs, appropriateness and utilisation of services. BMC Fam Pract 2013; 14: 52
  • 20 Kühne F, Behmann M, Bisson S et al. Non-response in a survey of physicians on end-of-life care for the elderly. BMC Res Notes 2011; 4: 367
  • 21 Adelman RD, Tmanova LL, Delgado D et al. Caregiver burden: a clinical review. JAMA 2014; 311: 1052-1060
  • 22 Mitchell SL, Berkowitz RE, Lawson FM et al. A cross-national survey of tube-feeding decisions in cognitively impaired older persons. J Am Geriatr Soc 2000; 48: 391-397
  • 23 Mitchell SL, Lawson FM. Decision-making for long-term tube-feeding in cognitively impaired elderly people. CMAJ 1999; 160: 1705-1709
  • 24 Callahan CM, Haag KM, Buchanan NN et al. Decision-making for percutaneous endoscopic gastrostomy among older adults in a community setting. J Am Geriatr Soc 1999; 47: 1105-1109
  • 25 Ahronheim JC, Mulvihill M, Sieger C et al. State practice variations in the use of tube feeding for nursing home residents with severe cognitive impairment. J Am Geriatr Soc 2001; 49: 148-152
  • 26 Seltzer B, Rheaume Y, Volicer L et al. The short-term effects of in-hospital respite on the patient with Alzheimer’s disease. Gerontologist 1988; 28: 121-124
  • 27 Mitchell SL, Tetroe JM. Survival after percutaneous endoscopic gastrostomy placement in older persons. J Gerontol A Biol Sci Med Sci 2000; 55: M735-739
  • 28 Grunow JE, al-Hafidh A, Tunell WP. Gastroesophageal reflux following percutaneous endoscopic gastrostomy in children. J Pediatr Surg 1989; 24: 42-44; Discussion 44-45
  • 29 Hassett JM, Sunby C, Flint LM. No elimination of aspiration pneumonia in neurologically disabled patients with feeding gastrostomy. Surg Gynecol Obstet 1988; 167: 383-388
  • 30 Feinberg MJ, Knebl J, Tully J. Prandial aspiration and pneumonia in an elderly population followed over 3 years. Dysphagia 1996; 11: 104-109
  • 31 Hickman SE, Tolle SW, Brummel-Smith K et al. Use of the Physician Orders for Life-Sustaining Treatment program in Oregon nursing facilities: beyond resuscitation status. J Am Geriatr Soc 2004; 52: 1424-1429
  • 32 Rice KN, Coleman EA, Fish R et al. Factors influencing models of end-of-life care in nursing homes: results of a survey of nursing home administrators. J Palliat Med 2004; 7: 668-675
  • 33 Hanson LC, Eckert JK, Dobbs D et al. Symptom experience of dying long-term care residents. J Am Geriatr Soc 2008; 56: 91-98
  • 34 Hanson LC, Ersek M. Meeting palliative care needs in post-acute care settings: “to help them live until they die”. JAMA 2006; 295: 681-686
  • 35 Lynn J, Teno JM, Phillips RS et al. Perceptions by family members of the dying experience of older and seriously ill patients. SUPPORT Investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments. Ann Intern Med 1997; 126: 97-106
  • 36 Flacker JM, Kiely DK. Mortality-related factors and 1-year survival in nursing home residents. J Am Geriatr Soc 2003; 51: 213-221
  • 37 Duncan JG, Bott MJ, Thompson SA et al. Symptom occurrence and associated clinical factors in nursing home residents with cancer. Res Nurs Health 2009; 32: 453-464
  • 38 Reynolds K, Henderson M, Schulman A et al. Needs of the dying in nursing homes. J Palliat Med 2002; 5: 895-901
  • 39 Carlson MD, Lim BMD. Strategies and innovative models for delivering palliative care in nursing homes. J Am Med Dir Assoc 2011; 12: 91-98
  • 40 Shega JW, Ersek M, Herr K et al. The multidimensional experience of noncancer pain: does cognitive status matter?. Pain Med 2010; 11: 1680-1687
  • 41 Pharmacological management of persistent pain in older persons. J Am Ger Soc 2009; 57: 1331-1346
  • 42 Lenzen-Großimlinghaus R, Schulz RJ. Geriatrische Untersuchungen. In: Schnabel KP, Ahlers O, Dashti H, Georg W, Schwantes U, Hrsg. Ärztliche Fertigkeiten. Stuttgart: Wissenschaftliche Verlagsgesellschaft; 2009: 299-305