by Joann P. Reinhardt

Palliative care can reduce suffering for elder residents in long-term care and for their families.

Significant numbers of adults in advanced old age live in long term-care, where residents commonly have multiple chronic health conditions. At the same time, healthcare in this setting often continues to focus on curative goals -- with a lack of attention to the need to shift to palliative goals when appropriate. Both the uncertainty of any individual elder’s prognosis and the availability of advanced medical technology may result in less acceptance of the natural reality of death.

Research has shown, however, that the failure to identify and address end-of-life issues in long-term care settings can be associated with unnecessary pain and suffering for both residents and their families. By contrast, family members and long-term care residents who hold end-of-life discussions with healthcare providers can make informed choices about the extent and types of medical care needed and about ways to relieve symptoms that cause suffering. Options could include increased use of both palliative care and hospice services.

Qualitative and Quantitative Research

Qualitative and quantitative research on end-of-life care in the setting of long-term care has been increasing. For older residents who are nearing the end of life and for their families, person-centered, culturally sensitive approaches, along with pain and symptom management, the provision of support and attention to spirituality, are important.

Although most research on this topic has been conducted using Caucasian samples, some studies have shown ethnic and cultural differences in preferences for end-of-life care, including attitudes about aggressive life-sustaining treatments and the use of advance directives. More research is needed regarding how end-of-life care may need to be adapted for older adults and families from diverse cultural backgrounds. Importantly, findings from existing and future research can be used to inform evidence-based interventions focused on optimizing end-of-life care for elders in long-term care.

Joann P. Reinhardt is associate director of research at Jewish Home Lifecare in New York City.

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