Palliative geriatrics

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Reason: A sensible lemma for which there is scientific literature under the term geriatric palliative care . Unfortunately, in this case a specialist society took care of this article - unfortunately because they ignored available literature and literally copied their own policy paper here. Including their own political demands. The article has to be completely rewritten, so it can't stay, and because I don't have the capacity to rewrite it, it should be gone. See also the discussion on WP: QSM .-- Jaax ( discussion ) 15:49, 10 Aug 2020 (CEST)
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Reason: Advertising for a specialist society, little technical added value compared to the article palliative medicine .

Medical editors

Palliative geriatrics is a multi-professional care approach for very old people in their last phase of life. The focus is on both those affected and their relatives. The aim is to enable those affected to live a life that meets their physical and psychological needs until their death and to support their relatives during this time. This is achieved by merging the principles of geriatrics with those of palliative care . Palliative geriatrics should and can be implemented in all care settings.

Elderly hospice work and palliative geriatrics

Palliative geriatrics sees it as its most important task to enable old people to lead a dignified life with few symptoms right up to the end. Pain, stressful physical symptoms and social and emotional distress should be alleviated. The focus is on the wishes and needs of the seriously ill and the dying. The guiding principle is to maintain an individual quality of life for very old people, who are often affected by dementia and have multiple illnesses.

Volunteer hospice service employees accompany dying people together with full-time nurses and doctors in their familiar surroundings in the nursing home, at home or in the hospital. Trained volunteers advise and accompany seriously ill, dying people and those close to them during the time of dying and saying goodbye. The care approach intends to combine curative as well as rehabilitative and palliative measures, which shifts towards the end of life in favor of hospice-palliative offers. One of the goals is to continuously improve the quality of care and support for old people through training and further education for full-time and voluntary workers, which is dovetailed with organizational development. In the professional world, the term "palliative geriatrics" has established itself, which is supplemented by the term "senior citizens' hospice work".

target group

The target group of palliative geriatrics are very old people with and without dementia as well as their relatives and loved ones. Palliative geriatrics aims to strengthen the self-determination of old people through so-called empowerment .

Palliative geriatrics is also aimed at the carers and carers who support old and very old people. They need conditions, places and people to help maintain and replenish their resources.

aims

Palliative geriatrics respects the individuality of very old people, does not press them into a (care) scheme and expresses appreciation for their individual biography. The focus is not on individual physical aspects, but on the whole person with his environment, his values ​​and goals, his resources and needs and his right to empathetic attention.

An essential goal is to promote social participation and to try to “lure back into life” people who have been hurt and disappointed to a large extent. This can only succeed if very old people are included in the social environment with the support of families, neighbors, informal and professional helpers.

Palliative geriatrics should be implemented in all care settings, at home, in the shared apartment, in the hospital, in the nursing home or in the hospice. She pays attention to continuity in the nursing and medical support as well as to a functioning interface management. In addition, palliative geriatrics endeavors to provide reliable municipal, district-related care. The proximity to the living space has priority over the "dispatch mode" to other care settings. Older people should be able to live in their familiar surroundings until the end.

Palliative geriatrics demands social recognition for the elderly and for the services of elderly care. It calls for framework conditions that enable elderly people and their loved ones to be adequately cared for - above all, sufficient employees in the care facilities for the elderly. They need to be valued and their skills need to be strengthened. Professionalism and the ability to self-reflect are important resources and deserve consistent support. In the course of training, there is an unconditional change in the subject-specific focus. The imparting of attitude and knowledge in the “generalist” training must focus above all on communication and relationships. Attention must be paid to the quality of training, especially in palliative geriatric care and medicine, and this must be further developed.

Total Pain and Palliative Geriatrics

The Total Pain concept developed by Cicely Saunders is a basic pillar of palliative medicine as well as palliative geriatrics. In addition to physical and psychological treatment and support, it also takes into account the loneliness of old people caused by the death of loved ones and helps to prevent social isolation . The concept encompasses responding to existential and spiritual needs and needs and offers support.

Old age is characterized by special processes. Therefore, in palliative geriatrics, all three pillars - curative, rehabilitative and palliative - are important at the same time and side by side. The objectives can change quickly and often when accompanied by very old people.

Lifelong companion until the end

Palliative geriatrics is a lifelong companion to the last. It starts early

  • when chronic symptoms, increasing helplessness and mental hardships the need for care increase
  • from the point at which several people (professionals, family, volunteers) are faced with the question of how the care will be continued with which focus.
  • when the old person becomes aware of the limited life expectancy in a crisis. Such a moment is e.g. B. moving into a nursing home.

High-quality, palliative geriatric lifelong support is possible to the very end if interprofessionalism is implemented as a basic consensus in the care and support of elderly people.

Old people affected by multimorbidity need individual support as well as good care and medicine. Doctors are often only briefly with the elderly; Nursing, supervisors and volunteers, e.g. B. from a hospice service, often spend more time with them.

The aim is for the interprofessional team to speak to one another in one language and at eye level. The notion of “ultimate medical responsibility” falls short of the mark; what is needed is a common understanding of the problem, therapy goal and care offer. In the interprofessional team everyone contributes their part; the very old themselves contribute the most.

Death wishes for people receiving palliative geriatric care

Old people are often less afraid of death than they are of the time before then. Palliative geriatrics confronts dying and death together with those affected. She recognizes that dying can be a desirable perspective for old people and can have something wholesome. Palliative geriatrics accepts the end of life and is ready to allow death and not to prolong it unnecessarily. “Older, mostly multimorbid people often express death wishes. In this situation, it is the task of the treatment team to fathom the background of the wish, to alleviate stressful symptoms and to recognize and treat any depression. Wishes to die are not primarily to be regarded as suicide wishes, but as an expression of existential need ”. Assistance to suicide, killing on demand, voluntary renouncement of food and fluids as well as sedation at the end of life are discussed controversially again and again. Palliative geriatrics does not make these topics taboo. Through empathy and communication, she creates space for discussion, even if she cannot offer a solution. Framework conditions for caring for the dying, but also the ability of society and the professional world to talk openly about dying and to allow it to happen, are heterogeneous and generally still inadequate. Reliable and empathetic palliative geriatrics can only be implemented if professionalism, humanity and solidarity form the basis of palliative geriatric action. This also includes taking people seriously and listening to them when they wish to die. Which actions are ultimately legally permitted remains a question of democratic-social decision.

Sociopolitical relevance

Acting in elderly care is increasingly under economic pressure. Among other things, the pressure of the DRGs means that older people who are still in an unstable state and who have rehabilitation potential are being transferred to nursing homes. This shapes the way people care for the elderly and the sick. Despite these challenges, it is of great importance that all supply and care offers for old and very old people primarily serve the people and not exclusively to finance care structures, and certainly not to maximize profit. Elderly people do not need “services”, but relationship offers. Palliative geriatrics also has a political dimension. It demands social recognition for the elderly and for the great achievements of the elderly. It calls for framework conditions that make it possible to adequately care for old people and their loved ones - above all, sufficient employees in the facilities for elderly care.

The Palliative Geriatrics Competence Center (KPG) and the Palliative Geriatrics Association (FGPG) are committed to this.

Individual evidence

  1. ↑ Katharina Heimerl (Vienna), Marina Kojer (Vienna), Roland Kunz (Zurich), Dirk Müller (Berlin): Policy Paper "Palliative Geriatrics". FGPG eV, accessed on April 6, 2020 (German).
  2. ↑ KPG: Senior Citizenship Work and Palliative Geriatrics. Competence Center Palliative Geriatrics, accessed in April 2020 (German).
  3. Jump up ↑ Karin Böck (Vienna), Katharina Heimerl (Vienna), Marina Kojer (Vienna), Roland Kunz (Zurich), Dirk Müller (Berlin), Ursa Neuhaus (Bern), Manuela Röker: Policy paper on autonomy and self-determination. FGPG eV, October 11, 2019, accessed on April 6, 2020 (German).
  4. ↑ Heimerl Katharina, Berlach-Pobitzer Irene: Obtaining autonomy: a qualitative patient survey in home nursing. In: Elisabeth Seidl, Martina Stankova and Ilsemarie Walter (eds.): Autonomy in old age. Wilhelm Maudrich . Vienna 2000, p. 102-165 .
  5. ↑ Katharina Heimerl (Vienna), Marina Kojer (Vienna), Roland Kunz (Zurich), Dirk Müller (Berlin): Policy Paper Palliative Geriatrics. In: www.fgpg.eu. FGPG eV, 2018, accessed on April 7, 2020 (German).
  6. ↑ Switzerland. Academy of med. Sciences SAMS (2006/12): Medical-ethical guidelines for palliative care. Https://www.samw.ch/de/Publikationen/Richtlinien.html
  7. ↑ Radbruch Lukas et al. (2015): Euthanasia and physician-assisted suicide: A white paper from the European Association for Palliative Care. Palliative Medicine 1–13, DOI: 10.1177 / 0269216315616524
  8. ^ Journal of Palliative Geriatrics (2018): Desire to die. 4th year 1/2018, ISSN 2365-8762

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