Palliative Care and End-of-Life Issues

From the time of a new diagnosis, health care for older adults with serious illness or nearing the end of life (EOL) emphasizes relief of suffering along with attempts at curative or disease-modifying treatments. Goals of care typically evolve as an illness progresses, from primarily curative to primarily palliative as the end of life approaches. End-of-life issues are intertwined with issues of grief and loss. Clinicians should elicit these concerns and employ empathy in an effort to support patients and families and relieve their distress. Clarification of health-care goals helps the provider determine which treatments to offer and helps the patient and family decide which treatments to pursue. Palliative care is provided by interdisciplinary teams that offer an extra layer of support to patients and families, is appropriate at any stage of illness, and may be provided by primary and specialty clinicians. Medication choices for symptom relief should reflect geriatric prescribing principles such as “Start Low and Go Slow.”