Monthly Archives: March 2015

Being on the same page

The support systems & social circumstances of people accessing palliative care services needs to be considered to ensure access to the right service at the right time.

The “Demographics of living alone” report from the Australian Institute of Family Studies (March 2015) says “Living alone is increasingly on the public radar. One in four Australian households is a lone – person household….In some quarters these developments have been interpreted as signifying a decline of commitment to family living, increasing social fragmentation and a rise in loneliness. For others….celebrated as reflecting the greater choice people have….”.

It doesn’t matter which view you ascribe to, what is important is how living alone influences choices for palliative care.

There are three basic types of graphs used to illustrate disease time lines.

  • The chronic disease pattern. Up and down like a yo-yo (but never quite going back to the previous functional level) over a prolonged period of time and with death at any of the low points a real possibility. Because a person’s health goes up & down so often, death seems a surprise when it occurs.
  •  The frail aged person whose life graph is a progressive downward decline in independence over a long period, where everyday tasks are difficult or time consuming.
  • The cancer trajectory where there is a slight decline in functional ability over a period of time with a shorter, more rapid deterioration ending in death.

Palliative care is an approach that improves quality of life when faced with problems associated with life threatening illness through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems physical, psychological & spiritual (WHO, 2008).

General care clinicians deliver palliative care to the majority of people and specialist palliative care services provide care to those with more complex needs. Palliative care isn’t crisis care or focussing only on the end- of-life care situation. Good palliative care has a role in preventing the crisis. This can only occur by recognising that palliative care principles should run alongside other treatment. However a health crisis or end of life care situation is significant for people living alone as these circumstances often don’t allow a person to be alone in their own home. Additional support of family, close friends, paid carers or even a hospital admission usually results.

This doesn’t mean a person’s preferences and choices can’t be respected and met. The longest period of care is outside the hospital environment. If you live alone or know someone who will turn to you for support when they aren’t well perhaps

v  Pause & listen. Try to be clear about what is going on and why

v  Have frank and honest conversations about what is important

v  Appoint a medical power of attorney (someone to make medical decisions on your behalf if you are unable)

v  Understand that sometimes people cannot see risks or problems and that trusted people will have to give advice that is uncomfortable to hear

v  Be flexible. At least flexible enough to reach a solution of sorts!

v  Life is important, people aren’t being difficult, they are just trying to deal with a challenging situation

Research indicates people prefer to die in their own home, however the majority die in hospital. The bulk of the care is delivered outside of hospital. Living alone shouldn’t preclude the delivery of good care that respects the unique circumstances, individual choice and wishes. Everybody just needs to be on the same page.

References:

De Vaus, D & Qu,L.(2015). Demographics of living alone (Australian Family Trends No.6). Melbourne: Australian Institute of Family Studies

Swerisson, H & Duckett, S (2014). Dying well. Melbourne: Gratton Institute

World Health Organisation