Principles of Palliative Carein Terminally-Ill Older Adults 

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Singapore is a first world country that as is advancing, is rapidly ageing with over 200,000 Singaporeans currently aged 75 and above (Arivalanan, Y. and Gee, C., 2019). The Government is striving not only in promoting better health to the living, but also delivering optimal quality care for the dying older adults. The shift of past mindsets from death being a taboo topic is seen when 63% of respondents taking part in a local survey thought favourably of palliative care because of knowing someone who received it (Lien Foundation, 2014).

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Pain and Symptoms Relief

Pain is very common among terminally-ill older adults. Everdingen, V. B., Rijke, D., Kessels, et ly al. (as cited in Quate, L., Brabin, E. & Mitchell, A., 2013) reported 85% of specialist palliative care inpatients were troubled by pain. Because of its nature to cause great distress and discomfort, timely and accurate assessments to pain-relieving interventions are greatly appreciated. Since pain is subjective, the right assessment tools should be used such as the numerical rating scales. Terminally-ill older adults should be encouraged to describe the pain they feel in their own words (K.E. Miller, M.M. Miller & Jolley, M.R., 2001). Symptoms like breathlessness and nausea are not to be ignored as well.

Affirms life and views dying as natural. Achieving maximum comfort for the terminally-ill older adults should be the main priority among healthcare providers. Towards their end-of-life, patients and their family members are to be carefully discussed to discontinue further life-sustaining interventions like blood transfusion, intravenous feeding or drip (Ahmedzai, S. H. et al., 2004), that only prolonged the death of most critically-ill hospitalized patients (Granda-Cameron, C. & Houldin, A., 2012).

Involves spiritual and psychological facets of care. The importance for a holistic patient or family-centred approach rather than just a disease or symptoms-focused one cannot be overstated enough. The process of dying is often met with feelings of severe grief, anxiety, loneliness, depression, hopelessness, and fear for the unknown. Low (as cited in Arivalanan, Y. and Gee, C., 2019) discovered that such spiritual distress could combine with the physical pain experienced by the terminally-ill older adults. Additionally, dying with dignity by having a sense of control, maintaining one’s self-esteem, self-respect and pride (Ho et al., 2017) should not be overlooked.

Provides a help system to assist dying patients to live actively prior to death. Information and education on palliative care should be made easily accessible and available for the dying older adults and their families. Having the autonomy to plan how one should live his last few months or weeks should give a sense of empowerment and strength in times of uncertainty in the face of mortality. However, continued research should be done in this area that will be of beneficent and non-maleficence to the dying older adults.  

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