1 of 13

Physical Therapy for Geriatrics

Hospice and Palliative Care for Elderly

Saad Al-Nassan

PT, PhD

2 of 13

An overview of hospice and palliative care

WHO defines palliative care as an approach that improves the quality of life for patients and families facing life-threatening illness.

Palliative care manages patients’ symptoms and pain levels, providing relief from distress and ultimately, facilitating improved function

An overview of hospice and palliative care

Cancer patients were traditionally viewed as the primary recipients of palliative care
Currently; it is directed toward toward patients with incurable diseases, whatever the diagnosis is
Most people die at an older age. And mostly they die at hospitals
Care providers for the terminally ill patients must professional in dealing with their patients in order to provide them a better quality of life at this stage of life.

The Dying process

Depending on the nature of the contributory disease, this process may take anywhere from several months to several hours.
Very common for patients to sleep most of the time in the days before death.
Eating and drinking significantly decline (Problems in swallowing and digestion)
“Terminal restlessness” is a specific form of delirium and agitation that occurs in the final weeks, days, or hours of life.

(Could be due to physiological or Psychological failure)

“Active death” typically occurs in the final days or hours and involves observable signs of systemic failure

The Dying process

The patient may be unresponsive, or even comatose. Family members need to be assured that the patient hears them as hearing is one of the last senses to fail.

Nearing Death Awareness. A variety of altered mental states may be experienced as the end of life approaches
Clinical caregivers as well as family members learn from close listening and observation of the person in their care.

Caregivers who do not have an understanding of this communication may experience more anxiety.

The interdisciplinary model of care

Hospice care involves an interdisciplinary medical, psychological, and spiritual approach to the promotion of comfort and quality of life in patients with a terminal illness and a life expectancy of 6 months or less.

Physiotherapy in palliative care

Early referral to palliative care rehabilitation has been linked to higher-functioning patients
appropriate referral to palliative care physiotherapy is critical for optimal and patient-centerd care
Patients can receive palliative care physiotherapy at any time and any stage of illness, whether it is terminal or not. It can be offered:
In a hospice
In the patients home
As a day patient in a hospice
In a hospital
In the community

Patient needs and our role as a physiotherapist

Each individual will have different needs depending on how well they are handling their life-limiting illness.
The needs of a patient in palliative care often include:
To remain as independent as possible/maximize independence and daily function.
To optimize and maintain quality of life (QoL)
Reduction/control of the consequences of the illness
Coping mechanisms and self-management. to be in more control of their lives.
To avoid secondary complications associated with life-limiting illnesses.
Psychological support.

Common symptoms and physiotherapy management

Physiotherapy treatment and suitable phase during palliation (Example)

Family involvement in PT treatment:

PT goals in palliative care:

The primary goal of physiotherapy in palliative care is to achieve the best possible QoL for both the patient and their families.

Suggested topics for presentations related to hospice and palliative care: