Palliative care is an interdisciplinary medical caregiving approach aimed at optimizing quality of life and mitigating suffering among people with serious, complex, and often terminal illnesses. Within the published literature, many definitions of palliative care exist. The World Health Organization (WHO) describes palliative care as "an approach that improves the quality of life of patients and their families facing the 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, psychosocial, and spiritual". In the past, palliative care was a disease specific approach, but today the WHO takes a broader patient-centered approach that suggests that the principles of palliative care should be applied as early as possible to any chronic and ultimately fatal illness. This shift was important because if a disease-oriented approach is followed, the needs and preferences of the patient are not fully met and aspects of care, such as pain, quality of life, and social support, as well as spiritual and emotional needs, fail to be addressed. Rather, a patient-centered model prioritizes relief of suffering and tailors care to increase the quality of life for terminally ill patients.
Geriatrics, or geriatric medicine, is a medical specialty focused on providing care for the unique health needs of older adults. The term geriatrics originates from the Greek γέρων geron meaning "old man", and ιατρός iatros meaning "healer". It aims to promote health by preventing, diagnosing and treating disease in older adults. There is no defined age at which patients may be under the care of a geriatrician, or geriatric physician, a physician who specializes in the care of elderly people. Rather, this decision is guided by individual patient need and the caregiving structures available to them. This care may benefit those who are managing multiple chronic conditions or experiencing significant age-related complications that threaten quality of daily life. Geriatric care may be indicated if caregiving responsibilities become increasingly stressful or medically complex for family and caregivers to manage independently.
In medicine, specifically in end-of-life care, palliative sedation is the palliative practice of relieving distress in a terminally ill person in the last hours or days of a dying person's life, usually by means of a continuous intravenous or subcutaneous infusion of a sedative drug, or by means of a specialized catheter designed to provide comfortable and discreet administration of ongoing medications via the rectal route.
Terminal illness or end-stage disease is a disease that cannot be cured or adequately treated and is expected to result in the death of the patient. This term is more commonly used for progressive diseases such as cancer, dementia or advanced heart disease than for injury. In popular use, it indicates a disease that will progress until death with near absolute certainty, regardless of treatment. A patient who has such an illness may be referred to as a terminal patient, terminally ill or simply as being terminal. There is no standardized life expectancy for a patient to be considered terminal, although it is generally months or less. Life expectancy for terminal patients is a rough estimate given by the physician based on previous data and does not always reflect true longevity. An illness which is lifelong but not fatal is a chronic condition.
The Icahn School of Medicine at Mount Sinai, formerly the Mount Sinai School of Medicine, is a private medical school in New York City, New York, United States. The school is the academic teaching arm of the Mount Sinai Health System, which manages eight hospital campuses in the New York metropolitan area, including Mount Sinai Hospital and the New York Eye and Ear Infirmary.
The Beers Criteria for Potentially Inappropriate Medication Use in Older Adults, commonly called the Beers List, are guidelines published by the American Geriatrics Society (AGS) for healthcare professionals to help improve the safety of prescribing medications for adults 65 years and older in all except palliative settings. They emphasize deprescribing medications that are unnecessary, which helps to reduce the problems of polypharmacy, drug interactions, and adverse drug reactions, thereby improving the risk–benefit ratio of medication regimens in at-risk people.
Ira Robert Byock is an American physician, author, and advocate for palliative care. He is founder and chief medical officer of the Providence St. Joseph Health Institute for Human Caring in Torrance, California, and holds appointments as active emeritus professor of medicine and professor of community health and family medicine at the Geisel School of Medicine at Dartmouth College. He was director of palliative medicine at Dartmouth–Hitchcock Medical Center, from 2003–14, and associate director for patient and family-centered care at the affiliated Norris-Cotton Cancer Center.
Christine K. Cassel is a leading expert in geriatric medicine, medical ethics and quality of care. She is planning dean of the new Kaiser Permanente School of Medicine. Until March 2016, she was president and CEO of the National Quality Forum. Previously, Cassel served as president and CEO of the American Board of Internal Medicine (ABIM) and the ABIM Foundation.
End-of-life care refers to health care provided in the time leading up to a person's death. End-of-life care can be provided in the hours, days, or months before a person dies and encompasses care and support for a person's mental and emotional needs, physical comfort, spiritual needs, and practical tasks.
A fellowship is the period of medical training, in the United States and Canada, that a physician, dentist, or veterinarian may undertake after completing a specialty training program (residency). During this time, the physician is known as a fellow. Fellows are capable of acting as an attending physician or a consultant physician in the specialist field in which they were trained, such as internal medicine or pediatrics. After completing a fellowship in the relevant sub-specialty, the physician is permitted to practice without direct supervision by other physicians in that sub-specialty, such as cardiology or oncology.
Geriatric nephrology is the branch of internal medicine and geriatric medicine that deals with diseases of the kidney.
In the United States, hospice care is a type and philosophy of end-of-life care which focuses on the palliation of a terminally ill patient's symptoms. These symptoms can be physical, emotional, spiritual or social in nature. The concept of hospice as a place to treat the incurably ill has been evolving since the 11th century. Hospice care was introduced to the United States in the 1970s in response to the work of Cicely Saunders in the United Kingdom. This part of health care has expanded as people face a variety of issues with terminal illness. In the United States, it is distinguished by extensive use of volunteers and a greater emphasis on the patient's psychological needs in coming to terms with dying.
Hospice care is a type of health care that focuses on the palliation of a terminally ill patient's pain and symptoms and attending to their emotional and spiritual needs at the end of life. Hospice care prioritizes comfort and quality of life by reducing pain and suffering. Hospice care provides an alternative to therapies focused on life-prolonging measures that may be arduous, likely to cause more symptoms, or are not aligned with a person's goals.
Albert Siu is an internist and geriatrician and the Ellen and Howard C. Katz Chairman and Professor of the Brookdale Department of Geriatrics and Palliative Medicine at Mount Sinai Hospital in New York City. He is also the director of the Geriatric Research, Education, and Clinical Center at the James J. Peters VA Medical Center in The Bronx, a senior associate editor of Health Services Research, a senior fellow of the Brookdale Foundation and a former trustee of the Nathan Cummings Foundation.
Teresa Thomas "Terry" Fulmer, is the current president of The John A. Hartford Foundation. Earlier positions include distinguished professor and dean of the Bouvé College of Health Sciences at Northeastern University and dean of the College of Nursing at New York University. She is known for her extensive research in geriatrics and elder abuse. She has received funding from the National Institute on Aging, the National Institute of Nursing Research and other foundations for her research regarding elder abuse.
POLST is an approach to improving end-of-life care in the United States, encouraging providers to speak with the severely ill and create specific medical orders to be honored by health care workers during a medical crisis. POLST began in Oregon in 1991 and currently exists in 46 states; some of the 46 states have the program in development. The POLST document is a standardized, portable, brightly colored single page medical order that documents a conversation between a provider and an individual with a serious illness or frailty towards the end of life. A POLST form allows emergency medical services to provide treatment that the individual prefers before possibly transporting to an emergency facility.
The John A. Hartford Foundation is a private United States-based philanthropy whose current mission is to improve the care of older adults. For many years, it made grants for research and education in geriatric medicine, nursing and social work. It now focuses on three priority areas: creating age-friendly health systems, supporting family caregivers and improving serious illness, and end-of-life care.
Ramona Rhodes is an American geriatrician and physician.
Doris Howell was an American physician who specialized in pediatric oncology. She became known as the "mother of hospice," for her pioneering work in palliative care.
Karen Bullock is an American sociologist, clinical social worker, and an academic research scholar. She is the Ahearn Endowed Professor at the Boston College, School of Social Work.
