Jan/Feb 2004 Annals of Family Medicine tip sheet

Researchers Propose New Framework for Palliative Care of the Elderly
Asserting that the prevailing model for palliative care of the elderly is fundamentally flawed and ill-suited for older patients suffering from slowly progressive chronic illness, four researchers from the University of California Davis School of Medicine have proposed a new framework for palliative care the TLC model. The new model is named for its five defining characteristics timely, team-oriented, longitudinal, collaborative and comprehensive.

The authors submit that palliative care in older patients should not be viewed as synonymous with hospice or end-of-life care; rather, it should be viewed as care primarily intended to relieve the burden of physical and emotional suffering that often accompany illnesses associated with aging. Further, they suggest that palliative care should be a major focus of care throughout the aging process, regardless of whether death is imminent.

The proposed model for palliative care for the elderly has five core characteristics: 1) Timely care should be proactive rather than reactive to avoid prolonged and unnecessary suffering; 2) Team-oriented health care team members, such as nurses and trained lay persons, should play a major role in supporting family self-care efforts and implementing palliative care; 3) Longitudinal care should be provided at all points along the disease trajectory, with an evolving balance of palliative and curative treatments; 4) Collaborative care and decision making should be a shared enterprise among physicians, patients and their loved ones; and 5) Comprehensive care should be informed by comprehensive geriatric assessment research literature.

In an effort to evaluate the efficacy of the TLC model, the researchers recently tested the new model at two assisted living facilities in the Sacramento, Calif., area. Preliminary findings provide initial support for the TLC model as a promising

Contact: Angela Lower
American Academy of Family Physicians

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