Morrison Laura J, Morrison R Sean
Department of Medicine, Section of Geriatrics, Baylor College of Medicine, 1709 Dryden, Suite 850, Houston, TX 77030, USA.
Med Clin North Am. 2006 Sep;90(5):983-1004. doi: 10.1016/j.mcna.2006.05.016.
Palliative care aims to improve quality of life and relieve suffering for patients with advanced illness and those close to them by specifically addressing communication, symptom management, coordination of care, psychosocial and spiritual realms, grief and bereavement support, and legal and ethical concerns. It has an interdisciplinary focus and may co-exist with curative and life-prolonging treatment. Palliative care is a key component of appropriate, routine medical care, especially for clinicians caring for older adults. In revisiting Mrs. B, the many needs of a typical elderly patient are apparent, as are the gaps in the current level of care. A discussion of prognosis and goals of care is a potential starting point. This includes obtaining input from an oncologist with regard to treatment options for Mrs. B's metastatic breast cancer and her pathologic hip fracture. Soliciting her treatment goals in the context of her chronic obstructive pulmonary disease and significant recent decline is the next challenge. Pain, dyspnea, constipation, anorexia, and anxiety could then be addressed with pointed assessment and symptom-specific management. Code status discussion, communication with her support network, and care coordination for her increased care needs would follow. Hospice should be introduced as a potential option. Advance care planning might also be initiated. Psychological and spiritual support needs could also be explored in time. Clearly, there is much to be done for Mrs. B and her loved ones in clarifying and coordinating whatever path comes to be. Older patients and their families face prolonged courses of chronic disease and gradual decline. Physicians caring for these patients need to be expert in the domains of palliative care so these patients and their families can receive the best quality of care while they are still living full lives and later as they approach the end of life.
姑息治疗旨在通过专门解决沟通、症状管理、护理协调、心理社会和精神领域、悲伤与丧亲之痛支持以及法律和伦理问题，来提高晚期疾病患者及其身边亲人的生活质量并减轻痛苦。它具有跨学科的重点，并且可以与治愈性和延长生命的治疗同时存在。姑息治疗是适当的常规医疗护理的关键组成部分，尤其对于照顾老年人的临床医生而言。在回访B夫人时，典型老年患者的诸多需求显而易见，当前护理水平的差距也同样明显。讨论预后和护理目标可能是一个潜在的起点。这包括从肿瘤学家那里获取关于B夫人转移性乳腺癌和病理性髋部骨折的治疗方案的意见。在她患有慢性阻塞性肺疾病且近期病情显著恶化的背景下，征求她的治疗目标是下一个挑战。然后可以通过针对性评估和特定症状管理来解决疼痛、呼吸困难、便秘、厌食和焦虑等问题。接下来是讨论心肺复苏状态、与她的支持网络沟通以及为她增加的护理需求进行护理协调。应将临终关怀作为一种潜在选择引入。也可以启动预先护理计划。心理和精神支持需求也可以及时进行探索。显然，为B夫人和她的亲人澄清并协调任何即将采取的路径还有很多工作要做。老年患者及其家人面临着慢性病的漫长病程和逐渐衰退的状况。照顾这些患者的医生需要在姑息治疗领域成为专家，以便这些患者及其家人在仍然过着充实生活以及后来接近生命终点时能够获得最佳的护理质量。
