Castagna Alberto, Militano Vincenzo, Ruberto Carmen, Manzo Ciro, Ruotolo Giovanni
ASP di Catanzaro, Primary Care Department Catanzaro Italy.
AOU "Renato Dulbecco," SOC di Medicina Nucleare Catanzaro Italy.
Aging Med (Milton). 2024 Oct 16;7(5):645-648. doi: 10.1002/agm2.12367. eCollection 2024 Oct.
The geriatric vision of palliative care is based on a multidisciplinary, patient-centered approach, looking for a balance between human dignity and medical treatments with a particular focus on the social and ethical aspects. In order to develop the best care models, there is a rising need for a tighter collaboration of all the involved players (i.e., doctors, nurses, social workers). Indeed, the idea of a fragmented system without considering the patient or his/her family is not at all applicable to older patients with chronic disease. The causes of death, the phase of death changes, and the extend of last period of life could be a long phase characterized by complicated treatment decisions, difficult management of symptoms, multiple psychosocial problems, and complex spiritual distress. Recently, Italian guidelines on Comprehensive Geriatric Assessment (CGA) have been published. However, none of the identified studies on patients in hospice and other palliative care facilities met the criteria for inclusion. These findings underscore the need for further research to determine the potential benefits of a multidimensional approach for patients in hospice and other palliative care settings. Our reflections and suggestions on the CGA use for older persons in palliative care may be a starting point for an open and continuous dialogue with all the operators concerned.
老年姑息治疗的理念基于多学科、以患者为中心的方法，寻求在人的尊严与医疗治疗之间取得平衡，特别关注社会和伦理方面。为了开发最佳的护理模式，所有相关参与者（即医生、护士、社会工作者）之间更紧密的合作需求日益增加。事实上，一个不考虑患者或其家人的碎片化系统的想法根本不适用于患有慢性病的老年患者。死亡原因、死亡阶段的变化以及生命最后阶段的时长可能是一个漫长的阶段，其特点是治疗决策复杂、症状管理困难、多种心理社会问题以及复杂的精神痛苦。最近，意大利关于综合老年评估（CGA）的指南已经发布。然而，在临终关怀机构和其他姑息治疗机构中针对患者的已确定研究均未符合纳入标准。这些发现强调了进一步研究的必要性，以确定多维方法对临终关怀机构和其他姑息治疗环境中的患者的潜在益处。我们对在姑息治疗中对老年人使用CGA的思考和建议可能是与所有相关从业者进行开放和持续对话的起点。
