Care of Geriatric Patients with Advanced Illnesses and End-of-Life Needs in the Emergency Department

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Key points

  • Older patients with advanced illnesses are presenting more frequently to emergency departments (EDs).

  • These patients have complex needs that challenge busy EDs tuned to provide emergent, life-sustaining interventions and rapid dispositions.

  • Matching the appropriate level of medical intervention to a patient’s goals of care requires specialized communication skills.

  • Providing comfort at the end of life requires the ability to manage the following situations in the acutely dying patient: acute pain,

Screening of emergency department patients for palliative care needs

It is known that patients with advanced illness are at risk for not getting the care they want at the end of life.15 Given the resource limitations of EDs, it is critical to identify which patients would benefit most from a palliative care intervention.

Two patient presentations in the ED requiring palliative care predominate16:

  • 1.

    Likely terminal event (massive stroke, cardiac event, or surgical emergency): palliative care in the ED addresses of end-of-life care, including its provision,

What are the barriers to palliative care in the emergency department?

For ED providers who are on the front line in caring for people with advanced illness, there are multiple barriers to the initiation of palliative-centered care, ranging from goals of care discussions to comfort oriented care at the end of life. Reported obstacles include (1) lack of readily accessible palliative care consultation services 24/7, (2) incomplete medical records and patient information to aid in prognostication and inform goals of care discussions, (3) communication and training

Providing palliative care in the emergency department

Three core skills ED providers need to deliver palliative care in the ED are discussed: (1) screening for palliative care needs, (2) communicating effectively with patients and families, and (3) managing palliative care symptoms for acutely ill or actively dying patients.

Summary

ED providers represent the front line for providing palliative care to the sickest and most vulnerable patients. Although the ED may not traditionally be designed to meet these needs, ED providers have a great opportunity to identify patients with palliative care needs and initiate goal-oriented palliative services that can have an impact on patient care dramatically. By screening for needs assessments, using specialized communication techniques, attending to symptom management at the end of

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  • Disclosures: The authors have nothing to disclose.

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