While the needs of patients receiving palliative care services transcend age, it is a demographic fact that older people comprise the bulk of those with chronic palliative care needs.1 When someone has an advanced illness or is nearing the end of life, communication with the patient and family is an essential ingredient in the delivery of quality palliative care to an ever-increasing geriatric population.
The number of hospital palliative care teams has more than tripled since 2000, exceeding 1,900 in 2012, and, of course, is expected to continue to increase given changes in healthcare funding that emphasize discussions about end-of-life decision making.
The opportunity to bring excellent geriatric and palliative care to people most in need of these services is unprecedented. Audiologists should be proactive, as they could have an important role to play as team members.1
GERIATRIC VS PALLIATIVE CARE
Before defining audiology's part on the palliative care team, let's discuss the similarities and differences between geriatrics and palliative care.
Geriatricians seek to improve the health, independence, and quality of life of older people. Increasingly, geriatricians are the gatekeepers for healthcare delivery to people 65 and older, providing consultation to hospital and outpatient colleagues on syndromes that affect this population, including hearing loss.2
In contrast, palliative care specialists provide care to seriously ill and vulnerable people who require pain management and are facing end-of-life decisions. With a core skill set that includes symptom management, communication, and caregiver support, the mission of palliative care is to provide services that are grounded in an understanding of the patient's goals and focused on quality of life and on the functional and supportive needs of the patient and caregiver.1
Palliative care specialists work in a variety of settings, including the home, nursing homes, cancer centers, physician offices, and, most commonly, in hospital and hospice settings. Theoretically, palliative care teams serve in a primary care capacity, rather than a consulting role.2,3
Palliative and geriatric medicine are similar in that person- and family-centered care are at the heart of their service delivery model. Fundamental to palliative care is attention to caregiver needs and their inclusion in care planning and implementation.1
Additional areas of common ground include delivery of goal-oriented care based on individual preferences, multidimensional assessment and identification of unmet needs, and embrace of the biopsychosocial rather than a medical model of care delivery.
CALL TO ACTION
When someone has an advanced illness or is near the end of life, stakeholders look beyond the medical and physical needs, shifting their focus to communication with family and the development of a plan and formula to deliver better and more compassionate care.3
Recipients of palliative care must have control over their situation, with their preferences voiced, respected, and followed.3 Promotion of communication, shared decision making, and empowerment, even in the case of people with mild cognitive impairment, can enhance patient autonomy and dignity, helping to improve the quality of remaining life.3
In fact, Lynn Friss Feinberg, MSW, advocates that public policies offer “sufficient resources and supportive technology to address coordination and continuity of care; a trained interdisciplinary care team, with the older adult and family at the center; and the provision of services and supports that matter most to older adults and to their families” (p. 100).3
Audiologists must become proactive and work with palliative care team members, educating them about best practices for the delivery of relationship-centered healthcare communication. We have an invaluable role to play in both raising awareness and recognition of behaviors typical of people with hearing impairment, and delineating skills and strategies essential to improving the communication experience and associated outcomes.
Information on using personal sound amplifiers like pocket talkers, including how and when; optimizing the physical environment so that it is free of distractions and has advantageous lighting; and employing multiple communication modalities are just a few examples of the expertise we can share with team members.
We should provide a behavior checklist that underscores the importance of asking, checking, and confirming that the patient and family member can hear and understand by either observing clues that surface early on or asking patients or family members directly about hearing status.
Similarly, we should provide a solutions checklist that includes information on assistive technology, with directions on how to use it, and a list of the value added by incorporating such systems in everyday practice (e.g., making communication less effortful by reducing the cognitive load involved in straining to understand, and reducing caregiver burden and stress associated with difficulty communicating).
Of course, if a patient or caregiver owns hearing aids, audiologists must instruct team members on how to ensure proper placement and, of utmost importance, verify that the hearing aids are working and adjusted to a comfortable listening level.
NOW IS THE TIME
In its report on Dying in America, the Institute of Medicine (IOM) underscored the importance of providing high-quality care for people who are nearing the end of their life.
Minimizing sensory and other obstacles that arise, and providing solutions to ensure that end-of-life care is compassionate and of the best possible quality, should increasingly be considered part of audiologists’ scope of practice.
Geriatricians and palliative care specialists provide care to the five percent of patients who consume 50 percent of health costs. It is the right time for audiologists to partner with these providers and help realize their goals of improving care throughout the course of serious illness for a primarily aging population.3
In Golden Rules, Dr. Weinstein, professor of audiology and founding executive officer of Health Sciences Doctoral Programs at the Graduate Center, City University of New York (CUNY), will focus on how to achieve better and more comprehensive care for hearing healthcare patients, particularly older adults. An expert on this topic, Dr. Weinstein is coauthor of the Hearing Handicap Inventory for Adults and the Elderly.