Enriching Lives: Palliative Care in Geriatrics

A special issue of Geriatrics (ISSN 2308-3417).

Deadline for manuscript submissions: closed (15 April 2024) | Viewed by 4356

Special Issue Editor


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Guest Editor
Institute of Gerontology and Geriatrics, Department of Medicine and Surgery, University of Perugia, 06132 Perugia, Italy
Interests: aging; geriatrics; nutrition; senescence; telomeres; telomerase; dementia; cognition; diabetes; metabolism
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Special Issue Information

Dear Colleagues,

The confluence of an aging global population, rising chronic disease prevalence, and the imperative to provide appropriate care during the final stages of life has led to an essential focus on the quality of end-of-life care, as well as supportive and palliative interventions. In this context, the significance of providing tailored, holistic, and person-centered care becomes imperative, ensuring that individuals not only receive medical attention but also find comfort at the end of life. However, a significant number of seniors spend their final moments in hospitals, often receiving aggressive medical treatments even in the face of terminal conditions. The challenge lies in the early identification of the so-called end-of-life phase, initiating timely supportive and palliative care alongside traditional treatments, employing a multidisciplinary approach, and providing valuable support to family members during the grieving process. Despite its recent inception, the realm of geriatric palliative care (GPC) still lacks development. The aim of this Special Issue is to identify the main topics related to palliative and supportive care in older persons, shedding light on the challenges, innovations, and best practices that shape the landscape of care for individuals facing chronic diseases, frailty, and disabilities.

Dr. Virginia Boccardi
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Geriatrics is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1800 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • aging
  • disabilities
  • end-of-life
  • frailty
  • palliative care
  • supportive care

Published Papers (3 papers)

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Research

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10 pages, 232 KiB  
Article
Short-Term Opioid Treatment of Acute Locomotor Pain in Older Adults: Comparison of Effectiveness and Safety between Tramadol and Oxycodone: A Randomized Trial
by Wim Henri Janssens, Pauwelijn Verhoestraete, Ruth D. Piers and Nele J. Van Den Noortgate
Geriatrics 2024, 9(2), 46; https://doi.org/10.3390/geriatrics9020046 - 5 Apr 2024
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Abstract
Introduction: We conducted a head-to-head comparison of step 2 (tramadol) and step 3 (oxycodone) of the WHO pain ladder in older adults with moderate to severe acute locomotor pain. Materials and methods: Multi-center prospective randomized study. Patients were 70 years or older, admitted [...] Read more.
Introduction: We conducted a head-to-head comparison of step 2 (tramadol) and step 3 (oxycodone) of the WHO pain ladder in older adults with moderate to severe acute locomotor pain. Materials and methods: Multi-center prospective randomized study. Patients were 70 years or older, admitted to the acute geriatric ward of three hospitals, suffering from acute moderate to severe locomotor pain, and opioid-naive. Patients were randomized into two treatment groups: tramadol versus oxycodone. The Consort reporting guidelines were used. Results: Forty-nine patients were included. Mean numeric rating scale (NRS) decreased significantly between day 0 and 2 of the inclusion in both groups. A sustained significant decrease in mean NRS was seen at day 7 in both groups. Nausea was significantly more prevalent in the tramadol group, with a trend towards a higher prevalence of delirium and falls and three serious adverse events in the same group. Conclusions: Opioid therapy may be considered as a short-term effective treatment for moderate to severe acute locomotor pain in older adults. Oxycodone may possibly be preferred for safety reasons. These results can have implications for geriatric practice, showing that opioids for treatment of acute moderate to severe locomotor pain in older patients are effective and safe if carefully monitored for side effects. Opioid therapy may be considered as a short-term treatment for moderate to severe acute locomotor pain in older adults, if carefully monitored for (side) effects, while oxycodone may possibly be preferred for safety reasons. These results can have implications for daily practice in geriatric, orthopedic, and orthogeriatric wards, as well as in terminal care, more precisely for the treatment of moderate to severe acute locomotor pain in older adults. Full article
(This article belongs to the Special Issue Enriching Lives: Palliative Care in Geriatrics)

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20 pages, 638 KiB  
Systematic Review
Pharmacological Treatment for Terminal Agitation, Delirium and Anxiety in Frail Older Patients
by Dine A. D. Jennes, Tim Biesbrouck, Maaike L. De Roo, Tinne Smets and Nele Van Den Noortgate
Geriatrics 2024, 9(2), 51; https://doi.org/10.3390/geriatrics9020051 - 18 Apr 2024
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Abstract
Context: Psychological distress symptoms in the last days of life often contribute to the overall symptom burden in frail older patients. Good symptom management practices are crucial to ensure high-quality end-of-life care in an aging population, though the best pharmacological approach to treat [...] Read more.
Context: Psychological distress symptoms in the last days of life often contribute to the overall symptom burden in frail older patients. Good symptom management practices are crucial to ensure high-quality end-of-life care in an aging population, though the best pharmacological approach to treat these psychological symptoms has yet to be established. Objectives: To identify current evidence-based and practice-based knowledge of pharmacological interventions for the treatment of agitation, delirium, and anxiety during the last days of life in frail older patients. Methods: A systematic, mixed methods review was performed through MEDLINE via PubMed and EMBASE from inception until February 2022 and updated through March 2023. National and international guideline databases and grey literature were searched for additional studies and guidelines. Results: Four quantitative studies, two non-randomized and two descriptive, were identified. No randomized controlled trials met inclusion criteria. No qualitative studies were withheld. The three consensus-based protocols that were found through citation searching and screening of grey literature did not meet the standards for inclusion. Haloperidol is recommended in consensus-based guidelines for delirium and is widely used, but high-quality evidence about its efficacy is missing. Better control of agitation or refractory delirium might be achieved with the addition of a benzodiazepine. There is no evidence available about the treatment of anxiety in the last days of life in frail older patients. Conclusions: This mixed methods review demonstrates the lack of good quality evidence that is needed to help clinicians with pharmacological treatment decisions when confronted with psychological symptoms in the last days of life in frail older patients. Population aging will only emphasize the need for further research in this specific population. Full article
(This article belongs to the Special Issue Enriching Lives: Palliative Care in Geriatrics)
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8 pages, 231 KiB  
Perspective
Enriching Lives: Geriatricians’ Mission of Supportive Care for Older Persons
by Virginia Boccardi
Geriatrics 2023, 8(6), 106; https://doi.org/10.3390/geriatrics8060106 - 26 Oct 2023
Viewed by 1571
Abstract
The growing older population, the increasing prevalence of chronic illnesses, and the pressing need to enhance the quality of end-of-life care have underscored the importance for geriatricians to focus on supportive and palliative measures. Within this context, the emphasis on delivering comprehensive and [...] Read more.
The growing older population, the increasing prevalence of chronic illnesses, and the pressing need to enhance the quality of end-of-life care have underscored the importance for geriatricians to focus on supportive and palliative measures. Within this context, the emphasis on delivering comprehensive and person-centered care has become crucial, ensuring that individuals not only receive medical treatment but also experience comfort during chronic illness and in their final days. Nevertheless, a significant number of older individuals often find themselves in hospitals during their last moments, sometimes undergoing aggressive medical interventions even when facing terminal conditions. The challenge lies in the early recognition of the end-of-life phase, initiating timely supportive and palliative care in conjunction with conventional treatments, adopting a multidisciplinary approach, and providing crucial support to grieving family members. Despite being a relatively recent field, geriatric palliative care (GPC) still requires further development. With this perspective, I aimed to shed light on the challenges and best practices for enhancing care for individuals facing chronic critical illnesses and frailty. Full article
(This article belongs to the Special Issue Enriching Lives: Palliative Care in Geriatrics)
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