Effectiveness of a Geriatric Palliative Care Consult on Pain Management and Advance Directives among Older Adults

Abstract

Objectives: 1. Discuss how a geriatric palliative care consult can improve pain management in older adults. 2. Recognize the impact of a geriatric palliative care consultation in quality of life of older adults. I. Background: Palliative care (PC) teams focus on alleviating symptoms, and ensuring that end-of-life (EOL) future health decisions are known and documented through advance directives. The benefit of consultation has been recognized and has therefore evolved from solely EOL care patients to include those with chronic illnesses and symptoms in the hospital, many of them older adults (OA). Potential benefits for OA include managing complex symptoms and completing advance directives (AD). II. Research Objectives: To identify if a geriatric PC consult was effective in managing pain and improving completion of AD for OA at tertiary VA hospital. III. Methods: Retrospective electronic medical record review of OA admitted to a tertiary VA hospital within one year. OA > 65 and received geriatric PC consult. Presence of pain, pain scores, and AD were identified both before and after consult to determine effectiveness. IV. Results: Sixty records reviewed. Mean age of 76.9 years, 97% were male (VA) and average RAND Co-Morbidity Score of 16.87. PC consult lowered pain score from pre-consult to post-consult (2.63 vs. 1.17; P =.012) and effectively eliminated pain in 20% of patients (41.7% vs. 21.7%; P =.002). There was a 22% increase in AD completion after consultation (P = NS). V. Conclusion: Geriatric PC consultation significantly decreased pain scores among OA and eliminated pain in 20% of patients. PC teams have proven to be effective in many areas such as lowering health costs, clarifying goals, but also improving quality of life for OA with chronic diseases. VI. Implications for Research, Policy, or Practice: Larger trials are needed to further elucidate the benefits of PC consultation tailored to OA in the hospital setting. Domain: Structure and Processes of Care.