Palliative and End-of-Life Care
Palliative care is an interdisciplinary approach that aims to improve quality of life for people living with serious illness and their families by anticipating, preventing, and relieving suffering across physical, psychological, social, and spiritual domains. End-of-life care is the part of this continuum focused on the last phase of life. In geriatric practice the approach is central because older adults frequently live with multiple chronic conditions, frailty, and limited prognosis.
Definition
Palliative care is an approach that improves the quality of life of patients and families facing problems associated with life-threatening or serious illness, through prevention and relief of suffering by early identification, assessment, and treatment of pain and other physical, psychosocial, and spiritual problems; end-of-life care denotes its application during the final period of life.
Scope
This area orients the reader to palliative and end-of-life care as practised within geriatric medicine. It frames three connected topics: clarifying goals of care and planning ahead, relieving distressing symptoms near the end of life, and assessing decision-making capacity together with surrogate decision-making. It is a reference overview of how the field is organised, not a manual for managing an individual patient.
Sub-topics
Core questions
- What distinguishes palliative care from hospice and from disease-directed treatment?
- How are a patient's values translated into goals of care?
- How is suffering assessed and relieved across multiple domains near the end of life?
- Who decides when a patient can no longer decide, and on what basis?
Key concepts
- Total pain and multidimensional suffering
- Goals of care
- Advance care planning
- Hospice versus palliative care
- Quality of life as an outcome
- Interdisciplinary team care
- Prognostic uncertainty in serious illness
Mechanisms
Palliative care is organised around concurrent attention to four domains of distress: physical (such as pain, dyspnoea, and nausea), psychological, social, and spiritual. Care is delivered by an interdisciplinary team and can be offered alongside disease-directed treatment rather than only after it is stopped. A defining contribution to the field was evidence that introducing palliative care early in the course of serious illness, rather than reserving it for the final days, can improve patient-reported quality of life (Temel, 2010). Consensus guidelines structure the field into domains of care and emphasise that palliative care is appropriate at any stage of a serious illness (Ferrell, 2018; Radbruch, 2020).
Clinical relevance
Palliative and end-of-life care describe how clinicians and teams understand and respond to serious illness in older adults; the area is presented to explain concepts, terminology, and the structure of the field. It is reference-educational and does not provide prescriptive instructions for the care of any individual patient.
Epidemiology
Serious illness and the need for palliative care rise steeply with age, and older adults account for a large share of deaths in high-income health systems. Multimorbidity, frailty, and dementia make prognosis uncertain and goals-of-care conversations common in geriatric settings (Kelley, 2015).
Evidence & guidelines
The National Consensus Project Clinical Practice Guidelines for Quality Palliative Care, now in their fourth edition, define the domains and standards of the field (Ferrell, 2018). An international consensus has proposed a revised definition of palliative care emphasising suffering and serious illness rather than prognosis alone (Radbruch, 2020). Randomised evidence supports integrating palliative care early in serious illness (Temel, 2010).
History
The modern hospice and palliative care movement is usually traced to Cicely Saunders and the founding of St Christopher's Hospice in London in 1967, where the concept of total pain was articulated. Over subsequent decades palliative care developed as a distinct field and was increasingly integrated into mainstream medicine, broadening from cancer to other serious illnesses and from the dying days to earlier in the disease course (Kelley, 2015; Radbruch, 2020).
Debates
- When should palliative care be introduced?
- There is broad agreement, supported by trial evidence, that palliative care can be offered early and concurrently with disease-directed treatment rather than only at the very end of life, but how to operationalise early integration across diseases and settings remains an active question.
Key figures
- Cicely Saunders
- Diane Meier
- R. Sean Morrison
- Jennifer Temel
Related topics
Seminal works
- temel-2010
- kelley-2015
- ferrell-2018
Frequently asked questions
- Is palliative care the same as hospice?
- No. Hospice is one form of care, typically delivered late in a terminal illness when disease-directed treatment has stopped. Palliative care is broader: it can be provided at any stage of a serious illness, alongside treatments intended to cure or control the disease.
- Is palliative care only for people who are dying?
- No. It focuses on relieving suffering and improving quality of life for anyone with a serious illness, and consensus definitions deliberately frame it around suffering and illness severity rather than a fixed prognosis.