The value of allied health at end of life

A blog by Dr Olivia Farrer, Teaching Program Director and Lecturer in Nutrition and Dietetics, Flinders University, and ELDAC Postdoctoral Research Fellow

Approximately 407,000 people were using aged care, home care or transition care in Australia and an additional 818,000 people were assisted under the Commonwealth Home support program, based on 2022 data. [1] In aged care, approximately 2% of the ageing population will need palliative care but many more older adults are likely to benefit from palliative services as they approach their end of life.

Outside of hospice or acute care, palliative care is often delivered by primary health care professionals, including allied health.[2] This is particularly true for the palliative care of older adults in residential aged care, or ageing in place in their own homes. Older adults are likely to have multimorbidity [3], making palliative health management more complex. As a result, older people will likely experience more rapid loss of independence and function, particularly in activities of daily living as their condition deteriorates. As palliative care can be weeks, months, or even years in length, allied health professionals’ provision of palliative care has the advantage of supporting continuity of care, particularly at a time when the individual’s needs may be rapidly changing.

Allied health professionals who should be involved in palliative and end of life care include physiotherapists, occupational therapists, dietitians, speech pathologists, social workers, and pharmacists (amongst others), and some of their key roles are:

• Providing support to manage physical symptoms including support related to medication, nutrition, communication, and mobility.
• Assisting people to maintain their functionality and independence.
• Providing therapies that focus on improving the person’s quality of life.
• Sharing information about disease progression and providing education for people living with a life-limiting illness, their families, and carers.

When working in a palliative care context, allied health professionals may also provide psychological support, social support, pastoral care, and in some cases even bereavement support. The continuity of care offered by regular allied health care during palliative care may also foster incidental conversations around end of life, which may help to raise timely referrals to the broader health care team. In a study by Morgan et al [4], individuals were asked about their experience of end of life, and a key theme was the feeling of disrupted function as their physical health deteriorated, but a desire to stay functional and useful for as long as possible. Allied health professionals (even when working as an independent provider) should work as part of the multidisciplinary care team to deliver a care plan that is considerate of the person's goals.

At present, with the current funding schedules, there are no mandatory timings or frequencies for allied health input. However, the literature has demonstrated in a variety of settings, including palliative care, that the patient experience is enhanced where interprofessional care is provided. While there is a paucity of literature to guide best practice palliative and aged care allied health interventions, there is some evidence to suggest that allied health input has the potential for positive outcomes. Several studies in older adults and an aged care and palliative context, have noted improvement in quality of life measures for the individual and carers, improved independence in activities of daily living, better mobility and balance, as well as sleep and cognition. [5-7]

Palliative care requires a broad clinical skillset, and confidence to individualise care plans which at times may include difficult conversations. For allied health professionals who are interested in improving their skills in palliative care, the ELDAC Allied Health Toolkit contains resources to support best practice, including forms to identify patient needs and allied health referral; links to allied health professional websites to find local allied health practitioners; and more information on each profession that can offer support to an older adult receiving palliative care.

References

1. Australian Institute of Health and Welfare (AIHW), (2023) People using aged care accessed 13^th October 2023. https://www.gen-agedcaredata.gov.au/Topics/People-using-aged-care.
2. Palliative Care Australia, (2018) Palliative care service development guidelines accessed 29^th Sept 2023, https://palliativecare.org.au/wp-content/uploads/dlm_uploads/2018/02/PalliativeCare-Service-Delivery-2018_web2.pdf.
3. Australian Institute of Health and Welfare (AIHW), (2023) Older Australians – Health, accessed 13^th October 2023, https://www.aihw.gov.au/reports/older-people/older-australians/contents/health/health-disability-status.
4. Morgan DD, Currow DC, Denehy L, Aranda SA. Living actively in the face of impending death: constantly adjusting to bodily decline at the end-of-life. BMJ Support Palliat Care. 2017 Jun;7(2):179-188. doi: 10.1136/bmjspcare-2014-000744.
5. Ćwirlej-Sozańska A, Wójcicka A, Kluska E, Stachoń A, Żmuda A. Assessment of the effects of a multi-component, individualized physiotherapy program in patients receiving hospice services in the home. BMC Palliat Care. 2020 Jul 9;19(1):101. doi: 10.1186/s12904-020-00600-6.
6. Cousse S, Gillibert A, Salaün M, Thiberville L, Cuvelier A, Patout M. Efficacy of a home discharge care bundle after acute exacerbation of COPD. Int J Chron Obstruct Pulmon Dis. 2019 Jan 22;14:289-296. doi: 10.2147/COPD.S178147.
7. Baggetta R, D'Arrigo G, Torino C, ElHafeez SA, Manfredini F, Mallamaci F et al. Effect of a home based, low intensity, physical exercise program in older adults dialysis patients: a secondary analysis of the EXCITE trial. BMC Geriatr. 2018 Oct 20;18(1):248. doi: 10.1186/s12877-018-0938-5.

 

Dr Olivia Farrer
Postdoctoral Research Fellow, ELDAC