The Occupational Therapist (OT) role in working with an older adult receiving palliative care at the end of life is the assessment, management and support in maintaining independence and ability to participate in meaningful activities such as self-care and leisure activities.
The Occupational Therapist liaises within the interprofessional care team to promote best outcomes. OT’s who work with older adults receiving palliative care at the end of life may contribute in numerous ways during end of life:
- Assessment for people approaching the end of life is often observational and functional, and the mode is determined by disease progression, presenting symptoms, along with patient and carer priorities, values and emotional state.
- Standardised screening tools may be used in some settings to measure symptoms such as (some of these can be found in the ELDAC Clinical Tools page):
- Fatigue (Brief Fatigue Inventory)
- Breathlessness (Modified Borg Breathlessness Scale)
- Falls risk assessments and pressure risk screens may also be conducted (e.g., Norton Pressure Sore Risk Assessment Scale or the Braden Scale)
Additionally, standardised cognitve assessments used by occupational therapists in palliative and end-of-life care may include the Montreal Cognitive Assessment (MOCA), the Rowland Universal Dementia Assessment Scale (RUDAS) or the MMSE (Mini Mental State Examination). However, it is important to note that standardised assessments around goal setting must be used with care as not all people approaching the end of life relate to goal oriented language and may find it confronting. Priorities is an alternative term that may be more meaningful, tools that may be useful.
Further services an OT might provide
- Assisting with non-pharmacological management of symptoms such as fatigue, breathlessness, pain and anxiety through assessment, education, counselling, relaxation techniques, task redesign and skilled equipment prescription (see general tools and resources).
- Providing support to the person to remain in/return to the place of care of their choice through assessment, intervention and care co-ordination.
- Providing expert assessment of the person’s ability to manage as safely and independently as possible within their own home. Assessment and intervention often occur simultaneously and may include the following:
- prescription of and training for patients and carers in the use of assistive equipment such as wheelchairs, pressure relieving devices (cushions and mattresses), showering and toileting equipment
- environmental modifications when appropriate.