A lecture presentation of the factors that may influence the life of an elderly or palliative care patient.

1. By: ROMMEL LUIS C. ISRAEL III
B Y : R O M M E L L U I S C . I S R A E L I I I

2.  Loneliness from losing a spouse and friends
 Inability to independently manage regular
activities of living
 Difficulty coping and accepting physical
changes of aging
B Y : R O M M E L L U I S C . I S R A E L I I I

3. Frustration with ongoing medical problems and
increasing number of medications.
It can be magnified when you have an illness
you feel you can’t control (as in the case of
Palliative Care patient).
It may lead to anger or the feeling of not caring
about anything, that may get in the way of the
person’s ability to achieve what he/she want in life.
B Y : R O M M E L L U I S C . I S R A E L I I I

4. Social isolation as adult children are
engaged in their own lives.
Boredom from retirement and lack
of routine activities
B Y : R O M M E L L U I S C . I S R A E L I I I

5. Often seen as the hallmark of ageing is the
physical changes and the vulnerability to
chronic health conditions where it may limit
their mobility, restricting them from their social
contact and may have potentially precipitating
mental health problems, occurrence of other
health problems that maybe secondary to lower
education, lower income, less health knowledge,
and poorer health practices
B Y : R O M M E L L U I S C . I S R A E L I I I

6. Social support networks are transformed into:
- caregiving (many older adults may become
caregivers to others (an older person, such as
a parent or partner, who may be experiencing
cognitive impairment or physical frailty)
- spousal bereavement (Studies indicate that
grieving the death of a partner is frequently a
cause of medical and psychiatric problems for
both older men and older women.)
- social isolation
B Y : R O M M E L L U I S C . I S R A E L I I I

7. Lesbian, gay, bisexual, transsexual, transgender,
two-spirit, intersex or queer (LGBTTTIQ) face
discrimination from people they know, from strangers
and from health care and social service providers.
- Rates of substance use and mental health problems are
high in this community.
- Due to fear of discrimination and stigma, many of them
do not access care.
- They may have developed alternative family structures
(unrecognized/unwelcomed by mainstream services) of
support. Many LGBTTTIQ elderly may have hidden lives
or go “back into the closet” to avoid facing the discrimina
of service providers.
B Y : R O M M E L L U I S C . I S R A E L I I I

8. Palliative care patients find fatigue as a cause in
preventing them from enjoying activities or
engaging with family and friends. Fatigue may
result from a disease, medication, treatment,
poor eating or sleeping patterns, anxiety,
depression, conditions such as anaemia or low
grade infection, uncontrolled pain or other
symptoms may all contribute to it.
B Y : R O M M E L L U I S C . I S R A E L I I I

9. Palliative Care patients may experience Confusion
caused by:
- Elevated body temperature.
- New or higher dose of medications
- Insufficient supply of oxygen to the brain by
any causes (not uncommon in heart or lung disease).
- Brain diseases (brain tumour, stroke).
- Pain or other discomfort.
- The body’s chemical imbalances caused by disease or
- effects of the disease on other organs.
- A combination of the above effects.
B Y : R O M M E L L U I S C . I S R A E L I I I

10. Most of the elderly are more likely to experience
bereavement, a drop in socioeconomic status with
retirement, or a disability.
Depression is common in older adults.
It is more frequent in older women and people
over 85.
B Y : R O M M E L L U I S C . I S R A E L I I I

11. Mild depression and situational depressi
are more frequent
example:
depression in response to
physical or social losses
B Y : R O M M E L L U I S C . I S R A E L I I I

12. Signs and symptoms of depression in the elderly
are often physical rather than emotional:
- changes in sleep patterns
- decline in appetite
- weight loss
- constipation
- minor aches and pains.
Depression in the elderly is associated
with increased morbidity and mortality
B Y : R O M M E L L U I S C . I S R A E L I I I

13. The elderly over 65 have a higher rate of suicide
than other groups:
- men at higher risk than women
- 50% of suicide attempts by people over 65
are successful
- possible causes include depression, anxiety,
physical illness, history of stroke, and being
widowed and living alone, uncertainty and fear
about the ability to influence one’s own dying,
a “weariness of life”
B Y : R O M M E L L U I S C . I S R A E L I I I

14. Most of the elderly experiences loneliness which is
“an unwelcome feeling of loss of companionship, or
feeling that one is alone and not liking it”
(Forbes, 1996, cited in MacCourt, 2004*).
- closely related to depression and an ensuing risk
of suicide.
- highly correlated with physical health, low econom
status and a lack of security and social networks,
highly demonstrated by widowed men and women
than their married counterpart
- determining factor: absence of supportive friends
B Y : R O M M E L L U I S C . I S R A E L I I I

15. Palliative care patients may fear of being in pain,
anticipating that pain may become worse. Most are
also frightened that pain will return.
The symptom of dyspnoea can be a frightening
and debilitating for them.
In pain, there is the inability to take deep breaths an
to cough resulting into accumulation of secretions i
chest, thus, increasing breathlessness.
B Y : R O M M E L L U I S C . I S R A E L I I I

16. Dysphagia (difficulty of swallowing) can also caus
distress to people living with terminal cases.
Lack of appetite can also be felt which may be due
to illness, medicine or treatment, or it may be due
other symptoms such as pain, fatigue, constipatio
sore mouth and/or feelings of anxiety, sadness,
emptiness or frustration.
B Y : R O M M E L L U I S C . I S R A E L I I I

17. Constipation in can also be considered to patients
Terminal cases, and may result from:
- the effects of disease or from the
medicines that the patient is taking,
- lower activity,
- eating and drinking less, and changes in what
the patient is are eating and drinking.
B Y : R O M M E L L U I S C . I S R A E L I I I

18. The elderly may welcome retirement as an opportun
to do things they were not able to do when they wer
still employed. But others may consider this as:
- Limited social network and support system
- Unfavourable change in self-image and identity
- The recognition of their mortality
- Has an impact on a person’s partner where they
both adjust to changing roles and expectations.
While a partner remains in the workforce, the
retiree may experience increased loneliness.
B Y : R O M M E L L U I S C . I S R A E L I I I

19. Many of the elderly cannot afford to pay health cos
prescription drugs.
The elderly may feel inadequate from inability to
continue to work.
The elderly have lower income than their younger
counterparts
They suffer financial stresses from the loss of
regular income
B Y : R O M M E L L U I S C . I S R A E L I I I

20. Majority of the elderly do not work.
They have fewer options for continued incom
They are at risk for rising costs of living, whic
may place them at an economic disadvantage
B Y : R O M M E L L U I S C . I S R A E L I I I

21. Supportive care (palliative care) is proven clinically
effective, but a financial burden which is considere
as the main perceived barrier in a supportive progr
The following are being considered:
cost-utility analysis, outcomes, refractory symp
requiring sedation, and hospitalization among
others.
B Y : R O M M E L L U I S C . I S R A E L I I I

22. There are countries who have their respective
Palliative care projects.
Like in Australia, National Palliative Care Projects (new Funding) has
been there (Closed, 6 August 2014) to support the Australian Government's
commitment to enhance the quality of palliative care service delivery and
increase support for people who are dying, their families and carers where an
Invitation to Apply (ITA) for an open competitive grant round under the
Chronic Disease Prevention and Service Improvement Flexible Fund,
National Palliative Care Projects, has been released with the objective of
delivering nationally focused projects that:
- Improve palliative care education and training of health and aged care
workforce; and
- Identify quality improvements that can assist in improving the delivery
of palliative care services across Australia.
B Y : R O M M E L L U I S C . I S R A E L I I I

23. Nabili, S. N. (no date) Senior Health (Successful Aging): Health and
Disease Prevention - How can social issues affect the life and health
of seniors?. Available at:
http://www.medicinenet.com/senior_health/page3.htm
(Accessed: 1 May 2015)
What factors influence the mental health and social well-being of
older people? (no date) Available at:
http://knowledgex.camh.net/policy_health/mhpromotion/mhp_older_adults
/Pages/factors_mh_wellbeing.aspx
(Accessed: 1 May 2015)
Mental health and older adults (2014) Available at:
http://www.who.int/mediacentre/factsheets/fs381/en/
(Accessed: 1 May 2015)
B Y : R O M M E L L U I S C . I S R A E L I I I

24. Risk factors of ill health among older people (no date)
Available at:
http://www.euro.who.int/en/health-topics/Life-stages/healthy-ageing/data-
and-statistics/risk-factors-of-ill-health-among-older-people
(Accessed: 1 May 2015)
Pain and symptom management for palliative care patients | Palliative
Care Victoria. Available at:
http://www.pallcarevic.asn.au/families-patients/information/pain-symptom-
relief/
(Accessed: 3 May 2015)
Economic Factors Affecting Supportive Care (no date)
Available at:
http://www.onclive.com/publications/obtn/2012/august-2012/Economic-
Factors-Affecting-Supportive-Care
(Accessed: 4 May 2015)
B Y : R O M M E L L U I S C . I S R A E L I I I

25. Australian Government Department of Health (2006) Palliative Care.
Available at:
http://www.health.gov.au/palliativecare
(Accessed: 4 May 2015)
B Y : R O M M E L L U I S C . I S R A E L I I I