TY - JOUR
T1 - The TLC model of palliative care in the elderly
T2 - Preliminary application in the assisted living setting
AU - Jerant, Anthony F
AU - Azari, Rahman S.
AU - Nesbitt, Thomas S
AU - Meyers, Frederick J
PY - 2004/1
Y1 - 2004/1
N2 - Substantial shortfalls in the quality-of palliative care of the elderly can be attributed to 5 fundamental flaws in the way end-of-life care is currently delivered. First, palliative care is viewed as a terminal event rather than a longitudinal process, resulting in a reactive approach and unnecessary preterminal distress in elderly patients suffering from chronic, slowly progressive illnesses. Second, palliative care is defined in terms of a false dichotomy between symptomatic and disease-focused treatment, which distracts attention from the proper focus of healing illness. Third, the decision about whether the focus of care should be palliative is not negotiated among patients, family members, and providers. Fourth, patient autonomy in making treatment choices is accorded undue prominence relative to more salient patient choices, such as coming to terms with their place in the trajectory of chronic illness. Fifth, palliative care is a parallel system rather than an integrated primary care process. A new theoretical framework-the TLC model-addresses these flaws in the provision of palliative care for elderly persons. In this model, optimal palliative care is envisioned as timely and team oriented, longitudinal, collaborative and comprehensive. The model is informed by the chronic illness care, shared decision making, and comprehensive geriatric assessment research literature, as well as previous palliative care research. Preliminary results of an intervention for elderly assisted living residents based on the TLC model support its Promise as a framework for optimizing palliative care of elders.
AB - Substantial shortfalls in the quality-of palliative care of the elderly can be attributed to 5 fundamental flaws in the way end-of-life care is currently delivered. First, palliative care is viewed as a terminal event rather than a longitudinal process, resulting in a reactive approach and unnecessary preterminal distress in elderly patients suffering from chronic, slowly progressive illnesses. Second, palliative care is defined in terms of a false dichotomy between symptomatic and disease-focused treatment, which distracts attention from the proper focus of healing illness. Third, the decision about whether the focus of care should be palliative is not negotiated among patients, family members, and providers. Fourth, patient autonomy in making treatment choices is accorded undue prominence relative to more salient patient choices, such as coming to terms with their place in the trajectory of chronic illness. Fifth, palliative care is a parallel system rather than an integrated primary care process. A new theoretical framework-the TLC model-addresses these flaws in the provision of palliative care for elderly persons. In this model, optimal palliative care is envisioned as timely and team oriented, longitudinal, collaborative and comprehensive. The model is informed by the chronic illness care, shared decision making, and comprehensive geriatric assessment research literature, as well as previous palliative care research. Preliminary results of an intervention for elderly assisted living residents based on the TLC model support its Promise as a framework for optimizing palliative care of elders.
KW - Aged, 80 and over
KW - House calls
KW - Palliative care
KW - Residential facilities
KW - Signs and symptoms
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U2 - 10.1370/afm.29
DO - 10.1370/afm.29
M3 - Article
C2 - 15053284
AN - SCOPUS:2142813891
VL - 2
SP - 54
EP - 60
JO - Annals of Family Medicine
JF - Annals of Family Medicine
SN - 1544-1709
IS - 1
ER -