Integrative Palliative Care for Geriatric Population

Globally, an estimated 56.8 million people each year need palliative care, yet only 14% receive it. Integrative palliative care for the geriatric population can provide significant benefits by relieving symptoms and improving the quality of life for those with a serious illness while also offering support and comfort to their families.

Integrative palliative care offers the geriatric population a nonpharmacologic, patient-centered approach to addressing their unique needs and enhancing their well-being. Integrative therapies in palliative care provide additional relief and support for these patients that are lacking in conventional care.

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What is Palliative Care?

Palliative care is specialized care for people living with a serious illness that is not intended to treat or cure a condition but rather to provide symptom relief and improve quality of life. It may be used in addition to care intended to cure a serious illness, but palliative care is provided to the patient and their family with a focus on comfort and quality of life.

Palliative care is sometimes thought of as end-of-life care, and for some, it may be. But it's also provided to those with a serious illness that are not in the end-of-life stage. In addition to symptom relief and improving quality of life, palliative care helps patients and their families understand their options for medical treatment and helps with planning for advanced care for when the patient is unable to make decisions.

This specialized type of care is provided by palliative care doctors, nurses, and other professionals such as nutritionists, chaplains, social workers, and caregivers.

Integrative Approach to Palliative Care in Geriatric Population

An Integrative approach to palliative care in the geriatric population offers non-pharmacologic support to improve quality of life, reduce symptoms, and enhance well-being. Integrative therapies used in palliative care may include acupuncture, tai chi, aromatherapy, massage therapy, meditation, and music therapy.

Integrative palliative care offers seniors a patient-centered, whole-person approach for relief during this stage, whether nearing end-of-life or in treatment for a serious condition. It's an approach that invites the patient into the therapeutic relationship and addresses all dimensions of a person's health, including mind, body, spirit, environment, and relationships.

When Should Someone Be Offered Palliative Care?

Palliative care should be offered to someone who has discomfort and disability and needs symptom relief for any diagnosis or stage of the disease. This may include older adults with a newly diagnosed serious illness, a chronic debilitating condition, a terminal illness, older people who need extra care, or someone in the end-of-life stage.

Palliative care may be offered to someone undergoing cancer treatment to reduce side effects, or it may be provided to someone with debilitating arthritis. It is provided to relieve symptoms and improve comfort and quality of life, regardless of whether the patient's illness is terminal or nearing end-of-life stages. This care should be offered from the time of diagnosis until the end of treatment for a curable disease or until the end of the person's life.

Is Palliative Care the Same as Hospice?

While palliative care and hospice care share similarities, they are different. Hospice care is provided for people with terminal illnesses if their doctor believes they may die within six months. These types of care are similar in their goals of providing comfort and improving quality of life. However, hospice care is provided when there is no cure for an illness, when a patient isn't responding to treatment, or when a patient chooses not to go through with treatment.

Palliative care may be provided in conjunction with treatments to cure an illness. But with hospice care, there is no longer an attempt to cure the disease. Like palliative care, hospice care provides symptomatic relief and quality-of-life care for the patient and supports the family in this end-of-life stage. A person may receive palliative care in conjunction with treatment for an illness and then transition to hospice care if treatments fail or the patient chooses to discontinue treatment.

Functional Medicine Labs to Ensure Comfort During Palliative Care

Functional laboratory testing for older adults receiving palliative care should center around the patient's specific serious illness and care goals. When palliative care is provided as end-of-life care, minimal testing is performed, and the focus is placed on patient comfort and support. When palliative care is provided as an adjunct to treatment, an integrative medicine physician may order several functional laboratory tests to assess health and monitor treatment. The following are common tests that may provide helpful information in directing care:

Comprehensive Stool Analysis

Comprehensive stool testing provides information about the patient's digestion and absorption, which can be helpful information to determine whether a patient requires additional digestive support to improve their gut health and nutritional status. This test can also provide information about inflammation, immune response, and the health of the microbiome (the collection of microorganisms in the gut). This may be helpful in palliative care to determine whether inflammation, immune, or microbiome support will provide relief.

Micronutrients Panel

Malnourishment is common in older adults, contributing to frailty and poor health outcomes. This Micronutrients Panel is a valuable way to determine whether deficiencies or insufficiencies are present in 40 different vitamins, minerals, amino acids, and fatty acids to support the patient's health and well-being best. This test also measures Vitamin D3 levels, although a Vitamin D test can be tested separately.

Hormone Testing

Patients on palliative care are likely under significant stress and may even struggle to sleep well. The DUTCH Complete hormone test is a convenient urine test that assesses sex and adrenal hormones and their metabolites to determine the impact of stress on the hormone system. It also measures a daily free cortisol rhythm and melatonin, hormones that help regulate the body's natural 24-hour cycle or circadian rhythm. This information may help determine an effective method of improving the patient's sleep and supporting their stress response.

Blood Workup

Blood testing can provide information that may help direct palliative care. A CMP provides information about blood glucose, kidney function, and liver function, and can aid in determining whether a patient is dehydrated, a common finding in older adults. A CBC provides information that could help determine whether the patient has an infection or is anemic. Markers for inflammation, such as CRP and ESR, can also be tested in the blood to determine treatment effectiveness or whether measures need to be taken to reduce inflammation.

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Functional Medicine Treatment Plan for Palliative Geriatric Patients

A functional medicine treatment plan for palliative geriatric patients provides non-pharmacologic support for symptom relief, improved quality of life, and enhanced well-being. Treatment follows a patient-centered approach, acknowledging the importance of the mind, body, and spirit connections.

Exercise is a lifestyle-based intervention that may be incorporated into a functional medicine palliative care treatment plan. This randomized controlled trial showed improved fatigue and other symptoms for palliative care cancer patients engaged in a physiotherapy program, including active exercises, myofascial release, and proprioceptive neuromuscular facilitation techniques.

Sleep support, stress management, and ensuring social support are other important aspects of a functional medicine palliative care plan to enhance well-being and quality of life.

Nutritional Support for Palliative Patients

Nutrition support for palliative care patients includes ensuring hydration and nutrient needs are met in a supportive way. When the patient can get their nutrition orally (versus enteral or parenteral feeding), the focus should be on anti-inflammatory, nutrient-dense, easily digestible foods high in protein and healthy fats to meet their energy requirements, maintain a healthy weight, and support their nutritional status and health.

Palliative care patients often have a higher energy requirement than usual. Protein demand can be 1.5 to 2 grams per kilogram of body weight for a palliative care patient versus 0.8 grams per kilogram of body weight for a typical healthy person.

High-quality protein powders may offer an option that is easy to consume, digest and assimilate for palliative care patients in addition to their other food intake.

Supplements and Herbs in Palliative Care

There are supplements that functional medicine practitioners may incorporate into the care plan of a geriatric patient on palliative care. Here are three supplements that can provide palliative care support:

Vitamin D3 for Palliative Care

Vitamin D is essential for many aspects of health and well-being, and evidence indicates it may be helpful in palliative care. This study found Vitamin D supplementation improved pain and reduced infections for palliative care cancer patients.

Omega-3 for Palliative Care

Omega-3 is known for its anti-inflammatory properties. A systematic review of omega-3 supplements used for patients in chemotherapy or radiotherapy showed beneficial effects, with the most evident being the preservation of body composition.

Vitamin C for Palliative Care

Vitamin C is another important antioxidant in the body. Evidence shows Vitamin C may be helpful for palliative care patients to improve various aspects of quality of life, including loss of appetite, fatigue, physical and cognitive function, nausea, and vomiting.

Complementary and Integrative Medicine For Geriatric Patients

Complementary and Alternative Medicine (CAM) for geriatric patients offers gentle, nonpharmacologic relief for various symptoms common in palliative care, such as pain, nausea, and vomiting.

This systematic review of CAM therapies used in hospice and palliative care shows how these modalities can support these patients. Massage therapy and massage therapy combined with meditation provided pain relief and improved quality of life. Music therapy provides anxiety and pain relief. Reiki was also shown to reduce pain intensity.

Another systematic review found acupuncture helpful for pain relief for palliative care patients with cancer.

When used in palliative care, yoga, meditation, breathing techniques, and yoga nidra also improve quality of life.

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Summary

Integrative palliative care for the geriatric population offers a well-rounded, patient-centered approach to symptom relief, supporting well-being, improving quality of life, and providing comfort and support to families. Palliative care is offered to people with a debilitating chronic disease, such as severe osteoarthritis, or with a terminal condition, such as cancer.

Integrative palliative care combines conventional care with nonpharmacologic therapies, such as supplements and massage therapy, to provide the patient with symptom relief and support a better quality of life for patients with serious illnesses.

Palliative care is most beneficial when it is begun after a diagnosis so the patient can start to experience relief and improvements in quality of life. It should be continued until the serious illness is treated or until the end of the patient's life.

If you are experiencing a serious illness, consider discussing with your integrative medicine practitioner to explore if integrative palliative care might be beneficial for you.