Principles of Geriatric Palliative Care

Albert J. Kirshen, MD, MSc, FRCPC, FACP,
Certificate of Special Competence in Geriatric Medicine Assistant Professor--
Geriatric Medicine, University of Toronto, ON
Program Director--Palliative Care, Baycrest Centre for Geriatric Care, Toronto, ON, Academic Program Coordinator--The Temmy Latner Centre for Palliative Care, Mount Sinai Hospital, Toronto, ON.


Imagine a 92-year-old cognitively impaired woman tied into a chair with a lap belt. This woman lives in her own home and is assisted with all activities of daily living by her devoted daughter. To her daughter, this woman looks as if she is in pain and has trouble with breathing and constipation. Her daughter can't convince the physician, who never visits, the nurse, who visits once a month, or her own husband that mum has problems and she can't get any effective help in dealing with these issues.

Over a period of three months mum's appetite declines. She loses interest in playing rummy, listening to her grandchild sing, or watching the roses grow outside her window. Eventually she dies a withered death, impaled on her own feces.

This case could equally and as easily apply to someone younger, someone institutionalized, or even your relative. As we all know, significant parts of this situation--at the very least in keeping this senior comfortable--can be remedied.