Palliative Care
	Case 1
	Palliative Care: Slide 3
	Palliative Care: Slide 4
	Case 2
	Palliative Care: Slide 6
	Palliative Care: Slide 7
	Goals of Care in Geriatrics
	Death in the Elderly
	Death in the Elderly (2)
	Death in the Elderly (3)
	Care versus Cure
	The Experience of Dying
	Forced Choices
	Palliative Care
	Palliative Care (cont’d)
	Hospice
	Medicare Covered Hospice Services
	Hospice and Medicare
	Hospice
	Hospice (cont’d)
	Communicating Bad News
	Communicating Bad News (2)
	Step 1: Preparation
	Step 2: Establishing the Patient’s Understanding
	Step 3: What the Patient Wants to Know
	Step 4: Telling the Patient
	Step 4: Telling the Patient (cont’d)
	Step 5: The Prognosis
	Step 6: Responding to Feelings
	Step 7: Follow-up
	Pain Management
	Pain and Aging
	Altered Pain Perception in Aging
	The Reality
	Adverse Psychological Effects of Untreated Pain
	Undertreatment of Cancer Pain
	Barriers to Cancer Pain Management
	Barriers to Cancer Pain Management
	National Hospice Study
	Why is Pain Undertreated? Physician Issues
	Why is Pain Undertreated? Patient Issues
	Assessment
	Perception
	Non-communicative patient pain behaviors
	Goal
	What Really Happens?
	Propoxyphene
	Inadequate Pain Treatment
	Advances In Pain Management
	AGS Guidelines
	New AGS Guidelines
	New AGS Guidelines (2)
	New AGS Guidelines (3)
	What Should Happen
	No Patient...
	Palliative Care: Slide 57
	Palliative Care: Slide 58
	Palliative Care: Slide 59
	Palliative Care: Slide 60
	Palliative Care: Slide 61
	Palliative Care: Slide 62
	Pathophysiologic Classification of Chronic Pain
	Nociceptive Pain
	Neuropathic Pain
	Mixed or Undetermined Pathophysiology
	Psychologically-based Pain Syndromes
	Myth
	Long Acting Opioids
	Long Acting Opioids
	Long Acting Opioids Primarily Used in the U.S.
	Patient Concerns About Taking Opioids
	Physiology v. Psychology
	Pseudo-addiction
	Larger opioid doses
	The Good Side of Opioid Tolerance
	Acetaminophen
	NSAIDs
	TCA’s
	Anticonvulsants
	Tramadol
	Meperidine

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