Palliative Care for the Elderly — Dignity and Relief Until the Very End

Palliative care refers to the holistic treatment of patients with advanced disease and a limited life expectancy. This means that a cure is no longer possible and the patient will die from their illness within the foreseeable future.

Palliative care supports the patient during this time. It has the following goals, as modified by the WHO:

• Pain control and alleviation of suffering,
• Addressing the patient’s psychological and spiritual needs,
• Involving the patient’s family,
• Providing care and support at the time of death.

After the patient’s death, palliative care offers support to the family in coping with their loss.

In the case of colon cancer, there are no definitive laboratory or imaging criteria that indicate the need to initiate palliative care.

However, the following list summarizes some key indicators:

• Liver failure due to liver metastases, making chemotherapy no longer possible,
• advanced cachexia (wasting),
• intestinal obstruction caused by abdominal metastases,
• severe ascites,
• diminishing will to live.

Indications that the tumor could not be completely eradicated by previous treatments include:

• tumor spread,
• tumor-induced narrowing of the intestine, and
• metastasis.

These signs suggest that the patient may be entering the palliative care phase of the disease and approaching death. In older patients with frailty syndrome, the transition to the palliative care phase may occur earlier and requires a particularly sensitive assessment.

• Constipation,
• nausea and vomiting,
• heartburn,
• abdominal distension, e.g., due to abdominal fluid (ascites) or gas in the intestines,
• Pain, both visceral and neuropathic,
• Wasting (cachexia)—closely linked to the risk of malnutrition in older adults,
• Loneliness,
• despair—often associated with depression in older adults.

Contemporary medicine is highly technology-oriented. However, especially during the palliative care phase of the disease, technical treatment methods are not the primary focus. Rather, the emphasis is on comprehensive general care, even outside of palliative care units.

Treatment is guided by the symptoms listed above. However, many patients have a strong desire for conversation. The fact that this desire is now harder to fulfill than in the past is linked to staff reductions and the high level of bureaucracy in the healthcare system.

In palliative care for colon cancer, human connection matters more than further treatments © Photographee.eu | AdobeStock

Patients know how they are doing through self-observation and changes in the behavior of their caregivers. For a long time, the hope of curing the cancer takes center stage. Eventually, however, this gives way to the desire to avoid suffering during the final phase of life. Above all, they need spiritual support from chaplains or family members.

Medical procedures, such as a paracentesis or blood transfusion, should be performed only with the aim of alleviating suffering.

With a living will—and even better, supplemented by a power of attorney for healthcare—the patient can determine

• which treatments should still be provided and
• which should be withheld,

should they become confused. A structured geriatric assessment is also recommended, particularly for older patients, to realistically evaluate treatment goals and limits. Patients also feel reassured when they know that their passing will be easier—for example, through terminal sedation—and that their loved ones will be cared for. Addressing polypharmacy in older adults early on and implementing targeted deprescribing can reduce unnecessary burdens during this phase.