Document Detail


The TLC model of palliative care in the elderly: preliminary application in the assisted living setting.
MedLine Citation:
PMID:  15053284     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Anthony F Jerant; Rahman S Azari; Thomas S Nesbitt; Frederick J Meyers
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Annals of family medicine     Volume:  2     ISSN:  1544-1709     ISO Abbreviation:  Ann Fam Med     Publication Date:    2004 Jan-Feb
Date Detail:
Created Date:  2004-03-31     Completed Date:  2004-04-22     Revised Date:  2013-06-09    
Medline Journal Info:
Nlm Unique ID:  101167762     Medline TA:  Ann Fam Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  54-60     Citation Subset:  IM    
Affiliation:
Department of Family and Community Medicine, University of California Davis School of Medicine, Sacramento, Calif 95817, USA. afjerant@ucdavis.edu
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Assisted Living Facilities / organization & administration*
California
Female
Health Services for the Aged / organization & administration*
Humans
Male
Models, Organizational
Palliative Care / methods,  organization & administration*
Patient Care Planning / organization & administration*
Program Evaluation
Prospective Studies
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