The TLC Model of Palliative Care in the Elderly: Preliminary Application in the Assisted Living Setting
The TLC Model of Palliative Care in the Elderly: Preliminary Application in the Assisted Living Setting 1 Anthony F. Jerant, MD ABSTRACT 2 Rahman S. Azari, PhD Substantial shortfalls in the quality of palliative care of the elderly can be attrib- Thomas S. Nesbitt, MD, MPH1 uted to 5 fundamental fl aws in the way end-of-life care is currently delivered. First, palliative care is viewed as a terminal event rather than a longitudinal 3 Frederick J. Meyers, MD process, resulting in a reactive approach and unnecessary preterminal distress in 1Department of Family and Community elderly patients suffering from chronic, slowly progressive illnesses. Second, pal- Medicine, University of California Davis liative care is defi ned in terms of a false dichotomy between symptomatic and dis- School of Medicine, Sacramento, Calif ease-focused treatment, which distracts attention from the proper focus of healing 2Department of Statistics, University of illness. Third, the decision about whether the focus of care should be palliative is California Davis School of Medicine, not negotiated among patients, family members, and providers. Fourth, patient Sacramento, Calif 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 3Department of Internal Medicine, Univer- trajectory of chronic illness. Fifth, palliative care is a parallel system rather than an sity of California Davis School of Medicine, Sacramento, Calif integrated primary care process. A new theoretical framework—the TLC model— addresses these fl aws in the provision of palliative care for elderly persons. In this model, optimal palliative care is envisioned as timely and team oriented, longi- tudinal, collaborative and comprehensive.
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