Annals of Family Medicine Annals Impact Factor is 4.5
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

Annals of Family Medicine 2:54-60 (2004)
© 2004 Annals of Family Medicine, Inc.
doi: 10.1370/afm.29
This Article
Right arrow Figures Only
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow TRACK Comments: Submit a response
Right arrow TRACK Comments: View responses
Right arrow Alert me when this article is cited
Right arrow Alert me when TRACK Comments are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Jerant, A. F.
Right arrow Articles by Meyers, F. J.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Jerant, A. F.
Right arrow Articles by Meyers, F. J.

Article

The TLC Model of Palliative Care in the Elderly: Preliminary Application in the Assisted Living Setting

Anthony F. Jerant, MD1, Rahman S. Azari, PhD2, Thomas S. Nesbitt, MD, MPH1 and Frederick J. Meyers, MD3

1 Department of Family and Community Medicine, University of California Davis School of Medicine, Sacramento, Calif
2 Department of Statistics, University of California Davis School of Medicine, Sacramento, Calif
3 Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, Calif

CORRESPONDING AUTHOR: Anthony F. Jerant, MD, Department of Family and Community Medicine, University of California Davis School of Medicine, 4860 Y Street, Suite 2300, Sacramento, CA 95817, afjerant{at}ucdavis.edu

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.

Key Words: Palliative care • residential facilities • aged, 80 and over • house calls • signs and symptoms




This article has been cited by other articles:


Home page
 GerontologistHome page
R. L. Kane and J. R. Mach Jr.,
Improving Health Care for Assisted Living Residents
Gerontologist, December 1, 2007; 47(suppl_1): 100 - 109.
[Abstract] [Full Text] [PDF]

Home page
 Ann Fam MedHome page
K. C. Stange
In this Issue: Multimethod Research
Ann. Fam. Med, January 1, 2004; 2(1): 2 - 3.
[Full Text] [PDF]

TRACK Comments:

Read all TRACK Comments

Improving palliative care for the elderly: Moving a model forward
Joshua M. Hauser
Annals of Family Medicine, 2 Feb 2004 [Full text]
Will Better Assessment Enhance End-of-Life Care?
David R. Mehr
Annals of Family Medicine, 24 Feb 2004 [Full text]
One Small Step Toward a Comprehensive Approach to Palliative Care in the Elderly
Anthony F. Jerant
Annals of Family Medicine, 2 Mar 2004 [Full text]

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Copyright © 2004 by the Annals of Family Medicine.