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

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:

				I. Agren Bolmsjo Review Article: End-of-Life Care for Old People: A Review of the Literature American Journal of Hospice and Palliative Medicine, August 1, 2008; 25(4): 328 - 338. [Abstract] [PDF]

				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]

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

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