End of Life Care in Frailty: Rehabilitation
The aim of this guidance series is to support clinicians and others to consider the needs of frail older people as they move towards the end of their lives and help them to provide high quality care.
This chapter looks at maintaining independence and function in older people towards the end of life. Please click here to view the other chapters in this series.
Rehabilitation is a cornerstone of care of geriatric medicine, extending to older people with severe frailty. In the last phase of life, rehabilitation is essential in facilitating patient-centred goals, focusing on function and enablement. Living a normal life and maintaining independence for as long as possible become important routes to preserving dignity and a sense of self in the face of advancing illness.1
Rehabilitative palliative care integrates rehabilitation, enablement, self-management and self-care into the holistic model of palliative care.2 It provides an interdisciplinary framework through which all members of the team can enable older people living with frailty to participate as fully as possible in all aspects of their daily lives. It represents an important route for people to fulfill meaningful goals, maintain independence and dignity and to adapt constructively to the uncertainty and loss that is often intrinsic in the lived experience of advancing age and frailty at the end of life.3
Why is rehabilitation important?
Maintaining independence, normality and participation in everyday life are high priorities for people in older age and at the end of life. To enable us to support peoples’ personal priorities we first need to know what these are. Older people living with frailty have diminished functional homeostasis and ability to withstand illness without a loss of function, which places them at higher risk of sudden deterioration in their physical health or wellbeing. Evidence supports the safety and effectiveness of rehabilitative approaches to improve and maintain physical health and function in older people.4
Adopting a rehabilitative approach
Best practice initiatives
Person-centred goal setting
- ‘What matters to you?’
Focus on function
- What’s going well for you right now
- Evans CJ, Ison L, Ellis-Smith C, Nicholson C, Costa A, Oluyase AO, Maddocks M. Service Delivery Models to Maximize Quality of Life for Older People at the End of Life: A Rapid Review. Milbank Quarterly 2019;97(1):113-175.
- Tiberini R and Richardson H. Rehabilitative palliative care: enabling people to live fully until they die. A challenge for the 21st century. Hospice; 2015. ISBN:978-1-871978-91-9. Available at: https://www.hospiceuk.org/what-we-offer/clinical-and-care-support/rehabilitative-palliative-care
- Tiberini R, Turner K, Talbot-Rice H, Rehabilitation in Palliative Care. In: Textbook of Palliative Care, R MacLeod, L Block editors. Springer; 2018. Available at: https://doi.org/10.1007/978-3-319-31738-0_34-1
- Crocker T, Forster A, Young J, et al. Physical rehabilitation for older people in long-term care. Cochrane Database Syst Rev. 2013;2.
- Fettes L, Ashford S, Maddocks M. Setting and implementing patient-set goals in palliative care. 2018. Available at: https://www.kcl.ac.uk/cicelysaunders/research/studies/oacc/gas-booklet-2018-final.pdf
- Boa S, Duncan E, Haraldsdottir E, Letford A, Brabin E, Wyke S. Development, implementation and evaluation of a theory based goal setting framework for use in palliative care (G-AP-PC). BMJ Supportive & Palliative Care. 2014; 4. Available at: https://spcare.bmj.com/content/4/Suppl_1/A4.2
- Baron S, Stanley T, Colomina C, Pereira T. Strengths-based approach: Practice Framework and Practice Handbook. Department of Health and Social Care. 2019. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/778134/stengths-based-approach-practice-framework-and-handbook.pdf
- Morgan S, Williamson T. How can positive risk taking build dementia friendly communities? Joseph Rowntree Foundation. 2014. Available at: https://www.jrf.org.uk/sites/default/files/jrf/migrated/files/Positive-risk-taking-dementia-summary.pdf