Assess Palliative Care Needs

Each older person will have an individual symptom profile and requires a comprehensive assessment undertaken by a clinician or palliative care specialist.

Symptom Assessment Scale (SAS)

The SAS can be used as a self-report tool and provides a report of whether a symptom is present and an indication of the impact of that symptom. The SAS is based on a rating scale of seven common symptoms and has space to add additional symptoms. SAS also allows for rating by proxy when assessing an older person who has cognitive impairment or is non-verbal. The Palliative Care Outcomes Collaboration (PCOC) has a brochure explaining the Symptom Assessment Scale (577kb pdf).

Where a symptom has been identified, further assessment using specific tools can provide more details that might help identify the underlying cause of the symptom or assist with treatment options. The following is a suggested list of tools in addition to the SAS.

Comprehensive Pain Assessment

• The Brief Pain Inventory (short form) (51kb pdf) can be used to assess the severity of pain and the impact of pain on daily functions.

Dyspnoea (shortness of breath) Assessment

• Modified Borg Scale (mBORG) (182kb pdf) is used to measure the self-reported intensity of the sensation of breathlessness with a numeral rating linked to verbal descriptors..

Delirium Assessment

• 4AT (273kb pdf). A validated screening tool used as an initial assessment to detect delirium and cognitive impairment.

Nutrition Assessment

• The Mini-Nutritional Assessment Short-Form (MNA®-SF) (91kb pdf) is a screening tool used to identify older adults over 65 years of age who are malnourished or at risk of malnutrition.

Oral Health Assessment

• The Oral Health Assessment Tool (559kb pdf) is used to assess older people who are unable to reliably self-report and when a clinical assessment of oral health status is required.

Frailty Assessment

• Clinical Frailty Scale (Rockwood) (131kb pdf) is used to assess the degree of frailty.

Pressure Ulcer Risk

• The Braden Pressure Ulcer Risk Assessment (958kb pdf) evaluates risk for pressure ulcer development.

For people with cognitive impairment or dementia see the ELDAC Dementia Toolkit Assess Palliative Care Needs section for specific tools.

This domain explores the person’s experience in relation to:

• their background
• family and carers support
• emotional and social support
• practical concerns, and
• impact on their usual functioning.

For instance, consider the older person’s:

• Experience of family/carers and relationships: 'Do you have any concerns or worries about your family/carers or personal relationships?'
• Experience of support: 'Who is around to support you? What kind of support do they give? Has this been helpful?'
• Practical concerns, including any worries about finances, sorting affairs, and advance care planning.

The Needs Assessment Tool for Carers (NAT-CC-Caring for you) (148kb pdf) is a self-reported tool for carers supporting someone with a chronic illness. The tool identifies the care needs of someone living with a chronic condition, and the level of concern this causes the carer. This provides prompts for the carer and/or the health professional to discuss these issues.

Older people with life-limiting conditions often have psychological concerns. These can include anxiety, depression, and past experiences of trauma. Proactive assessment of these concerns is important.

• An open question such as 'Is there anything worrying you?' can be a helpful place to start.
• Depression is common in older people. The Kessler Psychological Distress Scale (K10) (64kb pdf)) is a simple clinician administered measure of psychological distress as a measure of outcomes following treatment for common mental health disorders. The K10 asks 10 self-reported questions with a 5-value scale. The maximum score is 50 indicating severe distress and the minimum score is 10 indicating no distress. Referral for psychological support may be required..

A person’s spiritual care includes faith, cultural background, beliefs, traditions, and any other ways an older person makes sense of their world and experience. Older people have the right to express their spirituality in a way that is meaningful for them. The identification of spiritual needs and offering of basic spiritual care is the responsibility of all who work in aged care, in ways that are appropriate to their role.

• palliAGED provides a summary of spiritual care.
• Hope Spiritual Assessment Tool: A Step-by-Step Guide aids in better understanding an older person’s spiritual beliefs and needs. This enables the team to provide meaningful spiritual care.