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The Importance of Resilience in End of Life Care Jenny Downes Social Worker Hammondcare Each year around 58 million people die world wide, with more than half aged 60 years and older. (Gomes and Higginson, 2008) Increasingly people are dying at an old age, as a result of chronic illness and in a hospital or institutional setting. Chronic illness makes up more than 70% of Australia’s disease burden and is expected to continue to grow. (PCA, 2010) Society Resilience The American Psychological Association defines resilience as ‘the process of Neighbourhood Reilience adapting well in the face of adversity, trauma, tragedy, threats or even significant sources of stress.’ Resilience is an important quality to be developed in people facing a chronic and life limiting illness. It is a multidimensional construct and can be defined on multiple levels (fig 1) and in different areas of life. (fig 2) Community Resilience Neighbourhood Reilience Family/Househ old Resilience Individual Resilience Financial Resilience Psycholog ical Resilience Cultural Resilience Areas of Resilience in later life Environm ental Resilience Physical Resilience Social Resilience Braeside Hospital is a 72 bed Wild et al 2013, fig 1 (top) Contextual and hospital situated in South West collective scales of resilience in later life Sydney in an area that is poor fig 2 (bottom) Different areas of life of socioeconomically, has a large resilience for old age populations. number of recent migrants, high unemployment and a high proportion of families on welfare. 60% of the population in the Fairfield area speak a language other than English at home. (SWSLHD Annual Report 2007/08) The palliative care unit at Braeside Hospital encompasses a 20 bed inpatient unit, an outpatient clinic and community service. The Importance of Resilience in End of Life Care Jenny Downes Social Worker Hammondcare Challenges to developing Resilience • Stressful life events • Illness • War and Trauma • Financial Strain • Poverty • Lack of social support • Language/cultural barriers • Lack of information/education Theories used in building Resilience include Strength Based Approach • Focus on client’s strengths • Affirms client’s resilience and capacities • • • • Anti-oppressive Theory Aims to challenge the dominant and oppressive structures of society impacting on one’s age, race and gender etc. Biopsychosocial Approach Biological factors (illness) Psychological factors (personality) Social factors (cultural, familial etc) Physical Bereavem ent End of Life Issues Spiritual Patients and Carers Psychologi cal Advanced Care Planning Emotional Social Areas of need Palliative Care Australia 2003 Examples of Building Resilience in Palliative Care • Casework – Focus on holistic care • Multidisciplinary Patient and Carer Education Sessions • Carer Support Days held at Local Clubs The Importance of Resilience Poster Title in End of Life Care Author/s Jenny Downes Social Worker Hammondcare Topics included in Patient and Carer Sessions • Advanced Care Planning • End of Life Issues/Crisis Management • Energy Conservation • Look Good, Feel Better Workshop • Legal Issues • Medications and Nursing Issues • Physical Activity/Exercise • Spiritual Care • Grief and Loss Issues • Healthy Eating • Guided Meditation and Massage • Stress and Relaxation, Laughter Therapy • Art Therapy/Leisure • Music Therapy/Concert Conclusion Palliative Care ‘affirms life and regards dying as a normal process’ and aims to enable patients to live as actively as possible until death. (WHO) With the aging of the world’s population and increasing chronic illness, the philosophy and principles of palliative care such as holistic care and maximizing quality of life assist in enabling patients and their families in building the resilience needed to live their lives to the fullest in the time they have left. References • • • • • Gomes, B and Higginson, I. Where people die (1974-2030): past trends, future projections and implications for care. Palliative Medicine. 2008:22; 33-41. Healy, K. Social Work Theories in Context (2005) Great Britain: Palgrave Macmillan. Min,J., Yoon, S., Lee, C., Chae, J., Lee., C., Song, K. and Kim, T. (2013) ‘Psychological resilience contributes to low emotional distress in cancer patients.’ Support Care Cancer. Vol 21: 2469-2476. Palliative Care Australia, ‘Health System Reform and Care at the End of Life: A Guidance Document,’ May 2010. Wild, K., J. L. Wiles and R.E.S. Allen. 2013. “Resilience: thoughts on the value of the concept for critical gerontology.” Ageing and Society 33(special issue 1): 137– 158.