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March 21, 2007

Frail Older Adults and Palliative Care

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2007;297(11):1193-1195. doi:10.1001/jama.297.11.1194-b

To the Editor: Drs Boockvar and Meier1 offered perspectives on palliative care. As they appropriately identified, among all of the other maladies seen at the end of life, the loss of independence in function of activities of daily living (ADL) is a cruel component in the deterioration of a person's well-being.

A patient in palliative care is vulnerable and will rely heavily on the physician for direction of care and recommendations for a dignified end-of-life experience. Although the authors did include recommendations for rehabilitation and physical therapy in their suggestions for how to address skill decline, they did not mention occupational therapy, a profession whose job definition is based on ensuring enhancement or maintenance of the highest possible level of independence in a patient's ADL. Occupational therapists' education includes both physical and psychosocial rehabilitation. As a patient's clinical status becomes progressively worse, and rehabilitation efforts to restore biomechanical skills become less effective, occupational therapists may offer ideas and training in adaptive methods and equipment to help maintain some level of independence and dignity in the patient's daily routine.