WHY: Worldwide the population of older adults is growing at unprecedented rates (Institute of Medicine, 2009). Advanced age is commonly marked by increased cancer risk, chronic disease, co-morbidities, the complexity of dementia, and increasing frailty.  Geriatric palliative care is an approach in the management of chronic illness and frailty in older adults (Matzo, 2008). Geriatric  palliative care differs from palliative care delivered to other patient populations in regard to overall disease trajectory and  prognostication with chronic illness (WHO, 2011). Health care providers’ recognition of who might benefit from symptom  management, advanced care planning, and care coordination is further hindered by the lack of formal training in recognition and management of advancing illness and functional decline in older adults (Evers, Meier, and Morrison, 2002). This can thereby delay the ability to identify and convey prognosis to patients and their families. Communication of prognosis is essential for informed decision making. 

BEST TOOL: The Palliative Performance Scale (PPSv2) Version 2 is a communication tool for quickly describing a person’s  current functional level. The PPSv2 allows more common language about performance status than the Karnofsky Performance scale from which it is based. The PPSv2 uses five observer rated domains: ambulation; activity & evidence of disease; self-care; intake; and conscious level. 

TARGET POPULATION: The PPSv2 is appropriate for use in all health care settings and for older adults with various diseases. It is appropriate to be used with adults of any age, with various language, culture, and literacy levels. Presently, it is translated into nine languages (English, French, Japanese, German, Thai, Arabic, Spanish, Portuguese and Dutch). There is limited data regarding the use of the PPSv2 in pediatric populations. 

VALIDITY AND RELIABILITY: The PPSv2 is intended for use by any health care professional such as physicians, nurses,  respiratory therapists, physical and occupational therapists, dietitians, chaplains, or trained volunteers. As such the scoring is subject to individual variation and interpretation. Although intended as a professional tool, there are many families, and some patients, who have used PPS. Ho and colleagues (2008) demonstrated strong inter and intra-rater reliability for the PPS among 2 groups with intraclass correlation coefficients for absolute agreement of 0.959 and 0.964 for group 1 at times 1 and 2, 0.951 and 0.931 for group 2 at times 1 and 2, respectively. Additionally, validity was established based on content validation through interviews of palliative care experts (Ho et al., 2008). 

STRENGTHS AND LIMITATIONS: The PPSv2 identifies potential needs of people with advanced illness. This is particularly useful in those with disease progression and functional decline. A succinct reporting of performance status allows for  communication about the amount of support the person may need with decreases in scores indicating a progressing condition.  Although initially designed for ‘palliative’ adults with advanced illness, the PPSv2 has been utilized across various settings and is  translatable for others based on performance or functional status. 

MORE ON THE TOPIC:

Evers, M.M., Meier, D.E., & Morrison, R.S. (2002). Assessing differences in care needs and service utilization in geriatric palliative care patients.  Journal of Pain and Symptom Management, 23(5), 424 -32. 

Ho, F., Lau, F., Downing, M.G., & Lesperance, M. (2008). A reliability and validity study of the Palliative Performance Scale. BMC Palliative Care, 7:10. doi:10.1186/1472-684X-7-10.

Institute of Medicine. Committee on the Future Health Care Workforce for Older Americans. (2009). Retooling for an Aging America. Washington: National Academies Press. Institute of Medicine.

Matzo, M. (2008). The universal nursing obligation: All gerontological care is palliative care. Journal of Gerontological Nursing, 34(7), 3-4. Palliative Performance Scale (PPSv2) version 2. Medical Care of the Dying, 4th ed. p. 121. Copyright Victoria Hospice Society, 2006. Wilner, L.S., & Arnold, R. (2018). The Palliative Performance Scale: Fast Facts and Concepts #125. The Palliative Care Network of Wisconsin. Available at: https://www.mypcnow.org/blank-irr0h 

World Health Organization, Regional Office for Europe. Palliative care for older people: Better practices. (2011). Hall, S., Petkova, H., Tsouros, A.D., Costantini, M., & Higginson, I.J. (Eds). Available at: http://www.euro.who.int/__data/assets/pdf_file/0017/143153/e95052.pdf.