Palliative care for older people - World Health Organization ...

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of this vulnerable group are far from being met.Addressing this gap should therefore be a primepublic health concern.This publication builds on the previous two bygiving specific examples of promising or betterpractices in palliative care for older people alongwith evidence of their effectiveness when this isavailable. This project is the work of a EuropeanAssociation for Palliative Care (EAPC) Task Force.“...older people suffer unnecessarily, owingto widespread underassessment and undertreatmentof their problems and lack of accessto palliative care.”Better palliative care for older people (3)The examples have been identified from literaturesearches and from an international call for examplesthrough various organizations, including theEAPC and the European Union Geriatric MedicineSociety. This publication aims to help those involvedin planning, funding or developing servicesmost appropriately and effectively. This guide isdeveloped for countries in the WHO EuropeanRegion. Where possible, examples from the Regionare used. However, some examples from outsidethe Region are included when these are consideredmore innovative or more rigorously evaluated thanEuropean examples and are relevant to Europeansettings. Palliative care needs to be improved forolder people in countries with fewer resourcessuch as those in Africa and Asia. However, thehealth care systems and the challenges to providingpalliative care are very different in these settings,which is why they remain largely outside the remitof this publication. Although some of the examplesare not originally intended solely for older people,they have been included because they illustrate carethat could also benefit this group.Many palliative care services provide care forpeople from different age groups. This publicationdoes not have space to cover many other examples;these are available from the Department of PalliativeCare, Policy and Rehabilitation of King’s CollegeLondon (http://www.csi.kcl.ac.uk/palliative).Why better palliative care for older peopleis an urgent public health priorityAgeing demographicsThe proportion of people aged 65 years and olderis steadily increasing in the WHO European Region.In 2009, this age group represented almost 15%of the population of most European Union (EU)countries (Fig. 1.1) (4).2
By 2050, estimates indicate that more than onequarter of the population of the European Regionwill be aged 65 years and older. In Spain and Italy,this is likely to rise to more than one third of thepopulation. The greatest percentage increase will beamong people aged 85 years and older. Althoughdisability is declining among populations of olderpeople in high-income countries, the increase inabsolute numbers means that increasing numbersof older people in almost every society will face therisk of indifferent or poor health care, dependenceand multiple illnesses and disabilities. This will alsoinevitably lead to higher demand for palliative carefor this group.Changing disease patternsPalliative care has traditionally been offered topeople with cancer, but people aged 85 years andolder are more likely to die from cardiovasculardisease than cancer (Fig. 1.2). Better meetingthe needs of older people in the future requiresimproving and widening the access to palliative careto include people dying from diseases other thancancer and who have multiple illnesses.Complex needs of older peopleOlder people reaching the end of life frequently havemultiple debilitating diseases (such as dementia,osteoporosis and arthritis), and they often do so overlonger periods of time. For example, one quarter ofthe people aged 85 years and older have dementia(6). They may therefore have palliative care needsat any point in the illness trajectory and not justthe terminal phase. As such, palliative care shouldbe integrated into chronic disease management.With non-malignant disease, the point in later lifeat which “really sick becomes dying” can be muchmore difficult to determine. This is a skill integralFig. 1.1. Percentage of people aged 65 years and older inselected countries in the WHO European Region in 2009and projections for 2030 and 2050CountryAustriaCzech RepublicDenmarkEstoniaFinlandFranceGermanyGreeceHungaryIcelandIrelandItalyLuxembourgNetherlandsNorwayPolandPortugalSlovakiaSloveniaSpainSwedenSwitzerlandTurkeyUnited Kingdom0 5 10 15 20 25 30 35 40Source: data from OECD factbook 2009 (4).200920302050Percentage3
Page 1: PALLIATIVE CAREFOR OLDER PEOPLE:BET
Page 4 and 5: AbstractPopulations around the worl
Page 7 and 8: ForewordSocieties in the WHO Europe
Page 9 and 10: AcknowledgementsThe WHO Regional Of
Page 11: 1IntroductionPalliative care is an
Page 15 and 16: • training of health care profess
Page 17 and 18: individuals and their families. Hea
Page 20: Fig. 3.2. Factors associated with p
Page 23 and 24: (Table 4.1). After 15 years, more t
Page 25 and 26: • the last days of life and death
Page 27 and 28: Box 4.4. Gerontology Institute “1
Page 29 and 30: 5National awareness“You matter be
Page 31 and 32: 6Educational interventionsA well-pe
Page 33 and 34: Box 6.3. European Association for P
Page 35 and 36: initiated at an early stage in the
Page 37 and 38: 8Improving care for older people in
Page 39 and 40: 9Improving palliative care for olde
Page 41 and 42: Box 9.3. Training in end-of-life ca
Page 43 and 44: 10Improving palliative care for old
Page 45 and 46: References1. Higginson IJ, Sen-Gupt
Page 47 and 48: Financial help, such as the paid co
Page 49 and 50: (Box 12.2). Several drugs can often
Page 51 and 52: 13Advance care planningAdvance care
Page 53 and 54: References1. Advance care planning:
Page 55 and 56: References1. Campbell H et al. Inte
Page 57 and 58: Box 15.1. Bus rounds as an educatio
Page 59 and 60: palliative care research initiative
Page 61 and 62: References1. Currow DC et al. A fra
Page 63 and 64:
• Promote public awareness of pal
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3. Invest in creative research into
Page 67 and 68:
GermanyEberhard KlaschikCentre for
Page 69 and 70:
United Kingdom (continued)Marilyn K
Page 71 and 72:
The Maruzza Lefebvre D’Ovidio Fou
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