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

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