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

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2<strong>Palliative</strong> <strong>care</strong>What is palliative <strong>care</strong>?WHO (1) has defined palliative <strong>care</strong> as:“…an approach that improves the quality of lifeof patients and their families facing the problemassociated with life-threatening illness, throughthe prevention and relief of suffering by means ofearly identification and impeccable assessment andtreatment of pain and other problems, physical,psychosocial and spiritual. <strong>Palliative</strong> <strong>care</strong>:…• affirms life and regards dying as a normal process;• intends neither to hasten nor to postpone death;[and]• uses a team approach to address the needs ofpatients and their families, including bereavementcounselling if indicated.…”Since Cicely Saunders (photograph) foundedthe modern hospice movement, the numbersof specialist palliative <strong>care</strong> services, physiciansand nurses (those who have accredited palliative<strong>care</strong> training) have continually increased acrossEurope (2).However, the number and scope of servicesavailable in countries vary widely, and specialistpalliative <strong>care</strong> often does not reach <strong>older</strong> <strong>people</strong>. Forexample, in the United Kingdom, where palliative<strong>care</strong> is well developed, the chance of dying in aninpatient hospice declines with age (3).There is a general move towards offeringgeneralist palliative <strong>care</strong>, which can be delivered byhealth and social <strong>care</strong> professionals, such as staffworking in primary <strong>care</strong> or in <strong>care</strong> homes <strong>for</strong> <strong>older</strong><strong>people</strong>, often aided by staff more specialized inpalliative <strong>care</strong>. Whether palliative <strong>care</strong> is specialist orgeneralist, services need to be integrated into health<strong>care</strong> delivery systems to be sustainable.Isn’t palliative <strong>care</strong> just good health <strong>care</strong>?All the fields of health <strong>care</strong> that provide holistic<strong>care</strong> <strong>for</strong> <strong>people</strong> with chronic illness are increasinglyrecognizing the wider needs of <strong>older</strong> <strong>people</strong>and their families. <strong>Palliative</strong> <strong>care</strong> has focused oncontrolling pain and other symptoms, definingneeds around <strong>people</strong> receiving <strong>care</strong> and theirfamilies and being flexible about doing what isnecessary to help <strong>people</strong> adapt and cope withtheir situation. The concept that palliative <strong>care</strong> isrelevant only to the last few weeks of life (whenno other treatment is beneficial) is outdated.People needing <strong>care</strong> and their families experiencemany problems throughout the course of an illnessand need help, especially when problems changeor become complex. A more appropriate conceptis there<strong>for</strong>e that palliative <strong>care</strong> is offered from thetime of diagnosis, alongside potentially curativetreatment, to disease progression and the end of life.<strong>Palliative</strong> <strong>care</strong> is a component of health <strong>care</strong> that canbe needed at any time in life, starting at a low baseand rising to eventually become the predominanttheme <strong>for</strong> many <strong>people</strong> (4).The WHO health systems approach<strong>Health</strong> systems have three goals: to improve thehealth status of the population (both the averagelevel of health and the distribution of health); toimprove fairness of financing (financial protectionand equitable distribution of the burden of fundingthe system); and to improve responsiveness tothe non-medical expectations of the population,including two sets of dimensions, respect <strong>for</strong><strong>people</strong> (patient dignity, confidentiality, autonomyand communication) and client orientation (promptattention, basic amenities, social support andchoice). <strong>Palliative</strong> <strong>care</strong> is especially relevant to thelatter because it is concerned with the psychosocialaspects of <strong>care</strong>, dignity and quality of life of6

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