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

8Improving care for older people in hospitalsAlthough most people wish to die at home, themajority of people in the European Region diein a hospital. Ensuring that older people receivegood palliative care in an acute hospital setting istherefore important (1).Recommendations to improve end-of-life carein hospitals include: educating staff members,identifying and assessing the people who need care,implementing care pathways and ensuring accessto specialist palliative care teams (2). Such carehas to meet the needs of older people, who oftenhave comorbid illnesses, such as cardiovasculardisease, arthritis, dementia or sensory loss and diefrom diseases other than cancer. Meeting thesemultiple needs in the hospital setting demands skilland good teamwork between specialists, includinggeriatricians, oncologists, cardiologists, palliative careclinicians, pharmacists, psychologists, social workers,dieticians, nursing staff, speech therapists andchaplains, at different stages of the illness (Box 8.1).A systematic literature review has shown thathospital palliative care teams are effective inimproving symptoms and other problems (6).© Christian SchulzIt is important to examine how such multidisciplinarypalliative care teams develop over time andhow they contribute to providing care in the hospitalsetting (Box 8.2) and as a home care supportservice (Box 8.3).Box 8.1. A multidisciplinary hospital-based palliative care teamThe Palliative Care Team at King’s College Hospital NHS Foundation Trust (3) is a multiprofessional teamcomprising consultants in palliative care, specialist registrars, clinical nurse specialists, psychosocial workersand an administrator. The team provides advisory and advocacy services to patients and staff. It complementsthe hospital services and enables evidence-based, individualized care, symptom control, complex psychosocialcare, liaison with other specialist palliative care services (in the hospital and the community) and end-of-life carefor people with advanced disease. The team conducts regular audits and is active in research and education.They have a referral rate of about 1100 people per year; 35% of these are for people with a disease otherthan cancer, such as multiple health problems, pneumonia or sepsis at the end-of-life, dementia, cardiovascularaccident and motor neuron disease. This represents one of the largest proportions of non-cancer activity in theUnited Kingdom. Most referrals are for people older than 65 years.Sources: King’s College Hospital NHS Foundation Trust, King’s College Hospital Palliative Care Team (4) and Kendall et al. (5).27