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

9Improving palliative care for older people living innursing and residential care homesIn many countries, care homes (nursing orresidential homes, aged or long-term care facilitiesand continuing care units) play an increasing rolein caring for frail older people at the end of life.For example, in England, 17% of the people olderthan 65 years who die each year do so in a carehome (1). The number of older people dying in carehomes is almost certain to increase with the ageingpopulation.Many older people who move to care homesacknowledge these as a last resting place beforedeath. Many develop palliative care needs. Specialistpalliative care services may be required for a smallnumber of residents, whereas general palliativecare is appropriate for all residents regardless oftheir diagnosis. When they die, they are likely tohave lived with multiple, often-disabling chronicconditions over a long period of time. Commondiagnoses include: stroke, cardiac failure, chronicobstructive pulmonary disease, Parkinson’s diseaseand dementia. There are also high levels of impairedcognition, sight and hearing. Many residentsexperience pain, which is often not well treatedand sometimes not treated at all (2). However, theassessment of pain can be complicated by cognitiveand sensory impairment. The losses experienced bysome residents (such as the loss of their homes andindependence) can result in a loss of their senseof dignity (3). Initiatives to improve palliative carein care homes include: the work of clinical nursespecialists, the use of hospice beds in care homes,education and training, the use of link nurses andquality initiatives such as developing guidelinesand standards for providing palliative care in carehomes (4). Asking bereaved family members fortheir views on the care residents received can beused to drive improvements in end-of-life care(Box 9.1). Innovative programmes to raise thestandards of palliative care by educating care home© Joan Tenostaff members are being implemented in Germany(Box 9.2) and in Scotland (Box 9.3). The GoldStandards Framework for end-of-life care in carehomes is being rolled out in the United Kingdom(Box 9.4). Guidelines are also in place for a palliativeapproach to care in such institutions in Australia(Box 9.5). A European Association for Palliative Caretask force has been developed to identify and mapthe different ways of developing palliative care inlong-term care settings (5).29