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

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References1. End of Life Care Strategy: promoting high quality care for alladults at the end of life. London, Department of Health, 2008.2. Pain in residential aged care facilities: management strategies.New Sydney, Australian Pain Society, 2005.3. Hall S, Longhurst SL, Higginson IJH. Living and dying withdignity: a qualitative study of the views of older people innursing homes. Age & Ageing, 2009, 38:411–416.4. Froggatt KA et al. End-of-life care in long-term care settingsfor older people. International Journal of Older PeopleNursing, 2006, 1:45–50.5. EAPC projects or taskforces: palliative care in long-termcare settings for older people [web site]. Brussels, EuropeanAssociation for Palliative Care, 2010 (http://www.eapcnet.org/projects/Long-termCare.html, accessed 1 December 2010).6. Vandenberg EV, Tvrdik A, Keller BK. Use of the qualityimprovement process in assessing end-of-life care in thenursing home. Journal of the American Medical DirectorsAssociation, 2006, 7(Suppl. 3):S81–S87.7. Leben bis zuletzt [web site]. Munich, Inneren MissionMünchen, 2010 (http://www.im-muenchen1.de/pflegeheime/hospizprojekt/s1/index.php?mid=1, accessed 1 December2010).8. GSF in care homes [web site]. Walsall, National GoldStandards Framework Centre, 2010 (http://www.goldstandardsframework.nhs.uk/GSFCareHomes, accessed1 December 2010).9. Thomas K and GSF Central Team. Briefing paper on the GoldStandards Framework in care homes (GSFCH) programme.Walsall, National Gold Standards Framework Centre, 2007.10. Badger F, Thomas K, Clifford C. Raising standards for elderlypeople dying in care homes. European Journal of PalliativeCare, 2007,14:238–241.11. Australian Palliative Residential Aged Care (APRAC) Project,Edith Cowan University. Guidelines for a palliative approachin residential aged care: enhanced version. Canberra,National Palliative Care Programme, Commonwealth ofAustralia, 2006 (http://www.nhmrc.gov.au/_files_nhmrc/file/publications/synopses/pc29.pdf, accessed 1 December 2010).© Catherine Higginson32
10Improving palliative care for older people at homeMost older people in the European Region preferto be cared for and die at home towards the endof life (1,2). This preference, however, remains stilllargely unmet. Despite efforts in some countries toimprove opportunities for people to die at home,the historical trend toward the hospitalization ofdeath continues, and most older people in Europedie in hospitals or in long-term care facilities(Fig. 3.1). Research shows a steady shift fromdeath in the community to death in institutions,with people older than 85 years accounting for thelargest rise in hospital and care-home deaths (3).In many countries in the eastern and southernparts of the WHO European Region, the lack ofstate-funded infrastructure for the care of olderpeople may place a greater burden of care onfamilies. Informal caregivers are often not equippedto manage pain and control other symptoms, andpeople’s needs are therefore not likely to be metat home. The reluctance of family doctors to makehome visits is an additional challenge.Promising initiatives have been developed tosupport individuals dying at home and their families,including specialist palliative care home care teams(Box 10.1) and nurse-led schemes (Box 10.2). Toincrease high-quality care at home until the endof life, services and policy-makers should developinitiatives that address the areas in the evidencebasedmodel (Fig. 3.2), including providing intensivehome support, support for the family and assessingand addressing risk factors (7).A meta analysis of palliative care and home careteams showed these were of benefit (8,9) confirmingother reviews (10–12). In addition to palliative care,the many older people who live alone at home alsoneed good health and social care, regardless oftheir current health needs.© Peter Higginson33
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 and 12: 1IntroductionPalliative care is an
Page 13 and 14: By 2050, estimates indicate that mo
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: Box 9.3. Training in end-of-life ca
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
Page 65 and 66: 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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