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

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