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

More documents

Recommendations

Info

The application of advance care planning incountries in the European Region needs to beevaluated and must consider the different culturesand values, the terms used and the differencesbetween health care systems when interpreting theevidence. For example, legislation in the United Statesof America requires that all individuals admitted toa care home be offered advance care planning. Inaddition to facilitating individual choice (Box 13.1),advance care planning may reduce the cost of healthcare at the end of life (Box 13.2).© Sue HallBox 13.1. Preferred Priorities for Care in the United KingdomThe Preferred Priorities for Care (7) is a document held by the person who is to receive care. It was developedin the United Kingdom and designed to facilitate choice in relation to end-of-life issues. People becomeempowered by sharing important information with all professionals involved in their care. The explicit recordingof the wishes of people receiving care and their caregivers can form the basis of care planning in multidisciplinaryteams and other services, minimizing inappropriate admissions and interventions. In care homes for olderpeople, this is an opportunity for residents and staff to work together to develop advance care plans. Residentscan initiate the plan at any time, and this will help staff members to follow their wishes and act as an advocateif the resident loses capacity towards the end of his or her life. Early evaluations suggest that such planssignificantly influence people receiving care in their preferred place of care at the end of life, without significantchanges in the services needed.Sources: The Preferred Priorities for Care (PPC) document: guidelines for health and/or social care staff (8) and Preferred Priorities for Care (9).Box 13.2. Advance directives in nursing homesStaff in local hospitals and nursing homes, residents and their families in Ontario, Canada were educatedin advance planning. Three nurses from care homes attended a two-day workshop and then disseminatedknowledge to other staff in the home. This resulted in fewer residents being sent to hospital and a reductionin the cost of hospital care from Can$ 1772 per resident in homes that used this approach versus Can$ 3869homes not using it. Total health care and implementation costs were also lower: Can$ 3490 per resident versusCan$ 5239. This includes the cost for hospitalization, drugs and costs related to implementing the advancecare planning.Source: Molloy et al. (10).42
References1. Advance care planning: national guidelines. London,Royal College of Physicians, 2009.2. Seymour J et al. Planning for the end of life: the views ofolder people about advance care statements. Social Scienceand Medicine, 2004, 59:57–68.3. O’Neill D. Present, rather than advance directives. Lancet,2001, 358:1921–1922.4. Toller CAS, House MS, Budge MM. Compliance with andunderstanding of advance directives among trainee doctorsin the United Kingdom. Journal of Palliative Care, 2006,22:141–146.5. Pautex S, Herrmann FR, Zulian GB. Role of advance directivesin palliative care units: a prospective study. PalliativeMedicine, 2008, 22:835–841.6. Garavan R et al. When and how older people discusspreferences for long-term care options. Journal of theAmerican Geriatrics Society, 2009, 57:750–751.7. Preferred Priorities for Care [web site]. Leicester, National Endof Life Care Programme, National Health Service, 2010(http://www.endoflifecareforadults.nhs.uk/eolc/ppc.htm,accessed 1 December 2010).8. The Preferred Priorities for Care (PPC) document: guidelinesfor health and/or social care staff. Leicester, National End ofLife Care Programme, National Health Service, 2007 (http://www.endoflifecareforadults.nhs.uk/eolc/files/F2111-PPC_Staff_Guidance_Dec2007.pdf, accessed 1 December 2010).9. Preferred Priorities for Care. Leicester, National End of LifeCare Programme, National Health Service, 2007 (http://www.endoflifecareforadults.nhs.uk/eolc/files/F2110-Preferred_Priorities_for_Care_V2_Dec2007.pdf, accessed 1 December2010).10. Molloy DW et al. Systematic implementation of an advancedirective programme in nursing homes: a randomizedcontrol trial. Journal of the American Medical Association,2000, 283:1437–1444.© Justine Desmond43
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 and 42: Box 9.3. Training in end-of-life ca
Page 43 and 44: 10Improving palliative care for old
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: 13Advance care planningAdvance care
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

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

Create successful ePaper yourself

Delete template?

Save as template?