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

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17© Sue HallRecommendationsPolicy-makers and decision-makers shoulddo the following.1. Recognize the needsa. Recognize the public health implications ofageing populations with palliative care needsand that substandard care towards the end oflife is a public health problem.b. Identify and support older people with palliativecare needs in various settings, including thecommunity, nursing homes and hospitals,including intensive care.2. Develop a strategya. Develop, invest in and implement a palliativecare strategy that includes specifically the needsof older people in relation to all diseases and theinsights and practice of modern care of olderpeople (geriatric medicine, geriatric nursing andmental health services for older people) anddementia care.b. Monitor the success of the strategy, learningfrom examples in other countries.c. Ensure a systems-wide approach and developpalliative care for older people as part of thewhole health care service.d. Embrace and invest in the needs of people withdiseases other than cancer, recognizing issues ofmultiple morbidity and long-term conditions.3. What the strategy should includea. Building knowledge and development• Develop national strategies for palliative careresearch that are formally linked with geriatricsand expand investment in this area acrossall diseases.• Include evaluation as a key outcome that healthprofessionals consider routinely. This involvesinvesting in audit and quality improvementmethods to improve the care provided forlocal populations and rewarding the healthorganizations, including nursing homes, involvedin auditing and quality improvement schemes.• Develop national data sets for palliative care.• Facilitate change by supporting demonstrationprojects.• Ensure that, when developments or new servicesare planned, evaluation is an integral part of this.b. Education and awareness• Promote and invest in developing palliative careskills among staff working across all settings.• Ensure that the training of health careprofessionals includes sufficient time devoted topalliative medicine, geriatric medicine, geriatricnursing and mental health services for olderpeople and that professionals are supported inkeeping up to date.52
• Promote public awareness of palliative andend-of-life care so that these issues can be moreopenly discussed and there is greater awarenessof what good care can achieve. One way toachieve this is by including a component ofpublic education in public health policies beyondtraditional adult education courses to reachpeople from a wide range of communities usinga variety of media.• Ensure that palliative care is a core part of thetraining and continuing professional educationof doctors, nurses, social workers, chaplains andother health professionals.c. Providing care and services• Use the examples in this booklet to locally adaptand invest in specific initiatives to improvepalliative care for older people in all settings.• Recognize the work of families and caregiversand invest in support to help them care for olderpeople reaching the end of life.• Invest in services based on need in terms ofsymptoms and problems and their effectivenessin meeting that need rather than on diagnosis.• Encourage health service providers to ask peopleabout their preference for place of care anddeath. Meeting individual preferences should bethe ultimate measure of success.• Ensure that multidisciplinary services shown tomeet the needs of older people for palliative careare adequately funded, rewarded and supported.• Demand and invest in high standards inpalliative care for older people, including painand symptom management, communicationskills and coordination of care.• Ensure that interventions are multifaceted andintegrated within the health system.© Joan TenoThose involved in the national, regionaland local planning of health care shoulddo the following.1. Guide planning, legislation and regulation ofpalliative care for older people (at the nationallevel) in conjunction with the specialist care ofolder people. The national administration shouldbe responsible for setting defined priorities onallocating scarce resources.2. Allocate resources to priorities set by the nationaladministration, so that national standardsare adapted to meet local needs, establishingregional guidelines for palliative care for olderpeople (district or regional management).53
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PALLIATIVE CAREFOR OLDER PEOPLE:BET
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AbstractPopulations around the worl
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ForewordSocieties in the WHO Europe
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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 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: References1. Currow DC et al. A fra
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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