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

ForewordSocieties in the WHO European Region are ageing. Thisproduces a need not only to improve health by preventingdisease and disability but also to improve the quality oflife that remains, enabling people to live well and, whenthe time comes, to die well. All countries in the EuropeanRegion face this issue, and the need for palliative carereflects very well the WHO values and principles fordignified, sensitive and patient-centred care for peopleand their families and caregivers.This publication builds on two previous publications inthe WHO Solid Facts series, Palliative care – the solid factsand Better palliative care for older people, which set outthe growing needs of older people, showed some of theproblems faced in the European Region and introducedthe concept of palliative care. These two booklets havebeen widely read and used, have been translated intomany European languages and have helped palliativecare to develop in many countries. However, they lackedspecific detailed examples of how practice may bechanged. This third publication addresses that gap andis concerned with providing information on the explicitsolutions that governments, policy-makers, practitionersand voluntary and statutory organizations can put intopractice.This publication represents the fruits of tremendousefforts over three years. The editors have gathered,from the literature and an international call, examples ofpromising and best practices in palliative care for olderpeople, particularly focusing on the European Region.They have appraised the examples with an internationalpanel of experts and have ensured that the work is peerreviewed and assessed by experts from many disciplinesand countries.The examples include ways to improve palliative carein various settings such as in hospitals, in nursing homesand at home. There are examples to help support people,such as by improving symptoms, introducing palliativecare services – often linked with services for older people– and to support family members and caregivers. Thereare examples concerned with finding better ways toeducate staff in the many places at which older peoplereceive care. Importantly, too, the need for researchinto the palliative care for older people is raised, sinceevidence-based practice needs to become integral tothe development of services to be taken forward. Theexamples are taken from all corners of the EuropeanRegion, and in some instances from elsewhere but showhow care may be taken forward in the European Region.The publication focuses on the European Region but mayreflect relevant issues in other parts of the world.The publication targets policy- and decisionmakerswithin government health and social care, thenongovernmental, academic and private sectors andhealth professionals working with older people. All thesegroups need to work to integrate palliative care morewidely across health services, and policy-makers needto be aware of the proven benefits of palliative care.The publication provides examples and suggestions thatwill help with this task. It makes recommendations forhealth policy- and decision-makers, health professionalsand those funding research on how services may bedeveloped and improved.I would like to express my thanks to the FondazioneMaruzza Lefebvre D’Ovidio Onlus, without whosefinancial support and tremendous enthusiasm this projectwould not have been realized. I would also like to recordour gratitude to Vittorio Ventafridda, who was a keycontributor and devoted champion of the publicationseries and worked towards this third publication beforehe died in 2008. My deep appreciation goes to all theexperts who contributed to preparing the publication,all the services and clinicians who helped by providingexamples and to the European Association of PalliativeCare and the European Union Geriatric Medicine Societyfor their technical assistance. Finally, a special word ofthanks is due to Irene J. Higginson, Sue Hall and theircolleagues in the WHO Collaborating Centre for PalliativeCare and Older People at the Cicely Saunders Institute ofKing’s College London and to Agis D. Tsouros of WHO forthe effective way they drove and coordinated the wholepreparation process and for their excellent editorial work.I am convinced that this publication will be a source ofinspiration, awareness and action.Zsuzsanna JakabWHO Regional Director for Europev5