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

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ForewordImproving the care for older people with chronic illnessand disability was a goal of Vittorio Ventafridda, foundingPresident of the European Association for Palliative Care,when he called together WHO leaders and palliativecare experts to advocate for the publication of a seriesof WHO monographs on palliative care. His vision wasthat palliative care would be available to everyone withlife-limiting illnesses and fully integrated into health caredelivery systems.Irene J. Higginson was selected as the senior editor forthis project and was asked to publish exemplary practicesin the care of older people with chronic life-limiting illnessthroughout Europe. Vittorio Ventafridda also wrote thepreface for Better palliative care for older people andsubsequently sustained a major stroke that impaired himphysically but never deterred his passionate concern forthe vulnerability and needs of this ageing population ashe lived that experience.This publication describes programmes that encompasscontinuity of care for chronically ill older people, focuson their needs and those of their families, providehospital and home-based care models with sophisticatedcommunication systems and integrate pain relief,symptom control and psychosocial care as well as qualityand cost (where available). These efforts vary fromcountry to country and are emerging at the community,national and regional levels.They demonstrate that the care for older people is nowidentified as a challenging and growing public healthissue. Research efforts to assess the outcomes of olderpeople receiving palliative care and develop an evidencebase for the various dimensions of palliative care for olderpeople are underway.This publication offers a way forward, with numerousexamples of care models at varying stages of integrationand implementation. These initiatives provide evidenceof the innovation and creativity focused on improvingthe quality of living for this vulnerable population withchronic illness. The recommendations to develop healthcare policies, educational programmes and clinicaland research initiatives frame an approach that can beadapted to country needs, but they clearly emphasize theneed for priority to be given to palliative care for olderpeople.Kathleen M. FoleyAttending Neurologist, Memorial Sloan-Kettering CancerCenter, New York, NY, USAProfessor of Neurology and Clinical Pharmacology, WeillMedical College of Cornell University, Ithaca, NY, USAMedical Director, International Palliative Care Initiative,Open Society Institute, New York, NY, USAvi 6
AcknowledgementsThe WHO Regional Office for Europe thanks thenumerous organizations and individuals for theirefforts in preparing this publication.Main partnerThe Maruzza Lefebvre D’Ovidio Foundationprovided funding and logistical support forrealizing this project and for developing, designingand publishing this book.Other key partnersOther key partners in preparing the publicationinclude: King’s College London; Cicely SaundersInternational; European Association for PalliativeCare; and European Union Geriatric Medicine Society.The project was a European Association for PalliativeCare task force and worked closely with the EuropeanUnion Geriatric Medicine Society.EditorsSue Hall had a central role in the conceptualdevelopment of the publication and led the writing.She is Dunhill Medical Trust Senior Lecturer,Department of Palliative Care, Policy and Rehabilitation,King’s College London, WHO CollaboratingCentre for Palliative Care and Older People, UnitedKingdom. Sue Hall is funded by Cicely SaundersInternational through a grant from the Dunhill MedicalTrust.Hristina Petkova led collation of the examplesand coordination and contributed to draftingthe booklet. She is a Maruzza FoundationResearch Associate at the Department ofPalliative Care, Policy and Rehabilitation, King’sCollege London, WHO Collaborating Centre forPalliative Care and Older People, United Kingdom.Agis D. Tsouros had a central role in theconceptual development and strategic approachof the publication, commented on the draft andprovided editorial input. He is Head of policy andcross-cutting programmes and Regional Director’sspecial projects at the WHO Regional Office forEurope.Massimo Costantini had a central role in theconceptual development of the publication,assessed examples and commented on the draft. Heis at the Regional Palliative Care Network, NationalInstitute for Cancer Research, Genoa, Italy.Irene J. Higginson led the project, supervisedthe booklet, had a central role in conceptualdevelopment, contributed to the writing and servedas senior editor. She is at the Department of PalliativeCare, Policy and Rehabilitation, King’s CollegeLondon, WHO Collaborating Centre for PalliativeCare and Older People, United Kingdom. She is alsoScientific Director, Cicely Saunders International,London, United Kingdom and a National Institutesfor Health Research Senior Investigator.Previous Maruzza Foundation ResearchAssociatesSreeparna Chattopadhyay and Anna Kolliakouconducted literature searches, assessed examplesand contributed to drafting. They were atthe Department of Palliative Care, Policy andRehabilitation, King’s College London, WHOCollaborating Centre for Palliative Care and OlderPeople, United Kingdom.Maruzza Foundation International SecretarySuzanne Bennett provided logistical support andassistance during the production of this publication.vii 7
Page 1: PALLIATIVE CAREFOR OLDER PEOPLE:BET
Page 4 and 5: AbstractPopulations around the worl
Page 7: ForewordSocieties in the WHO Europe
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
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Page 35 and 36: initiated at an early stage in the
Page 37 and 38: 8Improving care for older people in
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Page 41 and 42: Box 9.3. Training in end-of-life ca
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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
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Page 55 and 56: References1. Campbell H et al. Inte
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palliative care research initiative
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References1. Currow DC et al. A fra
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• Promote public awareness of pal
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3. Invest in creative research into
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GermanyEberhard KlaschikCentre for
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United Kingdom (continued)Marilyn K
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The Maruzza Lefebvre D’Ovidio Fou
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