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Palliative care for older people: Better practices

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This task force was establised with the support of the Maruzza Lefebvre Foundation,  Rome in September 2007. It has concluded its work with the publication of the booklet in May 2011. 

  • “I am convinced that this publication will be a source of inspiration, awareness and action.”
    Zsuzsanna Jakab, WHO Regional Director for Europe

  • “This publication offers a way forward, with numerous examples of care models at varying stages of integration and implementation.”
    Kathleen M. Foley, Professor of Neurology and Clinical Pharmacology, Weill Medical College of Cornell University, Ithaca, NY, USA

Background

Populations around the world are ageing, and more people are living with the effects of serious chronic illness towards the end of life. Meeting the needs of this vulnerable population is now identified as a challenging and growing public health issue.

This publication, which was supported by funding from the Fondazione Maruzza Lefebvre D’Ovidio Onlus, provides examples of better palliative care practices for older people to help those involved in planning and supporting care-oriented services most appropriately and effectively. It builds on two previous publications in the WHO Solid Facts series, Palliative care – the solid facts and Better palliative care for older people, which set out the growing needs of older people, showed some of the problems faced in the European Region and introduced the concept of palliative care. These two booklets have been widely read and used, have been translated into many European languages and have helped palliative care to develop in many countries. However, they lacked specific detailed examples of how practice may be changed. We have gathered, from the literature and an international call, innovative and creative examples of palliative care for older people, particularly focusing on the European Region. Examples were appraised by an international panel of experts from different disciplines and countries. We included examples of ways to improve palliative care in various settings such as in hospitals, in nursing homes and at home. We also included examples of how symptoms can be improved, family members and caregivers supported and staff educated in the many places in which older people receive care. Since this publication does not have space to cover many other examples, these are listed in a table available at: www.csi.kcl.ac.uk.

Palliative Care for older people: better practices targets policy- and decision-makers within government health and social care, nongovernmental, academic and private sectors and health professionals working with older people. We make recommendations for health policy- and decision-makers, health professionals and those funding research on how services may be developed and improved. These recommendations highlight the need to recognize the palliative care needs of our rapidly growing population of older people and to develop, invest in and implement a palliative care strategy that includes specifically the needs of older people.  They also highlight the need to invest in research programmes to determine the cost-effectiveness of ways to improve palliative care for older people.This task force worked closely with the European Union Geriatric Medicine Society.


Publication

Reversal of the British trends in place of death: Time series analysis 2004–2010

Palliative Medicine 2012; 26(2) 102– 107

Background: Increased attention is being paid to the place where people die with a view to providing choice and adequately planning care for terminally ill patients. Secular trends towards an institutionalised dying have been reported in Britain and other developed world regions.
Aim: This study aimed to examine British national trends in place of death from 2004 to 2010.
Design and setting: Descriptive analysis of death registration data from the Office for National Statistics, representing all 3,525,564 decedents in England and Wales from 2004 to 2010.
Results: There was a slow but steady increase in the proportion of deaths at home, from 18.3% in 2004 to 20.8% in 2010. Absolute numbers of home deaths increased by 9.1%, whilst overall numbers of deaths decreased by 3.8%. The rise in home deaths was more pronounced in cancer, happened for both genders and across all age groups, except for those younger than 14 years and for those aged 65–84, but only up to 2006. The rise was more evident when ageing was accounted for (age–gender standardised proportions of home deaths increased from 20.6% to 23.5%).
Conclusions: Following trends in the USA and Canada, dying is also shifting to people’s homes in Britain. Home deaths increased for the first time since 1974 amongst people aged 85 years and over. There is an urgent need across nations for comparative evidence on the outcomes and the costs of dying at home.

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Editors


Sue Hall, UK


Hristina Petkova - UK


Agis Tsouros - Denmark


Massimo Costantini - Italy


Ir
ene J Higginson - UK 


Partners and Contributors 

The Maruzza Lefebvre D’Ovidio Foundation provided funding for this publication. In addition to the EAPC, key partners in this taskforce, include: King’s College London; WHO; Cicely Saunders International; and European Union Geriatric Medicine Society.

The following people contributed to the project:

Elizabeth Davies - United Kingdom

John Ellershaw - United Kingdom;

Mariléne Filbet - France

Carl Johan Fürst - Sweden

Giovanni Gambassi - Italy

Stein Kaasa - Norway

Lukas Radbruch - Germany

Florian Strasser - Switzerland

Joan Teno - USA

Vittorio Ventafridda, Honorary President of the European Association of Palliative Care - Italy