THE PALLIATIVE CARE

The Palliative Care

The Palliative Care

Introduction

Many countries have experienced dramatic improvements in population life expectancy. The proportion of elderly people, and particularly those over 80, has increased significantly in recent decades. As populations age, people die in greater numbers after long illnesses from heart disease, cerebrovascular disease including stroke, chronic respiratory disease and respiratory infections, and cancer. Predictions suggest that these will be the five main global causes of death in twenty years. It is still controversial whether increased longevity is inevitably accompanied by longer periods of disability towards the end of life.

The unmet palliative care needs of older people and their families

Pain

Community surveys consistently find that pain is an important symptom for around one-third of older people. This problem makes people feel less positive about their health and is bad enough to limit activities in around one-fifth of people, although it tends to be under-reported and under treated. Pain also affects 55% to 95% of patients with advanced cancer, and multi-centre studies in France and the United States show inadequate pain relief in about one-half of patients. Unrelieved cancer pain has a serious affect on the quality of life, interfering with sleep, daily activity, enjoyment of life and social interaction. Issues for non-cancer illnesses Heart failure affects more than one in ten people aged over 70 and the five-year mortality of 80% is worse than for many cancers.

Practice of Palliative Care

The practice of palliative care varies widely throughout the United States. The most frequent sites for adult palliative care delivery include hospitals, nursing homes, home care as part of a hospice program, home care without hospice, and inpatient hospices.

Palliative care has become an area of special expertise within medicine, nursing, social work, pharmacy, chaplaincy, and other disciplines. The United Kingdom recognized palliative medicine as a medical specialty in 1987, followed by Australia, New Zealand, and Canada. An effort to win specialty recognition in the United States is under consideration. However, many agree that every health care professional that deals directly with seriously ill and dying patients and their families needs a basic grounding and demonstrated core competencies in palliative care. Fortunately, numerous professional societies (e.g., American Academy of Hospice and Palliative Medicine) and organizations (e.g., Last Acts Partnership, Initiative for Pediatric Palliative Care), journals (e.g., Journal of Pain and Symptom Management), meetings and conferences, academic centers (e.g., Duke University Institute on Care at the End of Life), ...