Palliative care in older people
Care and quality of life
Together with children and their families, the Maruzza Foundation is particularly sensitive to the palliative care needs of older people. As people age they are increasingly prone to illness and frailty, and distress caused by the prospect of facing their later years suffering from chronic illness and disability, of losing their independence and, above all, of living with pain and other debilitating symptoms is very common among older people.
In recent decades advances in medical science have significantly increased life expectancy. Also disease patterns in later life have changed dramatically; people are living much longer but often with the effects of serious, multiple chronic illnesses and dementia, especially toward the end of life. Furthermore, radical changes in the way families live and work mean that the elderly members of our society are often alone and vulnerable. Many of them are cared for in residential settings where appropriate and effective management of older people with multiple illnesses and disabilities is often lacking, thus resulting in poor quality of life and loss of dignity.
Studies by the World Health Organization indicate that by 2050 more than one quarter of the population of the European Region will be aged 65 years and older, the greatest percentage increase will be among people of 85 years and older. This means that an ever increasing number of elderly people live, and will eventually die, with comorbidities and disabilities such as cardiovascular disease, pulmonary conditions, diabetes, cancer, and dementia.
The wide range of health needs of older people with multiple illnesses requires joint work between many sectors; specialists in care for older people, palliative, primary and social care to provide care that is tailored to individual needs. Care goals should promote a holistic approach to the care of older people; whilst ensuring the effective management of pain and distressing symptoms, attention should also be focused on the psychological and spiritual needs of the patients and their families. The services provided should enable people, when possible, to be cared for in their own home.
Addressing the needs of this vulnerable population is one of the principal challenges currently facing our society and the medical/healthcare community. To encourage the development of new care models integrating palliative care into the disease management of older patients, the Maruzza Foundation has supported a series of initiatives aimed at stimulating interdisciplinary dialogue between two areas of medicine: geriatrics and palliative care.
In 2014, as part of its activities for the development of effective palliative care for older people, the Maruzza Foundation launched the MIRSA Project. The principal aim of this pilot training scheme is to improve the quality of care provided to older people living in nursing homes with advanced-stage, chronic, degenerative disease with a limited life expectancy. Following a series of initial focus groups with staff and family members, several aspects of care delivery were identified for improvement.
The initial results have shown that that the MIRSA Project successfully provided skills training to 43 healthcare professionals. These were included 4x4hourly sessions with an expert Instructor and 3X3hourly sessions for a guided discussion of cases studies.
After six months an audit meeting was organised with each head of department and respective nursing coordinator to examine the results according to the performance indicators identified.
The audit indicated a 100% positive implementation for the following indicators:
- definition of the individual care plan and information communicated to the patient, family and caregivers (100%);
- assessment of the patient’s psychological condition (100%);
- proposal and support for the active participation of the patient and/or family in the care programme (100%).
Once the evaluation of the of the improvements perceived by the patient, staff and family members is terminated, the replication of the project in other public and private care homes will be considered.
In the healthcare sector, skills training is strategic and essential to the development and attainment of care goals. It is acknowledged that the acquisition of a skill is a course of action that cannot be accomplished in a single episode but must be practised and repeated over time to be effective in producing significant and long-term changes in performance.
For this reason, the Foundation will continue to support the development of additional projects aimed at bettering the quality of life of older people through the delivery of appropriate and effective palliative care and pain management.
“Palliative Care for Older People in the European Union” Project
In 2012, the Maruzza Foundation launched the “Palliative Care for Older People” project bringing together experts from the largest professional associations in the fields of geriatric and palliative medicine in Europe: the European Union Geriatric Medicine Society (EUGMS) and the European Association of Palliative Care (EAPC), to develop strategies for the integration of palliative care principles to geriatric healthcare programs.
On September 25th, 2012, at the European Parliament Building in Brussels, during an event organised by the Maruzza Foundation, a joint manifesto “Palliative Care for Older People in the European Union” calling upon governments and institutions to ensure that every older citizen with chronic disease is offered the best possible palliative care approach possible was presented to MEPs. This document will be the basis of an ‘action plan’ for the integration of patient-centred palliative care for older generations into national healthcare policies throughout Europe.
“Palliative Care for Older People: Better Practices” Project
In 2011 World Health Organization (WHO), with the support of the Maruzza Foundation, published the booklet “Palliative Care for Older People: Better Practices” targeting policy- and decision-makers with recommendations for developing health care policies, clinical/research initiatives and educational programs aimed at improving and widening access to palliative care to include older generations dying from multiple diseases other than cancer. This initiative, led by Prof. Irene Higginson, Head of Palliative Care at King’s College London, and a steering committee of 15 international palliative care experts, was approved as an EAPC Taskforce project.
MJA – The Medical Journal of Australia – Italian translation ‘Clinical practice guidelines for communicating prognosis and end-of-life issues with adults…’ – 2014