What are the palliative care needs of older people and how might they be met?

Summary

The issue

Ageing populations are characteristic of many countries. The pattern of disease at the end of life is changing and more people are living with serious chronic circulatory and respiratory diseases as well as with cancer. More people will need help at the end of life, in a social context of changing family structure and wider migration, employment and ageing of potential care-givers. Despite evidence of dramatically increased need for supportive and palliative care, this area has been relatively neglected in health policy and research.

Findings

There is evidence on unmet needs among older people in the areas of pain relief, information, communication and preferences for place of care. Systematic reviews show evidence of effective pain relief methods and means of training health professionals to communicate well and give information to people with cancer. Coordinated care allows more people to die at home, if they wish, and specialist palliative care is associated with a range of better outcomes for patients and their families. There is also some evidence for the role of palliative care for cardiovascular, respiratory and dementia patients.

Evidence for the effectiveness of simple measures in these areas and for the role of coordinated team care, home nursing, and specialist palliative care is based mostly on studies of people with cancer. There are gaps in the evidence base for palliative care for older people with other serious chronic illness. But in many cases the needs and solutions are likely to be similar to those for people living with cancer.

Policy considerations

Although further research is important, the more pressing issue is to implement existing knowledge and sustain improvements in palliative care practice throughout health care systems. More specifically, policies are needed to encourage:

• investment in research on effective palliative care and treatment for older people with all serious chronic illnesses as well as cancer;
• funding and support for those treatments, actions, and coordinated multidisciplinary services shown to be effective;
• development of high standards for palliative care in pain and symptom management, communication skills and coordination of care; and
• investing in quality improvement methods, and rewarding health care organizations for their involvement, and expanding education and training for staff providing palliative care.