All over the world, and particularly in the so-called industrialised countries, the ageing population, which according to the WHO means people aged 65 or over, has progressively increased over the last few decades. Forecasts on several different levels indicate that this number will remain constant or increase, particularly in the sub-group of the very ageing population, with older people, in the middle of the XXI century, surpassing children and adolescents up to the age of 14 in number, which will be a new phenomenon in the history of humanity.
Several different factors have contributed towards this phenomenon: better working conditions, housing, sanitation and safety, but also the discovery of antibiotics and of almost all the medicine known today, the progressive improvement of health care, the reducing of maternal-child mortality and death through infectious diseases, the generalized vaccination of the population, etc.

A stereotype that is very prevalent among people in general, but also among health professionals, is to see the people in this age group as those who have multiple pathologies, being regular frequenters of doctors’ surgeries, consumers of medicine and health resources, and generally dependent on third parties to carry out the tasks in their daily lives.

And yet not all of them are like this: this age group includes people with very different physical, cognitive and functional conditions, and thus us neither a uniform nor homogeneous population, with a range of problems that require intervention that is necessarily complex due to this multifaceted aspect. (1)

A substantial number of these people remain healthy and active, often for decades, and thus never need the health services. However, others drag often incurable chronic health problems out over years, with a progressive deterioration of their functional capacity and their quality of life. If cancer is a paradigm of the illness in its terminal phase, organ failure (of the kidney, lung, heart or liver), and dementias are often more prevalent among the elderly. Others come towards the final phase of their lives through the normal process of ageing.

The health professional faces many challenges in relation to this ageing, heterogeneous population: the need to deal with a raft of pathologies and diversified therapeutic approaches, with communication difficulties, the absence of family members (2) or other carers, or, contrarily, the family members who are very present and demanding, constraints as to the costs of the therapeutic treatment, the need to refer to other levels of care, etc.


Palliative care is based on strict, internationally recognized scientific principles, and is an active response to the problems arising from prolonged, incurable and progressive illness, in an attempt to prevent the suffering that it generates and to provide the greatest quality of life possible for these patients and their families. (3)

For this reason they must be applied alongside curative care, but in a more intensive manner in the terminal stage, when life expectancy is little more than a few weeks or months (although this is often prolonged for years) and the patient’s needs and those of their family are pressing. The aim of this type of care then goes from cure to that of comfort and quality of life, with the patient defining the aims and priorities. (4)

An earlier approach leads to a better relationship with the therapy team, thus allowing one to deal with aspects that go far beyond symptomatic control, such as the old person’s expectations in relation to the future, their religious beliefs or spiritual, family, relationship or financial needs, or other unresolved issues, and which for the old person is a cause of concern, as well as accompaniment and support for the family at a difficult moment in their lives.

Therefore, providing palliative care demands suitable Basic training, both on the undergraduate and postgraduate level, in order to be able to respond to the patients’ needs, whatever their age group, and in the present case, that of old people.

Although health professionals have basic training in palliative care, they lack the support of (community and hospital) teams with more advanced training and experience, capable of responding to complex clinical, psychological, ethical, spiritual or social situations, granting the patient the best quality of life through the providing of a humanized approach such as palliative care, and allowing them to live an active life as possible until death.

Palliative care is thus a right for all older people, and as this prevents suffering and contributes towards maintaining personal dignity at the last stage of life, it is also an ethical and civic imperative that no doctor can reject.

 

Cristina Galvão
Beja Health Centre
Alentejo Health Region Assistant for Palliative Care
cristinamgalvao@gmail.com

Bibliography

1. Nazareth JM: Preface. in: Fernandes, A.A. (Eds.) Velhice e Sociedade Demografia, família e políticas sociais em Portugal. Oeiras: Celta, 1999.
2. Guidelines for a Palliative Approach in Residential Aged Care. The National Palliative Care Program 2006. Australian Government. National Health and Medical Research Council. Available on: www.health.gov.au/palliativecare [accessed on 14/12/2007]
3. Cuidados Paliativos: o que são? Available on:
http://www.apcp.com.pt/index.php?n=cuidados-paliativos&cod=79&subCat=79 [accessed on 01/07/2009]
4. Potash J, Horst P. Palliative Care at the end of life. in: Ham RJ, Sloane PD, Warshaw GA, eds. Primary Care Geriatrics. A case-based approach. Mosby, Inc. St Louis. 2002