European Journal of Public Health | Online – 4 July 2014 – Ageing and dementia are high on policy agendas around the world as is evidenced by recent activities of the European Commission, Council of Europe, World Health Organization, Organization for Economic Co-operation a& Development, United Nations, the G8 Dementia Summit and the European Union summit on chronic diseases organized by the European Commission. Motivated by the huge expected increase of the number of people over 80 ... and of older people with reduced physical and mental abilities, these initiatives focus extensively on promoting 'Active and Healthy Ageing' (one of five European Innovation Partnerships in the Europe 2020 Initiatives), protecting the human rights of older persons, preventing and delaying neurodegenerative diseases such as dementia and other chronic diseases and improving quality of life and long-term care for people affected by chronic diseases while ensuring sustainable and affordable health care for everybody. Studying these different policy initiatives, it is highly remarkable how little they focus on the importance and added value of palliative care for older people with chronic and life-threatening diseases...
Journal of Palliative Medicine | Online – 7 July 2014 – Nineteen experts participated and prioritized 34 components and principles in the first survey round, and 36 statements in the second survey round. There was consensus from all participants that the first priority of a consultation was to establish rapport with the family, and examples of how to achieve this were defined. Other components of a consultation included: establishing the family's understanding of palliative care; symptom management; an emergency plan; discussion of choices for location of care, and a management plan. Components considered suitable to defer to later consultations, or appropriate to address if initiated by family members, included: spiritual or religious issues; discussion around resuscitation and life-sustaining therapies; end-of-life care; and the dying process.
The Lancet, 2014; 384(9938):103. In today's Lancet are the first two papers in the Every Newborn Series, campaigning to ensure that every baby has a healthy start in life through improved quality of care at birth. Equally important, and an area that often receives much less attention, is improvements in quality of care for people who are dying. This week sees the phasing out in the U.K. of The Liverpool Care Pathway (LCP), a set of guidelines developed in the 1990s intended to ensure comfort and dignity for patients at the end of their life, but one that has been widely criticized by the U.K. media and some patients and their relatives for failing to provide appropriate care. The LCP was popular with many health-care professionals, and indeed with many patients' families. It offered a clear framework for clinical staff who were not experts in caring for patients in the last days of life, providing a structure for physical, psychological, social, and spiritual care, with an emphasis on comfort and symptom control. Last year's report on the LCP by Baroness Neuberger, 'More Care, Less Pathway,' was broadly supportive, but identified several problems with its implementation. The report found that communication around the LCP was often poor, with patients and families frequently feeling they had not been consulted or informed when the decision to focus on comfort rather than cure had been made by the medical team. In environments where care was generally poor, care of the dying patient on the LCP was no better: the issue was the organizational culture, rather than the pathway. The response to Baroness Neuberger's report commissioned by the Department of Health was One Chance to Get it Right, published last month.
Media Watch is intended as an advocacy and research tool. The weekly report, published by Barry R. Ashpole, a Canadian communications consultant and educator, monitors the literature and the lay press on issues specific to the quality of end-of-life care. It is international in scope and distribution. Each month, this section of the IAHPC will publish an abstract or summary of an article or report of special interest noted in a recent issue of Media Watch (see below).