gerontology study of age

1. CARE GIVING IN
DIFFERENT SETTING:
PALLIATIVE CARE

2. WHAT IS PALLIATIVE CARE?
 WHO defines palliative care as the prevention and
relief of suffering of adult and pediatric patients and
their families facing the problems associated with
life-threatening illness .
 These problems include physical, psychological,
social and spiritual suffering of patients and
psychological, social and spiritual suffering of family
members.

3.  Palliative care is an approach that improves the
quality of life of patients (adults and children) and
their families who are facing problems associated
with life-threatening illness.
 It prevents and relieves suffering through the early
identification, correct assessment and treatment of
pain and other problems.
 Palliative care is the prevention and relief of
suffering of any kind – physical, psychological,
social, or spiritual – experienced by adults and
children living with life-limiting health problems. It
promotes dignity, quality of life and adjustment to
progressive illnesses, using best available
evidence.

4.  Palliative care for children represents a special field
in relation to adult palliative care.
 Palliative care for children is the active total care of
the child’s body, mind and spirit, and also involves
giving support to the family.
 It begins when illness is diagnosed, and continues
regardless of whether or not a child receives
treatment directed at the disease.

5. PALLIATIVE CARE
 entails early identification and impeccable
assessment and treatment of these problems;
 enhances quality of life, promotes dignity and
comfort, and may also positively influence the
course of illness;
 provides accompaniment for the patient and family
throughout the course of illness;
 should be integrated with and complement
prevention, early diagnosis and treatment of serious
or life-limiting health problems;

6.  is applicable early in the course of illness in
conjunction with other therapies that are intended to
prolong life
 provides an alternative to disease-modifying and
life-sustaining treatment of questionable value near
the end of life and assists with decision-making
about optimum use of life-sustaining treatment
 is applicable to those living with long-term physical,
psychological, social or spiritual of serious or life-
threatening illnesses or of their treatment;

7.  accompanies and supports bereaved family
members after the patient’s death, if needed
 seeks to mitigate the pathogenic effects of poverty
on patients and families and to protect them from
suffering financial hardship due to illness or
disability
 does not intentionally hasten death, but provides
whatever treatment is necessary to achieve an
adequate level of comfort for the patient in the
context of the patient’s values;

8.  should be applied by health care workers at all
levels of health care systems, including primary
care providers, generalists and specialists in many
disciplines and with various levels of palliative care
training and skill, from basic to intermediate to
specialist
 encourages active involvement by communities and
community members
 should be accessible at all levels of health care
systems and in patients’ homes; and
 improves continuity of care and thus strengthens
health systems.

9. WHO NEEDS PALLIATIVE CARE?
 Palliative care is required for patients with a wide
range of life-limiting health problems. The majority
of adults in need of palliative care have chronic
diseases such as cardiovascular diseases (38.5%),
cancer (34%), chronic respiratory diseases
(10.3%), AIDS (5.7%) and diabetes (4.6%).
 Patients with many other conditions may require
palliative care, including kidney failure, chronic liver
disease, rheumatoid arthritis, neurological disease,
dementia, congenital anomalies and drug-resistant
tuberculosis.

10.  children may have a high incidence of congenital
anomalies and genetic conditions and mortality is
highest in the neonatal period
 Pain is one of the most frequent and serious
symptoms experienced by patients in need of
palliative care. Opioid analgesics are essential for
treating the pain and other common distressing
physical symptoms associated with many advanced
progressive conditions.

11.  Psychosocial support is another common need in
palliative care. Patients with life-threatening or
terminal illness and their caregivers go through
great stress, and health professionals treating them
need to be adequately trained or prepared to help
them manage their stress. The health system and
health facilities may need certain simple features to
facilitate other end-of-life needs of a patient, such
as spiritual needs, family support, legal support
where needed, and a motivating physical
environment

12. WHAT IT IS NOT?//
 hat palliative care is not only for the dying but for
any patient suffering in association with serious or
life-threatening health problems
 that palliative care is not an alternative to disease
prevention and treatment but should be integrated
with them
 that palliative care not only relieves suffering, but
also anticipates and prevents it
 that there is a massive burden of unnecessary
suffering due to pain, other physical symptoms, and
psychological, social and spiritual distress;
 that palliative care is essential to achieve UHC

13. ADDITIONAL BARRIERS INCLUDE
 lack of a national palliative care policy, a national
palliative care strategic plan, and national palliative care
clinical guidelines in many countries
 lack of basic, intermediate and specialist training
programmes in palliative care
 lack of inpatient and outpatient staff positions that
include palliative care as an official responsibility and
that enable trained clinicians to be paid for practicing
palliative care
 lack of insurance coverage of palliative home care;
 n excessive fear of opioid side effects, addiction and
diversion, resulting in excessively restrictive opioid
prescribing regulations;

14. WHAT IS PRIMARY CARE?
 According to the Declaration of Alma-Ata from
1978, PHC (Annex 1)
 is essential health care based on practical,
scientifically sound and socially acceptable
methods and technology
 should be universally accessible to individuals and
families in the community;
 should be affordable for the community and country
at every stage of their development

15.  is the central function and main focus of the
country’s health system
 is essential for the overall social and economic
development of the community; and
 is the first level of contact with the national health
system and brings health care as close as possible
to where people live and work

16. IN KEEPING WITH THE DECLARATION OF
ALMA-ATA, PHC ALSO (ANNEX 2)
 should address the main health problems in the
community
 should provide health- promotive, preventive, curative,
rehabilitative and palliative services across the life-
course
 should include:
 education on prevailing health problems and on
preventing and controlling them
 promotion of good nutrition, safe water and basic
sanitation
 maternal and child health care, including family planning
 immunization against the major infectious diseases;

17.  appropriate treatment for common diseases and
injuries, including continuity of care for people with
chronic conditions;
 basic palliative care; and
 provision of essential medicines, including
essential controlled medicines such as oral and
injectable morphine

18.  should be integrated into a referral system and
information system resulting in comprehensive,
coordinated and continuous health care for all
 should give priority to those most in need; and
 should be provided by an appropriately trained
team that includes physicians and nurses and also
may include clinical officers, assistant doctors,
nurses, midwives, community workers as
applicable, as well as traditional practitioners, as
appropriate, to respond to the expressed health
needs of the community.

19. GOAL OF PALLIATIVE CARE
 Palliative care (pronounced pal-lee-uh-tiv) is
specialized medical care for people with serious
illness. This type of care is focused on providing
relief from the symptoms and stress of a serious
illness. The goal is to improve quality of life for
both the patient and the family.

20. BENEFITS OF PALLIATIVE CARE
 Puts the patient's desires, goals and decisions first.
 Supports the patient and family.
 Helps patients and families understand treatment
plans.
 Improves quality of life.
 Provides pain and symptom control.
 Focuses on body, mind and spirit.
 Reduces unnecessary hospital visits.