PALLIATIVE CARE IS vital for achieving positive experiences for both people nearing the end of their life and their families. It is also very important for improving the quality of life for many others who have distressing and hard to manage symptoms.
Access to palliative care has been shown to benefit the wider family and informal caregivers and allows them to provide other support and care.
The early developments of palliative care were mainly providing support for people with cancer. While this group remain a very important focus, it is now recognised that palliative care can support the management of symptoms from other serious chronic illness such as respiratory disease, heart disease, stroke and many others.
However, the bigger challenge will be to meet the growing needs for palliative care that will result from population ageing. Over the next 25 years, the number of people living with serious chronic diseases, and the numbers dying annually, will increase rapidly. It is now very important to plan for a major expansion and strengthening of palliative care in Ireland.
Expanding services to meet current needs
Current needs for palliative care are only partially being met. Evidence from the Irish Longitudinal Study on Ageing (TILDA) reveals that over half of those who die in Ireland have some inadequately managed symptoms.
Key informants reported that many had suffered from poorly controlled pain, and there was a failure to address depression and other mental health issues. Better access to the skills of palliative care professionals would reduce the risk of distressing symptoms persisting.
People with serious chronic illness account for over half of hospital admissions and, on any given day, an estimated one in five people in Irish hospitals are in the last year of life. In regions where palliative care is well developed, both in hospices and in the community, hospital admissions can be avoided, and fewer people die in hospitals.
There is also some evidence that getting access to palliative care early can reduce the risk of futile tests and treatments, in some cases saving resources as well as improving the experiences of patients and their families.
There have been many initiatives to develop new services, and substantial progress made, but there remains a strong case for further expansion of current provision, and this is recognised in the Sláintecare plans.
Expanding services to meet the increasing numbers
A recent study estimated the current and future numbers of people living in Ireland who have diseases associated with a need for palliative care. Excluding those who are near the end of life, it shows that the numbers with these conditions will rise by around 90% by 2046, partly due to the increases in the population and partly due to ageing.
We need to look in more detail at the particular needs of this group. To a large extent, they will be best served in their home settings or on an ambulatory basis, but such a large increase in the numbers with needs will increase demands substantially.
Palliative care is not only needed near the end of life, but needs are greatest in this period. The successes in increasing life expectancy in recent years have reduced the annual number of deaths. However, this is now going into reverse, and the expected number of deaths each year will start to increase.
There were around 27,000 deaths in Ireland in 2016, but this will rise to around 45,000 by 2046. This is a rise of around 67%. However, given the older age of those near the end of life, the increase in those dying with palliative care needs is greater – probably around 75%.
Recognising palliative and end-of-life care as a core activity of our health care system
The growing population health needs in Ireland are daunting and require urgent, multi-faceted action from the health care system.
Training more specialist palliative care practitioners across clinical and allied health disciplines is a critical first step, but this will not be sufficient to meet all palliative care needs in the future.
End-of-life care is a core activity of a health care system but is infrequently recognised as such. We must improve integration between palliative care and other areas of the system such as general practice; and equip those who work with older people with complex health needs to practice a palliative care approach. Only then can we hope to provide the quality of care and experience that people living and dying with serious illness and their families deserve.
Dr Peter May is a Research Assistant Professor, Public Health & Primary Care, at the School of Nursing & Midwifery, Trinity College Dublin. Professor Charles Normand is Professor Emeritus at Trinity College Dublin, Professor of the Economics of Palliative Care and Rehabilitation at the Cicely Saunders Institute at King’s College London, and visiting Professor in Health Economics at the London School of Hygiene and Tropical Medicine. This week is Palliative Care Week across the island of Ireland. Visit The Palliative Hub for more information.
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