U n i v e r s a l h e a l t h c o v e r a g e a n d h e a l t h y a g e i n g when describing the dearth of palliative care services for the elderly, note that disintegrated services, practice and policy seem to dominate as older people do not fit neatly into traditional palliative care frameworks. Palliative care for the elderly also requires volunteers and non-government organisations, such as homebased care teams or third-sector providers. It must be recognised that, while some older people may be living with or supported by family networks, there are many older people who do not have such relational supports and are living instead in isolation. Research from Australia shows that elderly people who did not access community care services died six years earlier on average than those who did (AIHW, 2015). Services to deliver palliative care need to sit within a national health framework. Without policies, it is difficult to establish and maintain palliative care services that are fully integrated in a way that ensures older people entering the service through an acute exacerbation of illness, for example, or following a fall can be rapidly identified and treated as a matter of course, rather than as exceptions. Policies should support the distribution of resources, education, staff and services within the health budget; recognise and register patient preferences and decision-making about end-oflife care; govern and legislate for appropriate pain control through opioid management without restrictions of use for vulnerable or elderly patients; facilitate the palliative curriculum in national health-worker training for all medical, nursing and pharmacy trainees; and establish and support a legal framework for the protection of the widow/er (IOM, 2014). Conclusion There are many lessons to be gleaned from the ways in which older people speak about death. A Kenyan elder, nearing the end of his own life, captured the communal view when he explained, ‘death belongs to us, death is a path we all must tread’ (Murray et al., 2003). And yet, in contrast to such insights, health workers often fear that the introduction of these conversations will be interpreted by patients or their families as a marker of the end of care, and a sign of medical failure. And the closer an older person gets to death, those conversations may be inhibited further by the impending sense of loss, grief, fear of the unknown and by religious or superstitious beliefs on the part of carers. In many cultures, the time of death is seen to be in the hands of the divine. An old farmer in the Meru district of Kenya talking about death explained that the god of the mountain would make this call. But, from the point of view of UHC commitments, investing in palliative care for older people can inform the way that death and dying are constructed and configured. Older people, supported by good palliative care, can demonstrate that preparing to live with death in mind doesn’t diminish life but rather optimises it. Death is the natural conclusion to life. Care to live (and leave) life well is a basic human right. Endnotes 1 See http://thetblogging.blogspot.co.uk/2013/02/strengtheningpalliative care-in-5.html Accessed 7 April 2015. References AIHW (Australian Institute of Health and Welfare), 2015. Use of Aged Care Services Before Death. Canberra: AIHW. Barnett, K., Mercer, S. W., Norbury, M., Watt, G., Wyke, S. and Guthrie, B., 2012. ‘Epidemiology of multimorbidity and implications for health care, research, and medical education: A cross-sectional study’. The Lancet, 380, pp. 37–43. Gott, M. and Ingleton, C., 2011. ‘How can we improve palliative care provision for older people? Global perspectives’. British Medical Journal Supportive and Palliative Care, 1, pp. 115–116. IOM (Institute of Medicine), 2014. Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life. Washington, DC: IOM. Lloyd, A., 2015. ‘Exploring the changing multidimensional experiences of frail older people towards the end of life: A narrative study’. Unpublished PhD thesis 2015, University of Edinburgh. Murray, S. A., Grant, E., Grant, A. and Kendall M., 2003. ‘Dying from cancer in developed and developing countries: Lessons from two qualitative interview studies of patients and their carers’. British Medical Journal, 326, pp. 368–372. WHO (World Health Organization), 2014. Resolution WHA 67/19: Strengthening of palliative care as a component of comprehensive care throughout the life course pdf WHO. Available at: http://apps.who.int/gb/ebwha/pdf_files/WHA67/A67_ R19-en.pdf Accessed 16 March 2015. 28 Commonwealth Health Partnerships 2015 DR LIZ GRANT is assistant principal, Global Health, and director of the Global Health Academy at the University of Edinburgh, where she is programme lead for a Department for International Development Tropical Health and Education Trust grant to support the integration of palliative care into the health systems and health service training of Kenya, Zambia, Uganda and Rwanda. She co-directs the online master’s in family medicine, the MSc in global e-health and the certificate in global health challenges, and runs a number of programmes with partners in African and Asian countries focused on the non-communicable disease burden. She is on the Board of the Consortium of Universities for Global Health (CUGH) and CBM Scotland. She worked for the National Health Service (NHS) Lothian as an international health advisor and African Health and Social care specialist, and was the health advisor to the Scottish government’s International Development team. Previously she lived in Kenya, working as a community health advisor for a number of years. Her PhD studies were based in Sierra Leone.
Commonwealth Health Partnerships 2015
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