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Policy-makers and decision-makers should do the following s. 52
1. Recognize the needs
a. Recognize the public health implications of ageing populations with palliative care needs and that substandard care towards the end of life is a public health problem.
b. Identify and support older people with palliative care needs in various settings, including the community, nursing homes and hospitals, including intensive care.
2. Develop a strategy
a. Develop, invest in and implement a palliative care strategy that includes specifically the needs of older people in relation to all diseases and the insights and practice of modern care of olde people (geriatric medicine, geriatric nursing and mental health services for older people) and dementia care
b. Monitor the success of the strategy, learning from examples in other countries.
c. Ensure a systems-wide approach and develop palliative care for older people as part of the
whole health care service.
d. Embrace and invest in the needs of people with diseases other than cancer, recognizing issues of multiple morbidity and long-term conditions.
3. What the strategy should include
a. Building knowledge and development
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Develop national strategies for palliative care research that are formally linked with geriatrics and expand investment in this area across all diseases.
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Include evaluation as a key outcome that health professionals consider routinely. This involves investing in audit and quality improvement methods to improve the care provided for local populations and rewarding the health organizations, including nursing homes, involved in auditing and quality improvement schemes.
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Develop national data sets for palliative care.
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Facilitate change by supporting demonstration projects.
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Ensure that, when developments or new services are planned, evaluation is an integral part of this.
b. Education and awareness
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Promote and invest in developing palliative care skills among staff working across all settings.
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Ensure that the training of health care professionals includes suffi cient time devoted to palliative medicine, geriatric medicine, geriatric nursing and mental health services for older people and that professionals are supported in keeping up to date.
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Promote public awareness of palliative and end-of-life care so that these issues can be more openly discussed and there is greater awareness of what good care can achieve. One way to achieve this is by including a component of public education in public health policies beyond traditional adult education courses to reach people from a wide range of communities using a variety of media.
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Ensure that palliative care is a core part of the training and continuing professional education of doctors, nurses, social workers, chaplains and other health professionals.
c. Providing care and services
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Use the examples in this booklet to locally adapt and invest in specific initiatives to improve palliative care for older people in all settings.
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Recognize the work of families and caregivers and invest in support to help them care for older people reaching the end of life.
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Invest in services based on need in terms of symptoms and problems and their effectiveness in meeting that need rather than on diagnosis.
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Encourage health service providers to ask people about their preference for place of care and death. Meeting individual preferences should be the ultimate measure of success.
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Ensure that multidisciplinary services shown to meet the needs of older people for palliative care are adequately funded, rewarded and supported.
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Demand and invest in high standards in palliative care for older people, including pain and symptom management, communication skills and coordination of care.
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Ensure that interventions are multifaceted and integrated within the health system
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