Lieve Van den Block, Professor of Communication in Family Medicine, Chair of the Research on Palliative Care for Older People in the End-of-Life Care Research Group, Vrije Universiteit Brussel, Belgium.
Over the past decade, important policies have been developed concerning ageing, chronic diseases, dementia and long-term care, at national level as well as at international level (e.g. by the European Commission, Council of Europe, World Health Organization, Organisation for Economic Co-operation and Development (OECD), United Nations). Remarkably, these current policies focus almost exclusively on healthy ageing, prevention of disease, cure or disease modification, which is undoubtedly necessary. However, there is relatively little attention to the importance and added value of palliative care within these policy developments, this while death is inevitable for everyone and, in many cases, preceded by a relatively long period of gradual decline and potentially complex symptoms and problems. A recent review analysing dementia strategies from seven countries (1), for example, found that most or all national strategies adequately address earlier transitions in the trajectory (e.g. symptom recognition to diagnoses, or home to hospital and back) but far fewer address the later transitions such as those from home to residential care or to palliative or end-of-life care.
If palliative care hopes to impact on future health care practice and policy, I think it could be of real added value to further integrate into existing policy developments on ageing, chronic diseases, and dementia. Just as palliative care practice strives to integrate into mainstream health care, it would also be beneficial to integrate palliative care into the overall healthcare debates as it ought to become a crucial component of all national and international healthcare policies.
It is important to notice that there have been very exciting developments in this area, where existing ageing or dementia networks at EU level (such as Age Platform, Alzheimer Society) are starting to collaborate with palliative care research groups and organisations. An example of such collaboration is the EU FP7 project PACE (Comparing the effectiveness of palliative care for older people in long-term care facilities in Europe). Hopefully such initiatives will increase the inclusion of palliative care into policies on ageing in the future.
I have elaborated on this point in a recent Commentary for the European Journal of Public Health (2) and I hope the issue will be picked up by policy- and decision-makers in the field of ageing and dementia. I welcome everyone to react to this commentary to try to evoke as much debate as possible in the future. An ideal place for discussion will be the EU FP7 EURO-IMPACT and IMPACT final conference ‘Palliative Care 2020: towards integration of palliative care in an age-friendly EU’ in Brussels on 15 October 2014.
1. Fortinsky RH, Downs M. Optimizing person-centered transitions in the dementia journey: a comparison of national dementia strategies. Health Aff (Millwood) 2014; 33(4):566-73.
2. Van den Block L. The need for integrating palliative care in ageing and dementia policies. Eur J Public Health 2014 Jul.4; 1-2.
Links and resources
- PACE (Comparing the effectiveness of palliative care for older people in long-term care facilities in Europe) EU FP7 2014-2019 grant agreement no. 603111.
- IMPACT (IMplementation of quality indicators in PAlliative Care study).
- EURO-IMPACT (European Intersectorial and Multi-disciplinary Palliative Care Research Training).
- EU FP7 EURO-IMPACT and IMPACT final conference: ‘Palliative Care 2020’
- White paper on palliative care in dementia – recommendations from the EAPC.