The importance of palliative home care for older people

Sandra Silva Preciado gives a personal view of working as a physiotherapist in geriatric psychomotricity and palliative care in Bogotá, Colombia.

Sandra Silva Preciado at the 15th EAPC World Congress in Madrid, 2017.

In Colombia, the elderly have always received less palliative care because they have the preconception that it is normal for them to reach the end of their lives. Consequently, many families must care for their dying grandparents without the necessary experience or training. They are guided by love for their families, but often it is not enough to provide the necessary support. Therefore, when the person is approaching death relatives are not prepared to face it. They turn to the nearest hospital in the hope that their loved one can be revived ‘heroically’ and they can spend more time together. But in practice, many grandparents die alone in the emergency room or the intensive care unit of the hospital.

I have seen several cases of older adults in similar situations. I remember perfectly a Sunday in December when I worked in a clinic and did my shift in the intensive care unit. In cubicle number one was a 94-year-old patient admitted as an emergency after presenting with acute myocardial infarction. She had been resuscitated and subsequently extubated at dawn and was already in a good, general condition. When I entered her cubicle she was dressed and sitting on her bed. I greeted her, introduced myself and asked, “What are you doing?” She replied:

“Waiting for the time to let my children in and take me home because I’m going to die, and they won’t let me die here, they give me electric shocks and well, how can one die in peace?”

Given the importance of saying goodbye, not only to the life that you have built with so much effort, but also to loved ones, I consider that palliative home care in the elderly is the cornerstone for a good death. But the reality in our country is that we have an ageing population and an increase in chronic pathologies. Many of the caregivers of the elderly are themselves pensioners who take care of their relatives because they cannot afford to pay for private care. Nonetheless, they dedicate themselves to this work, regardless of the implications. For example, caregivers who are not trained do not know how to care and ensure a patient’s wellbeing and comfort, or the importance of the financial implications for both the health system and the family, not to mention how to address the physical and psychological pain of the elderly.

The reality of palliative care in Colombia is shown below. While older people, a growing population, are not specifically mentioned attention is drawn to the many illnesses that may affect them.

“In Colombia, there are an estimated 200,000 new cases of cancer and non-cancerous diseases such as Dementia, Parkinson’s, Amyotrophic Lateral Sclerosis, Multiple Sclerosis, Chronic Kidney Disease, AIDS, Liver Failure, Congestive Heart Failure and Severe, Chronic obstructive pulmonary disease. These diseases cause between 100,000 and 120,000 terminally ill patients requiring palliative care,” as highlighted by Juan Carlos Hernández Grosso, Director of the Palliative Care Unit Presentes in Bogotá and Chair of the Palliative Care Association of Colombia (ASOCUPAC). ¹

Hernández Grosso also states: “In the Quality of Death Index … Colombia, despite having a palliative care law (Law 1733 of 2014 that is yet to be regulated), has a low supply of palliative care – few specialized professionals. – and a high demand for these specialists. This … added to the difficulties of availability of opioids for the relief of pain, leaves us in the ranking of The Economist in a dishonourable position, 68 out of 80 participants, which means that we are from [one of] the countries with the worst quality of death.” ^1, 2

In working at home with an older adult, I have noticed that people are looking to me to find alternative therapeutic activities that help to change the environment. By providing support at home, it is possible to improve the management of time and quality of life that has often become monotonous and depressing, such as being bedridden. In particular, I’ve noticed the attitudes of others – relatives, caregivers and friends – who often act as if nothing has happened and ignore the preferences or thoughts of the elderly. Moreover, sometimes they believe that it’s enough just to supplement the basic daily activities and leave aside the individualism of the person. For example, they forget the simple pleasures that could brighten the day for an older person, such as listening to their favourite music or reading a book that they had saved to read after their retirement.

The therapy I offer fuses physical therapy, Shiatsu, geriatric psychomotricity and palliative care. I also explore the use of complementary or alternative therapies such as assisted therapy with dogs, aromatherapy, essential oils, vibration, quartz, music, reading, platonic solids and the pendulum, according to the needs of each individual. The session may evoke painful or happy memories and I will help the individual to use their physical, psychological, emotional and spiritual strengths to generate a better quality of life.

The message that I would like to leave is the importance of carrying out activities according to the needs of the elderly, especially in Colombia. What is fundamental, is a holistic philosophy that involves the body, the emotional, the psychological and the spiritual needs – for the elderly, the caregivers and the family. Thus, change can be created that facilitates the relationship between us all and offers inner peace at the moment of death.

I would welcome contact with others working in physiotherapy in palliative care, particularly with older people. Please email me here.

References and further reading

1. Villate A, Colombia se raja en el cuidado de pacientes con enfermedades. Las 2 Orillas.

2. The 2015 Quality of Death Index – Ranking palliative care across the world. A report by The Economist Intelligence Unit, October 2015.

Pastrana T, De Lima L, Pons JJ, Centeno C (2013). Atlas de Cuidados Paliativos de Latinoamérica. Edición cartográfica 2013. Houston: IAHPC Press. Download a copy here.