Palliative care is a support for people who have a life-limiting illness, therefore, it is also called supportive care (Can Mollaoğlu et al., 2019). The limiting illness is the disease that cannot be cured and the main cause of death for people having such disease. Examples include advanced cancer, dementia, and motor neuron disease. Therefore, palliative care is primarily aimed to provide good quality of life to people which involves the management of physical symptoms, providing psychological, emotional, and spiritual support, supporting family and friends, and providing social care. People with life-limiting diseases choose to receive palliative care but it does not mean that they will die soon. Instead, some people have palliative care for many years alongside other treatments, medicines, and therapies.
However, palliative care is not provided to the people who are approaching their end of life and for those patients, personalized care is called “end of life care”. Approaching the end of life means that the patient is likely to die within a year and such patients often have advanced incurable conditions, general frailty, co-existing conditions, and life-threatening acute conditions. This makes person-centered palliative care and end-of-life care very important to ensure the social and emotional strength of the patients and provide them with the necessary support to have decision-making ability and die with dignity. In this regard, many palliative care frameworks have been designed to assist patients in dealing with their life-limiting illnesses.
The following report analyses all such historical and current palliative care frameworks to investigate how they have been improved with time. Also, different social inclusion policies for older adults have been discussed to determine their effectiveness in achieving the intended purpose.
According to Luckett et al. (2014), it is the basic human right of the people to receive appropriate care at the end of life, however, with the increasing number of diseases every year, it has become highly important to decide who should be provided palliative care. Furthermore, it is not even feasible to provide specialized palliative care to everyone because some patients with complex palliative care deserve more. This further highlights the importance of advanced palliative care frameworks that integrate palliative care services according to needs and preferences in the healthcare sector.
In the following sections, some attributes of the most widely used frameworks i.e., home-based models, acute care models and residential aged care models, and models used for palliative care during transitions are discussed while certain elements that make these models effective are also been highlighted.
Home-based models are most commonly used for palliative care to support family-care givers and social health professionals. These models have been widely considered effective because they support coordination and communication and provide a channel for skill improvement both for informal caregivers and palliative care teams which includes practitioners as well. They also outline the goals of advanced care management (Luckett et al., 2014).
The acute care models consist of specialist consultative services (SCS) or in-patient palliative beds. Many studies according to Luckett et al. (2014) have demonstrated the positive impact of acute care models on the overall well-being of patients. These SCS models focus on discussing the prognosis, goals of care, and diagnostic interventions, pursuing documentation of advance directives, family and patient support, discharge planning, and symptom management. According to Hanks et al. (2002) and Morrison (2008), when these services are provided by the hospital palliative care teams, a significant improvement in quality of life and symptom control is observed while in some cases, patient satisfaction is also enhanced which consequently reduce the total cost of the hospital.
However, as noted by Luckett et al. (2014), only the larger hospitals, “not-for-profit” hospitals, academic medical centers, and “Veterans Affairs hospitals” offer such specialized palliative care. Therefore, the healthcare sector, in general, lacks the necessary facilities to meet the increasing need for palliative care. Furthermore, in some cases, the emergency departments perform this job and are often highlighted as an effective platform for end-of-life care. These emergency presentations have resulted from inadequate care, inappropriate symptom control in the community, and poor financial condition of the community where people prefer to receive necessary medication from emergency departments as compared to other services. However, in such departments, the health professionals have to face many challenges in effective decision-making when they do not have any previous medical history of the patents. Thus, the “coordinated models” of care can significantly decrease the use of unwanted emergency departments in intensive care (Richardson, 2012).
Residential ages care has proved very challenging to enhance the quality of “end-to-life” care. Older people especially are more likely to have weak symptom control, sub-optimal communication, unwanted hospitalizations and insufficient care management and are less likely to have SCS services. This requires an effective multi-component palliative care model that can be efficiently used to identify the residents who will receive specialized palliative care, to make palliative care leadership teams, educate the care staff and provide technical assistance, and target efficient symptom control strategies.
Certain challenges care models frequently face whenever the care settings are changed because, during such transitions, patients are highly likely to fall through the cracks while their quick response is also required. In such circumstances, an efficient management plan and support of caregivers is essential because patients and caregivers both can lack knowledge of the different services that they can access and use while navigating the transition. Otherwise, health professionals may lack the necessary knowledge and use treatment strategies focused solely at prolonging life at the expense of the quality of life especially in the case of dementia.
All palliative care frameworks have some integrated dynamic elements to improve communication and collaboration between service providers as well as enable access to required services and enhance palliative care skills for informal carers and non-specialist. All these factors together increase the capacity to effectively respond to the patients’ changing preferences and needs. Some of these elements include case management, shared care, integrated care, volunteers and cost-effectiveness. Case management is an important feature in all successful models that are aimed to analyse the palliative needs of the patients and then meet them efficiently to improve the quality of life. There it does only include healthcare services but also involves social services and personal care.
Shared care is also an important element for effective palliative care delivery which several different models have utilized (Trivedi et al., 2012). One of the most prominent characteristics of shared care is that it enables a recognized lead clinician to work with healthcare staff from completely other fields. Integration is the coordination among different services intended to meet the needs of individual patients. It has reported many positive effects of integrated care not only for the patients and their families but also for their overall efficiency of the organization and satisfaction level of the healthcare staff.
Volunteer models have been frequently used in different palliative care settings but as noted by Claxton-Oldfield & Claxton-Oldfield (2012), no substantial evidence of their evaluation is available. Lastly, the cost-effectiveness of such services has been established by many studies where they found no significant cost difference in palliative care services and usual care (Finlay et al., 2002).
From the above discussion, it can be assessed that several frameworks of palliative care have been adopted based on the care settings and particular needs of the patients, and they all have their effectiveness. There are also some common elements shared by all these frameworks to ensure that the quality of life of patients with the life-limiting disease is improved. In the following section, different policies that are utilized to increase the social inclusion of older adults are discussed and their effectiveness in achieving this purpose is examined and recommendations are made accordingly.
People with older age have more chances of being excluded from society. For instance, Sacker et al. (2017) have highlighted several factors such as low participation in social activities, no future aspirations, bad family relationships and poor financial health as the conditions that lead to the social inclusion of common members of the society and for older adults with some chronic disease, these factors have far greater consequences. In response, governments implement different strategies and policies to reduce this increase exclusion of older people and make them an active part of society. Therefore, as noted by Sacker et al. (2017), there are many such policies devised by European countries to cope with such issues and provide older adults with the environment in which they can engage themselves in the process of active ageing and realize their potential for social, physical and mental well-being.
Thus, these policies are oriented toward providing older adults with a platform to participate in several social activities based on their needs and preferences while also assisting them in their time of need. However, as argued by Sacker et al. (2017), although these policies are aimed at increasing the quality of life of older adults and improve their social inclusion, the exact understanding of different pathways and mechanism through which these objectives will be achieved is still missing. Moreover, as noted by Walker (2017), there is a demographic revolution taking place in society with older adults having a greater proportion of the overall population of the society every year. This population increase is the result of declining fertility and rising longevity. In 2014, the average age of mothers was observed to increase to 30.2 years while the fertility rate was decreased to 1.83 children per woman.
However, not only the fertility rate has led to the increased population of older adults but their life extension due to better health facilities has also contributed to this increase. There are some other factors as well to this equation, for example, the net migration. Therefore, the United Nations has called the UK an “ageing society” since 1930 when people with age above 65 years account for the 7% of the total population. It also estimated that currently this population even comprised 20% of the total population of the UK (WALKER, 2017). With such an increased population of older adults in the country, the possibilities of their social exclusion also increase. And when such a huge proportion of the society is disconnected, it has a lot more diverse consequences on almost all the sectors of the country. Therefore, it is essential to not only provide them with a platform to become an active member the society but also understand the whole ageing process and avoid any such circumstances for them in the later stages of people.
In policy terms, it is meant to measure the various risk factors of the ageing process and then take necessary actions to reduce the severity of the chronic conditions and improve the lifestyles of the people in the later stages of life. For instance, this can include increasing the taxes on harmful substances such as alcohol and tobacco and some new taxes on saturated fat etc. which often impact the health of the people in older age. In this regard, as noted by WALKER (2017), the modest levy on the sugar content of soft drinks was highlighted by the government authorities in 2018 aiming to reduce obesity among adults. Similarly, levy on other health hazardous products such as smoking, and alcohol can prevent cancers in the later stages of life and thus improve the health conditions of the older adults in society.
Furthermore, the government can shift their directions from older people’s policies to ageing policies to ensure the increasing inclusion of aged people the society. Also, it should improve the planning of neighborhoods for people of all ages to increase the inclusion of people in their local localities. Similarly, policymakers can launch different programs to promote the development of financial products among older people. According to CPA (2021), there have been several reports issued by the government departments on the issue of social exclusion of their adults, but no significant results have been produced yet. Therefore, considering the adverse impacts of an ageing society and their exclusion, more rigorous actions need to be taken.
Palliative care is the support provided to patients to make them their remaining life valuable and meaningful. And different framework has been developed to meet the particular needs of patients in different care settings. However, among all these frameworks, it is a shared factor that the primary goal of palliative care is not only to diagnose the diseases but also to meet all mental, psychological and physical needs of the patients. Moreover, from the administrative point of view, the government needs to understand the ageing process thoroughly and include the different strategies in the policies that not only address the aged population but also address the ageing process.
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