As demographic winter sets in, the world will need far more palliative care

Michael Cook
June 20, 2017
Reproduced with Permission
Demography is Destiny

Is the developed world prepared for the avalanche of elderly people who will die of cancer and dementia? A report in the journal BMC Medicin e says No.

About 75 percent of people approaching the end of their lives would benefit from palliative care services. But after crunching the numbers, researchers at the Cicely Saunders Institute at King's College London have concluded that England and Wales are woefully unprepared for a 42 percent increase -- 160,000 people a year -- requiring palliative care in 2040 as the population ages.

Healthcare systems must now start to adapt to the age-related growth in deaths from chronic illness, by focusing on integration and boosting of palliative care across health and social care disciplines. Countries with similar demographic and disease changes will likely experience comparable rises in need.

They point out that this is a world-wide trend. Even in developed countries, there is not enough access to palliative care, with the number of providers varying from 5 to 680 per million population. "Overall, only a minority who need palliative care, perhaps as low as 14 percent, receive it," they note.

What is needed to prepare this situation? First, "a massive increase in training of specialist nurses and physicians" right now. Second, a huge increase in geriatric training for healthcare providers. "It takes at least 9 years to train a community geriatrician, and so workforce planners need to act now," they point out. Third, a change in focus towards caring for patients with dementia will be needed.

Professor Irene Higginson, a co-author, says :

"There is an urgent need to act now to transform health, social and palliative care services to meet the projected growth in palliative care need. More attention should be given to the needs of people and those close to them when facing progressive illness, particularly those dying from chronic and complex illnesses, and age related syndromes such as frailty and dementia. There is a need to support their families, who shoulder so much of the care. The way in which we provide health care, and palliative care will need to change."

Unmentioned by the researchers is the impact of this grey wave on end-of-life debates. Unless the sick and elderly are well cared for at the end of their lives, legalised assisted suicide and euthanasia could very well seem like a plausible and cheaper alternative.