DELHI DECLARATION FOR PALLIATIVE CARE AND END-OF-LIFE CARE FOR OLDER PEOPLE
25 February 2018 – New Delhi
With the objective of improving palliative and end of life care for older people, the Indian Association of Palliative Care (IAPC), invited representatives of the Indian Academy of Geriatrics (IAG), Alzheimer’s and Related Diseases Society of India (ARDSI), and HelpAge India for a meeting at the Bangalore Baptist Hospital on 21/1/17. A draft joint statement was initiated, on the lines of the European Association for Palliative Care and EUGMS statement, drawn from the WHO Regional office for Europe document – ‘Palliative Care for Older People: Better Practices’. This was then worked on-line, and a final agreed statement was put up on the IAPC website for comments. The final document was approved in the Central Council meeting of IAPC at Kosish Hospice, Jharkand on 3/9/17. It was finally presented on 25/02/18 in the Silver Jubilee IAPCON2018 at AIMS, New Delhi, as the ‘DELHI DECLARATION FOR PALLIATIVE CARE AND END OF LIFE CARE FOR OLDER PEOPLE’. This will be published in our Indian Journal of Palliative Care
The other associations will also be requested to publish the joint statement and the Delhi Declaration in their respective journals. Ways and means of networking among the four associations will be considered to make the joint statement a reality in providing effective palliative care and end of life care for older people.
Decisions will also be taken for further advocacy with the Government to support and facilitate this care for older people.
Palliative Care and End of Life Care for Older People
Joint Statement By
The Indian Academy of Geriatrics (IAG)
Alzheimer’s and Related Diseases Society of India (ARDSI)
Indian Association of Palliative Care (IAPC)
25 February 2018
The Indian population is ageing: Elder population now stands at 100 million and is projected to grow to 324 million, constituting 20% of the total population, by 2050. More than 3.7 million are with Dementia. 51% of elderly are below poverty line and 73% are illiterate.
Increasing numbers of people are living with frailty and disability and dying with multiple chronic diseases. Appropriate and effective management of symptoms (pain, breathlessness, fatigue, depression, and other distressing problems) in the advanced stages of disease is often lacking; this results in poor quality of life and loss of dignity.
Too frequently, older people with terminal illness undergo unnecessary investigations, treatments, hospitalizations, and admissions to intensive care. This is burdensome and expensive for the patient, family, and society.
Access to high quality palliative care* for older people with serious life-limiting illness, and closer interaction between geriatric and palliative multidisciplinary teams, can enhance the quality of lives of these people and importantly reduce costs incurred by the family and the nation. The families, who are the cornerstone of any palliative care programme, will also be empowered to care and cope during this difficult situation.
Indian Association of Palliative Care (IAPC) definition of Palliative Care –
Palliative care is the active total care applicable from the time of diagnosis, aimed at improving the quality of life of patients and their families facing serious life-limiting illness, through the prevention and relief of suffering from pain and other physical symptoms as well as psychological, social, and spiritual distress through socially acceptable and affordable interventions.
This could be achieved by:
- Recognizing that older people with serious life limiting diseases including cancer and various forms of Dementia, have the right to the best possible palliative care:
All health care systems should delineate a palliative care and end of life care strategy that encompasses older people with serious life limiting diseases including cancer and various forms of Dementia, and this should be included as a priority of National health care policies.
- Promoting public awareness and Community participation:
Health care systems should empower older people and their families and promote public awareness of palliative care in Society.
- Promoting a collaborative effort between Geriatric and Palliative medicine: Health care systems should facilitate collaboration between geriatric and palliative medicine to foster synergies, and to design a plan for developing areas of common interest.
- Investing in capacity building through education and training:
Institutions should recommend that clinicians and care workers involved in the care of older people and their families have core competencies in palliative care. Training health care workers in these competencies should be part of undergraduate, postgraduate, and continuing education.
- Investing in research:
Institutions should increase the opportunities for, and the funding of, research in palliative care of older people. Public and consumer involvement should be promoted and the implementation of research findings into practice must be a core outcome.
- Establishing a platform for the exchange, comparison, bench marking, and documentation of best practices between members.
WE CALL UPON THE INDIAN GOVERNMENT TO ENSURE THAT EVERY OLDER CITIZEN WITH ADVANCED LIFE LIMITING DISEASES INCLUDING CANCER AND VARIOUS FORMS OF DEMENTIA, IS OFFERED THE BEST POSSIBLE PALLIATIVE AND END OF LIFE CARE WHEREVER THEY ARE CARED FOR.
Ref: PALLIATIVE CARE FOR OLDER PEOPLE: BETTER PRACTICES
WHO (Regional office for Europe) 2011