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Palliative care for the geriatric patient in Europe

Survey describing the services, policies, legislation, and associations

Versorgung geriatrischer Palliativpatienten in Europa

Umfrage zu Angeboten, Strategien, Gesetzgebung und Fachgesellschaften

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Abstract

Background

Knowledge about the quality of end-of-life care in the elderly patient in Europe is fragmented. The European Union Geriatric Medicine Society (EUGMS) Geriatric Palliative Medicine (GPM) Interest Group set as one of its goals to better characterize geriatric palliative care in Europe.

Objective

The goal of the current study was to map the existing palliative care structures for geriatric patients, the available policies, legislation, and associations in geriatric palliative medicine in different countries of Europe.

Methods

A questionnaire was sent to Geriatric and Palliative Medicine Societies of European countries through contact persons. The areas of interest were (1) availability of services for the management of geriatric patients by using vignette patients (advanced cancer, severe cardiac disease, and severe dementia), (2) policies, legislation of palliative care, and (3) associations involved in geriatric palliative medicine.

Results

Out of 21 countries contacted, 19 participated. Palliative care units and home care palliative consultation teams are available in most countries. In contrast, palliative care in long-term care facilities and in geriatric wards is less developed.

A disparity was found between the available services and those most appropriate to take care of the three cases described in the vignettes, especially for the patient dying from non-malignant diseases. The survey also demonstrated that caregivers are not well prepared to care for the elderly palliative patient at home or in nursing homes.

Conclusion

One of the challenges for the years to come will be to develop palliative care structures adapted to the needs of the elderly in Europe, but also to improve the education of health professionals in this field.

Zusammenfassung

Hintergrund

Der verfügbare Kenntnisstand zur europaweiten Qualität der Versorgung von Patienten in der Phase des Lebensendes ist fragmentarisch. Die Arbeitsgemeinschaft Geriatric Palliative Medicine (GPM) der European Union Geriatric Medicine Society (EUGMS) hat sich zum Ziel gesetzt, die Situation der palliativen Versorgung geriatrischer Patienten in Europa adäquater abzubilden.

Ziel

Ziel der Untersuchung war, bestehende Strukturen in der palliativen Versorgung geriatrischer Patienten zu kartieren, außerdem einen aktuellen Stand der Strategien und rechtlichen Rahmenbedingungen sowie der an geriatrischer Palliativmedizin beteiligten Fachgesellschaften in den verschiedenen europäischen Ländern abzubilden.

Methode

Medizinischen Fachgesellschaften in den Bereichen Geriatrie und Palliativmedizin in Europa wurde ein Fragenkatalog übermittelt. Interessenschwerpunkte waren (1) Verfügbarkeit von Diensten für das Management geriatrischer Patienten (dafür waren Fallvignetten − fortgeschrittenen Krebserkrankung, schwere Herzkrankheit, ausgeprägte Demenz – entwickelt worden), (2) Strategien und gesetzliche Rahmenbedingungen sowie (3) an geriatrischer Palliativmedizin beteiligte Fachgesellschaften.

Ergebnisse

Neunzehn der 21 kontaktierten Länder nahmen an der Studie teil. Palliativmedizinische Einheiten und Teams, die für die palliativmedizinische Betreuung zu Hause beraten, gibt es in den meisten Ländern. Im Gegensatz dazu ist die Palliativversorgung in Langzeiteinrichtungen und in geriatrischen Stationen weniger entwickelt.

Es zeigte sich eine Disparität zwischen den zur Verfügung stehenden Diensten und den am ehesten zuständigen Diensten für die in den Fallvignetten skizzierten Patienten. Dies galt vor allem für die Patienten, die an nichtmalignen Erkrankungen versterben. Die Umfrage zeigte weiterhin, dass die Versorgenden auf die Betreuung älterer Palliativpatienten zu Hause oder in einem Pflegeheim nicht gut vorbereitet sind.

Schlussfolgerungen

Zu den Herausforderungen, denen wir in Europa in den nächsten Jahren gegenüberstehen, zählt die Entwicklung von Versorgungsstrukturen, die den Bedürfnissen älterer Patienten entsprechen, und eine Optimierung der Ausbildung von im Gesundheitswesen Tätigen in diesem Bereich.

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Acknowledgments

We are extremely grateful to the designated participants from all countries.

Conflict of interest

The corresponding author states that there are no conflicts of interest.

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Authors and Affiliations

  1. Department of Geriatric Medicine, University Hospital Ghent, De Pintelaan 185, 9000, Gent, Belgien

    R. Piers & N. Van Den Noortgate

  2. Division of Palliative Medicine, Department of Rehabilitation and Geriatrics, Geneva Medical School and University Hospital, Geneva , Schweiz

    S. Pautex

  3. Acute Care for Elders Unit, Department of Gerontology, Galliera Hospital, Genoa, Italien

    V. Curale

  4. Klinik für Geriatrie, Evangelisches Krankenhaus Elisabethenstift, Darmstadt, Deutschland

    M. Pfisterer

  5. Department of Geriatric Medicine, CHR de la Citadelle, Liège, Belgien

    M.-C. Van Nes

  6. Palliative Care Unit, University Hospital Ramón y Cajal Madrid, Madrid, Spanien

    L. Rexach

  7. VU University Medical Center, Amsterdam, Die Niederlande

    M. Ribbe

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  1. R. Piers
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  2. S. Pautex
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  3. V. Curale
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  4. M. Pfisterer
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  5. M.-C. Van Nes
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  6. L. Rexach
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  7. M. Ribbe
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  8. N. Van Den Noortgate
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Corresponding author

Correspondence to R. Piers.

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Piers, R., Pautex, S., Curale, V. et al. Palliative care for the geriatric patient in Europe. Z Gerontol Geriat 43, 381–385 (2010). https://doi.org/10.1007/s00391-010-0149-y

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  • DOI: https://doi.org/10.1007/s00391-010-0149-y

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