Evolution of much-needed care for the elderly

Patients with chronic diseases have different physical, social, psychological, financial, and even legal concerns.
Evolution of much-needed care for the elderly

KOCHI: Modern medicine has increased life span of humans by curing diseases and improving lifestyle management. It has also addressed life-long chronic diseases and extended the life span of humans with incurable diseases. Patients with chronic diseases have different physical, social, psychological, financial, and even legal concerns.

Palliative care offers support to patients to attain near normalcy, dignity, comfort, and relief from symptoms to a great extent. Seamless integration of palliative care with curative care in acute and chronic diseases is essential throughout the treatment of diseases like cancer.

Care in India
Today palliative care is not just about managing terminal diseases such as spinal injuries related to paraplegics, motor neuron disease, Alzheimer’s disease, HIV, Parkinsonism, cancer, etc. The ultimate goal in these cases will be to offer the patients a healing touch.

The percentage of palliative care patients getting services in the world is 14%, while in India it’s just 2%.
Palliative care as a concept grew in the country in the mid-eighties. End-of-life hospices and terminal care were available till then and it was more like a charity than a system of medicine.

Today, patients with chronic illness live longer and need palliation of symptoms and increased quality of life. Kerala has been a pioneer in having a maximum number of hospitals with palliative units, spreading public awareness, and the reach of services to remote locations.

The Kerala model is based on community participation and also micro and macro funding. Every local body has a palliative care unit under the health system.

Hospital-based units
Since major hospitals are where most deaths take place, they need palliative care units to manage patients as well as create awareness on end-of-life care. Palliative units in hospitals other than taking care of their patients by facilitating advanced care, home care, terminal care, bereavement support, community participation, etc, are involved in creating awareness among health professionals, too. So, it’s a symbiotic relationship.

Current palliative care
Pain, especially in incurable diseases, is a foreboding symptom and has to be relieved as a right of every patient. Treating chronic pain (which lasts more than six months) is different from treating acute pain.
It may involve the use of opioids judiciously and continuous medications where the goal is to make the patient as functional as possible.

Terminal shortness of breath happens in many conditions and is treated with anti-anxiety measures and low-dose opioids do help. Managing bedsores in bedridden patients’ muscles and consequent limb contractures is another need. Psychological support for patients and families are also important.

At the hospital I work in, the department provides social help by coordinating with voluntary agencies and the government. We also provide first-day counselling for oncology patients and families. Round-the-clock availability of physicians on the phone and home care are also part of the palliative care system here.

Not just care
Today, palliative care has moved from tender loving care alone. It is now more focused on much-needed medical interventions to improve quality of life with effective communication. And professional chronic pain management using opioids also comes under its ambit.

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