Monday, March 26, 2018

Looking after the aged.

The Kerala state government has plans to set up hospice facilities in all district hospitals. It's a step in the right direction as the state is gonna witness a demographic transition - rise in the aged population and a decline in the growth rate of population - that necessitates care for more people. Against the backdrop of increasing ageing population and nuclear families, the aged face a tough battle on the health front.

So, what's a hospice?

Hospice focuses on palliative care of chronically/terminally ill patients' pain and symptoms and attending to their emotional and spiritual needs. The treatment is either given at home or in an institution called hospice that specialises in such care. In 1967, Cicely Saunders set up the first hospice in London based on her observation of a dying patient that, "As the body becomes weaker, so the spirit becomes stronger".

Certain facts.

   (a) Palliative care was established to look after dying cancer patients.
   (b) Regional Cancer Centre(RCC), Thiruvananthapuram  was the first hospital in the country
         to start a pain clinic, offering palliative care in 1986.
   (c) Around the same time, a formal palliative care service was initiated in Bombay and designated
         hospice.
   (d) Palliative care improves the quality of life of a patient and his/her family who're facing
         difficulties associated with life-threatening illness.
   (e) It curbs suffering through early identification, correct assessment and treatment of pain and
        other problems (Physical, psycho social or spiritual).
   (f)  In '12, the Central government developed a national palliative care strategy.
   (g) In '14, it amended the Narcotics Drugs and Psychotropic Substances(NDPS) Act that helped
         overcome regulatory barriers to ensure opioid access for pain relief.
   (h) In '17, it came out with a National Health Policy laying emphasis on community or home-based
         palliative care.
   (j)  Kerala in '08, Maharashtra in '12 and Karnataka in '16 have put in place a state palliative care
         policy.

Quality Palliative Care Still Miles Away.

    (a) In '14, WHO passed a resolution that palliative care must be integrated with healthcare at
          primary, secondary and tertiary levels.
    (b) A '16 review showed that India failed to move forward in this direction.
    (c) Palliative care should go hand in hand with curative treatment and start at the time of
         diagnosis.
    (d) Though the amended NDPS Act has been implemented in Kerala, the drugs control department
          recently issued a circular restricting the amount of morphine per patient to 50-100 tablets at
          a time.
    (e) The result is that many patients find it difficult to get their actual quota!

The Steps Being taken.

      1. The end-of-life patients will be given care in the hospices proposed to be set up.
      2. Geriatric wards within hospitals will follow hospice concept.
      3. The staff that man these wards will be trained on responding to pain crises.
      4. A day care home for the elders is being planned per district.
      5. The Kerala University of Health Sciences will introduce a palliative care module in the
          MBBS course.

(Adapted from an earlier article on the subject)  


Tailpiece.

After having said the above, it doesn't give any excuse for children to put away their elders in palliative care or geriatric wards as a matter of convenience.

       

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