Participants reviewed the World Report on Ageing and Health, which includes several references to palliative care, and discussed the Global Strategy and Action Plan on Ageing and Health. Palliative care advocates made three verbal interventions at the meeting.
World Report on Ageing and Health
The World Report is a comprehensive 233-page update on the global issue of ageing.
There are several references to palliative care as it relates to the continuum of universal health coverage, as well as a description of “what is palliative care”, using data from the Global Atlas of Palliative Care at the End of Life.
While it is good that palliative care has been included in the report, it does not get sufficient attention, given the importance of the issue to ageing in general.
Global Strategy and Action Plan on Ageing and Health
The main focus of the consultation was on the draft Global Strategy and Action Plan. The plan has five Strategic Objectives:
- Fostering healthy ageing in every country
- Creating age-friendly environments
- Aligning health systems to the needs of the older populations
- Developing systems for providing long-term care
- Improving measurement, monitoring and research on healthy ageing.
The five strategic objectives in the Global Strategy and Action Plan were also reviewed. Palliative care was only included in one of the five strategic objectives (Developing systems for providing long-term care ), but it was recommended that it be included in two additional objectives (Aligning health systems to the needs of the older populations  and Improving measurement, monitoring and research on healthy ageing ).
Declining intrinsic capacity
Both the report and the draft strategy and action plan focus on maintaining “intrinsic capacity.” This refers to maintaining cognitive and functional abilities as long as possible, and in fact to take actions to prevent their decline, especially in older age.
While this is a noble and good objective, the reality is that most people in older age will develop chronic conditions that will impair their intrinsic capacity, and there is not a great deal of attention paid to this issue.
Palliative care is an essential component to ‘healthy ageing’. It helps those with advanced chronic conditions to function at their highest level, by preventing and treating the anticipatable problems and symptoms that impair capacity.
As we get older, we may lose many of these capacities, develop multiple health problems, and often experience physical, psychological, social and spiritual suffering.
Therefore, palliative care principles and practices should be included in models for re-aligning health systems, and it is critical that palliative care measures be included in indicators for healthy ageing.
Several countries spoke favorably about including an increased focus on palliative care at the consultation, including Uganda, India, the Czech Republic, Switzerland, and Costa Rica.
Measurement, monitoring, and research
Measurement of what is a good death is challenging. It means different things to different people. Three things have been found to be most important – and most measureable – near the end of life:
- the importance of having conversations between people accessing care and the health professionals caring for them about the affected person’s goals for care.
- the extent to which people reported that their pain and other symptoms; physical, psychological, social and spiritual are relieved; and
- how people accessing care – and their families – evaluate the experience of the care they have received.
Global measures that are aligned with NCD measures and global goals for universal health coverage are essential for use in-country.
The consultation was very productive, with a lot of good interaction among the participants and valuable input to WHO on the Global Strategy and Action Plan.
Palliative care should have a more prominent place in the plans as a result of this consultation. It will be important to continue to review the draft strategy and action plan to ensure palliative care is more integrated. The final draft will be presented to the WHO Executive Board in January.
Dr Connor’s participation in this consultation was funded by the Open Society Foundation’s Public Health Program.