The WHO claims that older people suffer because of a lack of access to palliative care and has called for a palliative care approach to be adopted in their care.1 Across all conditions, people over the age of 85 are less likely to access palliative care than people below the age of 85.2 Evidence suggests that people over 85 have no less palliative care needs, and receive little hospice care despite this being a high preference.3 Older people can be considered to have less palliative care needs by virtue of death being more expected.4,5 They may be unwilling to accept care that they perceive might threaten their independence.6,7 Evidence suggests that there are a number of unmet needs in this patient group; for example, Higginson and Gao suggest that older people with cancer may receive less adequate pain relief.8 While the quality of care may be equitable in the last months of life, in the final days, older people may receive less emotional and spiritual support and be subjected to more unwanted treatment decisions.9 Hunt et al also found that those over 85 years of age were less likely to have their preferences for place of death recorded, or to actually die there.9 We thus set out to explore access to palliative care, pain and symptom control, quality and experience of care, and actual and preferred place of death in older people compared with younger people.
EUROPEAN JOURNAL OF PALLIATIVE CARE, 2016; 23(4) The hospice movement, which is akin to a civil rights movement, is partly based on volunteer work.1 Hospice and palliative care (HPC) volunteers are active in almost every country in Europe, and many services depend on their contributions to deliver the range and quality of care they provide.2 The numbers of volunteers, the tasks they perform and the development of their organisations vary greatly. In some European countries, volunteers have had a long involvement in the hospice movement, in some cases even starting it. In others, volunteering has only recently started and HPC pioneers are looking at other countries for inspiration and practical information to help develop volunteering in medically dominated care environments. Depending on the country, HPC volunteering can be well organised, with concepts and theoretical frameworks that clarify its meaning and value.3 In November 2013, a Taskforce on Volunteering in Hospice and Palliative Care was launched by the European Association for Palliative Care (EAPC); this followed on from the first symposium on HPC volunteering, which had taken place at the EAPC Congress in Prague in May/June 2013 and had attracted 110 delegates.4 A second symposium with over 160 participants from 12 European countries (volunteers, volunteer managers, researchers and other professionals) was held in April 2015 in Vienna; reports from a number of countries and early findings from a European study on volunteering5 were presented and the position of volunteering in Europe was discussed. Until recently, studies on volunteering have often investigated questions such as why volunteers do what they do,6 what common problems they face,7 why they choose to stay or go8 and the boundary issues they experience.9 However, insights emerging from the work of the Taskforce indicate that there is still much that we do not know about HPC volunteering in Europe. So far, there is no shared definition and a lack of clarity about the roles and tasks of volunteers. Basic information about numbers, roles, management and training is often missing or based only on estimates.4 This EAPC White Paper presents a consensual definition and typology of HPC volunteering, and clarifies its role, position, identity and value. It considers the unique position and identity of care-focused volunteering, in an attempt to address the ambiguities and tensions that exist in this EAPC update www.ejpc.eu.com
Brazil has a tremendous opportunity to integrate palliative care into its community healthcare services. Santiago Rodriguez Correa, Carla Mazuko, Mayara Floss, Geoffrey Mitchell and Scott A Murray describe the rationale behind, and opportunities for, developing primary palliative care in the country.
