Celina is a registered nurse and CIHR scholar interested in improving end-of-life (EOL) care in order to better meet the needs of patients as well as providers. She is currently enrolled in the Social and Behavioural Health Sciences PhD at the Dalla Lana School of Public Health. She views EOL care as a public health problem, which must be addressed through critical research, good policy, education, technology, resource allocation, and creativity.
End-of-life care: The abandonment of frail older adults and the potential of a public health approach
End-of-life (EOL) care, which is provided to “people in decline who are deemed to be terminal or dying in the foreseeable future,” has been shaped by both curative medicine and palliative care practices. In Canada, providing such care to frail older adults is uniquely challenging due to the way frail older adults fit poorly into curative medicine and palliative care models. Many frail older adults have complex co-morbidities and social challenges, and they experience poor response to life-prolonging medical interventions. Nonetheless, the use of curative treatments for frail older adults is increasing, often causing prolonged physical and psychological distress. Palliative care in Canada is characterized by a focus on palliating physical suffering and promoting well-being through patient autonomy. It is designed for patients with specific life-threatening conditions and their families, thus leaving it out of reach for the many frail older adults who do not have a diagnosable terminal condition or prognosis. In this sense, frail older adults are abandoned by both curative medicine and palliative care, as neither is able to address their needs and suffering. Overall, EOL care requires reform, which will likely demand a public health approach that promotes and protects health and prevents illness for people and their communities. Public health approaches to EOL care include the collaboration of a variety of actors in the private and public spheres, which support community networks that better address the needs of the dying and the bereaved. This poster will discuss how curative medicine, palliative care and public health initiatives to EOL care intersect and will describe emerging ideas about how public health policy and programs may improve EOL care for frail older adults.