Dying to Care: How can we provide sustainable quality care to persons living with advanced life limiting illness in British Columbia?
Around the world, the oldest segment of the population is expected to grow the fastest. Within the OECD (Organisation for Economic Co-operation and Development) countries the population share of those 80 years and over is expected to increase from 4% in 2010 to 9.4% in 2050.1 As of July 1, 2010, seniors aged 65 years and over accounted for 14.1% of the Canadian population. Projections show that seniors could account for more than 20% of the population as soon as 2026 and could exceed 25% of the population by 2056. Seniors aged 80 years and over now represent 3.9% of the total Canadian population; the number of people over 80 residing in Canada by the year 2061 is projected to be 5.1 million. In addition, the fastest growing age groups within the 2009/2010 period were people aged 90 years and over.2
As a consequence of the aging of our population, more people are living with advancing, chronic and life-limiting illness and often with multiple, interacting medical and social problems. At some point in this advancing illness trajectory, people die, and about 80% of these deaths will be caused by end stage chronic diseases such as cardiovascular, lung, and kidney disease, cancer, and dementias.3 In Western Canada, however, only 16% to 30% of people who die are identified as dying and receive palliative care services.4 The majority who access these services have cancer, a unique chronic disease as it can often be predicted when the end of life may be approaching. This is not the case with most chronic diseases. Consequently, most individuals with advancing chronic life-limiting conditions such as heart disease, chronic obstructive pulmonary disease, kidney disease and dementias, do not access palliative care services but dwell “in the indistinct zone of chronic illness that has no specific care delivery system”. 5
While specialist palliative care services are critical for those with complex care needs, such a model, alone, cannot meet current and future demand for the larger population outside of the traditional recipients of cancer care. The result is that many people who require and would benefit from a palliative approach are not served by specialized palliative care. Historically, these specialized models were not developed for those with advancing chronic non-malignant disease and such models are neither feasible nor desirable for the larger numbers affected by and dying from chronic illness.
