|End of Life Care in Canada||To EOL/Palliative Care theme page|
1. Core Knowledge:
End of life care refers to formal and informal care provided during the final year of life. It includes, but is not limited to, palliative care.
Declining birth rates and greater longevity have increased the proportion of seniors (here somewhat arbitrarily defined as those aged 65 and over) in society. In 1991, seniors formed 11.6% of the population; this will rise to 16% around 2016, and to 23% in 2041 (Statistics Canada. A portrait of seniors in Canada, second edition: Target groups project. 89-519-XPE. 1997. Ottawa, Statistics Canada).
The growth will not be linear; aging will accelerate as post-war birth cohorts turn 65. Between 1991 and 2011, the numbers of elderly will grow by 1.7 million; between 2011 and 2031 the increase will be by about 3.4 million. There will be a particularly rapid increase in the portion of the ‘oldest old’ (those aged 85 and over): from 1% of the population in 1995, they are expected to form 4%, or more than 1.6 million Canadians, by 2041.
A nice quote:
"preparing to die we shed our leaves, without regret, so that the essential person may be alive and well at the end" (May Sarton. In: M. Pearsall (ed.) The other within us: feminist explorations of women and aging. Boulder: Westview Press, 1977).
2. Nice to Know:
Health Care at the End of Life
About 18% of the lifetime costs of health care are incurred during the last year of life.
In the U.S., medical care at the end of life consumes 10%-12% of the total health care budget and 27% of the Medicare budget (Emanuel EJ. Cost savings at the end of life: What do the data show? JAMA 1996; 275:1907-1914).
Most deaths are due to chronic, disabling conditions that require long term care, so population aging has important implications for health care planning and policy development. The growing numbers with age-related conditions such as arthritis or dementia also implies more demands on health and community services.
Canada has seen little research on end-of-life issues and needs for care of the elderly. Dying people are among the most needy in our society in terms of care and relief of suffering, and they are among the most vulnerable in being too sick to express their needs effectively. They are vulnerable to changes in health care provision and there are several indicators that Canada may not be doing as well as we might wish:
- While most Canadians currently die in hospital, this is not their preference.
- The 1995 Special Senate Committee on Euthanasia and Assisted Suicide recommended that the government make palliative care a priority in restructuring the health system (Senate of Canada. Of life and death: report of the special senate committee on euthanasia and assisted suicide. Neiman JB, editor. YC2-351/1-01E. 1995. Ottawa, Ontario, Senate of Canada).
- Access to palliative care varies across Canada and some authors report a palliative care crisis (Chochinov HM, Kristjanson LJ. Dying to pay: The cost of end-of-life care. Journal of Palliative Care 1998; 14:5-15). A common estimate is that less than 5% of dying Canadians receive palliative care (Senate Report).
- The provision of palliative care has been criticized as being rooted too much in cancer (and more recently in AIDS) care. Patients with other terminal illnesses may require a different approach to that used for cancer or AIDS.
- Transitions from community, to institutional, to hospital and to palliative care are often not smooth.
Living wills Medical Ethics The case of Samuel Golubchuk
Stages of grieving The Liverpool Protocol
Why are we so unwilling to talk about dying? TED talk by Dr Peter Saul.
Link to U Toronto program on end of life care -- module on how culture influences our Thinking about dying
Information on Power of Attorney & Living Wills
Ontario government Power of Attorney kit
Advocacy Centre for the Elderly
"I am not afraid of dying. I just don't want to be there when it happens"