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T&T could soon feel the effects of a steady increase in the 65-and-over population, many of whom may require specialised palliative care. Ageing populations have been on the rise worldwide. The phenomenon is known in the USA as the silver tsunami, a term associated specifically to dramatic increases in the birth rate in the USA after World War II, between 1946 and 1964, the baby boomers generation.
That hike in the post-war birth rate finds a parallel in T&T, where, according to local census statistics, the highest population growth rate of the past century was during 1946 to 1960. The US bureau of statistics predicted that in 2020, one in four US workers will be over 55. By 2020, the projected elderly population is expected to be close to 29 per cent of the entire US population, compared to 24.7 per cent in 2010.
Data from the 2011 population and housing census in T&T, reported that nine per cent of the population was over the age of 65, compared to seven per cent in 2000 and 5.6 per cent in 1980. Based on this and other data, Dr Ravindra Maharaj, a lecturer in the postgraduate programme in Palliative Care at the Department of Clinical Medical Sciences, University of The West Indies (UWI) St Augustine, is predicting that more elderly people will be part of the local work force.
Maharaj said the expected increase in the geriatric population could result in an increased burden on the health services as elderly patients are more likely to have chronic diseases and multiple medical problems thus needing specialised palliative support. Palliative care is an area of health care that focuses on relieving and preventing patients suffering.
Palliative medicine is appropriate for patients in all disease stages, including those undergoing treatment for curable illnesses and those living with chronic diseases, as well as patients who are nearing the end of life. Responding to questions from the T&T Guardian, Maharaj said several things are necessary as T&T prepares for its own silver tsunami, including changes to infrastructure, economics, social support and healthcare.
“Palliative medicine takes a multi-disciplinary approach to patient care, relying on input from physicians, pharmacists, nurses, chaplains, social workers, psychologists, and other health professionals in formulating a plan of care to relieve suffering in all areas of a patient’s life. This multidisciplinary approach allows the palliative care team to address physical, emotional, spiritual, and social concerns that arise with advanced illness,” he said. In T&T, there are only three establishments offering in-patient palliative care: the Living Waters Hospice at Warner Street, Newtown, started in 1983, and Vitas House Hospice at the St James Infirmary, which opened in 2008, and Mercy Home, which provides care to only Aids patients.
However, Dr Karen Cox-Seignoret, secretary of the Palliative Care Society, said the recommended capacity is 50 palliative care beds per million population. Cox-Seignoret said palliative care infrastructure was “patchy at best” as she listed the major deficits which include few trained health care professionals, insufficient hospice beds for the population size, no hospice beds in east, central and south Trinidad and Tobago, no palliative medicine departments at any hospitals and minimal infrastructure for hospital and community-based services.
Cox-Seignoret said because that demographic was particularly vulnerable, it was necessary to ensure prompt access to the right medication. Suggesting several improvements, Cox said government could review palliative care services and infrastructure; introduce palliative care education as part of undergraduate medical education in the nursing curriculum; create palliative care posts in each major hospital; special training for teams at all health centres who can also provide out-of-hours cover; improve access to the required medication; and expand the drugs needed for symptom control in advanced disease.