On October 9, 2021, which is also marked as world hospice and palliative care day; Seniors Today hosted another one of its weekly Health Live webinars. This week we had Dr Eric Borges, a leading cardiologist, to speak on Palliative Care and Caregiving for Seniors.
Dr Eric Borges is Professor in Cardiology and Senior Cardiologist at the Bombay Hospital Institute of Medical Sciences. He is also Honorary Chairman of the King George V Memorial Trust, Mumbai.
An alumnus of the T N Medical College, Dr Borges is a recipient of 13 prizes and gold medals in his career. He is also associated as a cardiologist in Mauritius and Tanzania at hospitals which have a collaboration with the Bombay Hospital.
He has performed more than 30,000 angiograms including coronary and paediatric cases and performed over 7,000 cases of coronary angioplasty with and without stent implantations.
King George V Memorial – Anand Niketan (https://www.kgvmtrust.org/) is a charitable organisation established in 1938 under a trust formed by the Governor of the erstwhile Bombay State with the primary objective of providing care and shelter to the infirm and aged destitute. It runs the Sukoon Nilaya Centre, a 90-bed infirmary for destitute and abandoned patients. KGVM, with the support of the Cipla Foundation, has commenced palliative care services to address the needs of non-cancer patients.
Hospice care is synonymous with end of life care. Palliative care is NOT end of life care.
Palliative care is defined by the WHO as an approach that improves the quality of life of the patients and their families.
Short/ acute illnesses do not require palliative care; whereas if you’re suffering from a chronic illness that might be life threatening, you require palliative care. You provide this care by preventing and relieving suffering of these patients and families by means of early identification and impeccable assessment and treatment of pain and other problems.
Pain is not always the only symptom, but it is usually the dominant symptom of the disease. And palliative care treats these issues physically, psychologically, socially and spiritually.
Palliative care is a wide spread, multi factorial, multi disciplinary approach.
Goals of palliative care:
- To provide relief
- To make the patient realize that life is worth living and then make it worth living
- To treat life and death as normal processes. You try to make the patient not afraid of dying, try making them realize that death is a normal and inevitable process which should be treated ‘matter of factly’.
The treatment is not there to hasten or postpone death. With palliative care, you don’t want to prolong death but you want to prolong meaningful life.
- Integrate psychological and spiritual aspects of patient care
- Offer a support system for both the family and the patient so they can have comfort and dignity through the trajectory of their illness.
Good symptom control is the hallmark of good palliative care.
Great psychological support is very important. As a medical professional you can be a good listener and pass on that information to the team, be that the patient’s fears or his apprehensions. You can tell the counselors and the psychiatrists and social workers that these are the anxieties of the patient and they need to be addressed.
There are a lot of groups that help and provide psychosocial support. These patients should be introduced to those groups and provide them with social support.
Palliative care is the umbrella, and hospice care is one small segment of palliative care.
Palliative care, as a whole, can be offered at any stage of the disease. However when it is hospice care, it is end of life care. There is no curative treatment available at that point in time.
A patient who is referred to hospice care does not receive any active treatment and is unlikely to live for more than 6 months.
Palliative care is a partnership, and that partnership is between the patient and the caregiver on one side. They partner with the cardiologist, the primary caregiver, the physiotherapist, the nutritionist and the counselor. Each and every member of the team is important and vital.
Do all patients need palliative care? The answer, Dr Eric says is yes, provided it is not a short illness. Each and every person who has a severe illness that may lead to death needs palliative care. If he has a severe or even a not so severe illness that goes on for a long time, the patient needs palliative care.
You should obtain palliative care consultation as early as possible or soon after a diagnosis of a major and chronic cardiovascular illness is made.
You do not discontinue medical treatment once you start palliative care.