“You matter because you are you…You matter to the last moment of your life…We will do all we can not only to help you die peacefully…But also to live until you DIE…”–Dame Cicely Mary Saunders, an English Anglican nurse, social worker, physician and writer, involved with many international universities. She is best known for her role in the birth of the hospice movement, emphasizing the importance of palliative care in modern medicine.
Mangaluru: Palliative Care is care beyond cure delivered to patients with End stage diseases. Its focus is on the patient and his/her symptoms rather than the disease. Ir addresses the social, emotional and spiritual, and physical issues of patients suffering from incurable diseases. While the need for Palliative Care with reference to cancer is well known, its need in Geriatric is under-recognized.
The first ever CME in “Palliative Care” with special reference to Geriatrics organized by Department of Medicine-Kasturba Medical College-Mangaluru in association with Dr TMA Pai Endowment Chair in geriatrics-Manipal was inaugurated at Sushrutha Hall-KMC-Attavar on 8 April 2015, by Dr Frank Elsner- Anesthetist and Professor of Palliative Medicine at the RWTH, University of Aachen-Germany, along with other dignitaries on the dais, namely- Dr Cordula Dietrich-Psychiatrist, Music therapist-Berlin, Germany; Dr Prabha Adhikari- Professor of Medicine, KMC-Mangaluru; Dr Sudhakar Nayak- Professor and former HOD of Bio-Chemistry-KMC; Dr Damodar Shenoy- Professor and HOD of Medicine- KMC; and Dr Madhusudan Upadhya-Professor and former HOD of Anaesthetics, KMC.
The welcome address was delivered by Dr Damodar Shenoy, which was followed by briefing on the CME in Palliative Care in reference to Geriatrics by Dr Prabha Adhikari. Dr Adhikari said, ” This CME will aim to guide and train Physicians, Psychiatrists, Nurse, Physiotherapists to offer holistic care to the Geriatric population. It will also address caregiver needs and equip participants with tools and techniques for breaking bad news rapidly in the limited time available to a consultant”.
Addressing the participants through audio-video presentation, Dr Frank Elsner said, “Palliative care is an interdisciplinary medical specialty that focuses on preventing and relieving suffering and on supporting the best possible quality of life for patients and their families facing serious illness. The primary tenets of palliative care are symptom management; establishing goals of care that are in keeping with the patient’s values and preferences; consistent and sustained communication between the patient and all those involved in his or her care; psycho-social, spiritual, and practical support both to patients and their family caregivers; and coordination across sites of care.”
“Palliative care aims to relieve suffering in all stages of disease and is not limited to end of life care. Within an integrated model of medical care, palliative care is provided at the same time as curative or life-prolonging treatments. While palliative care was once considered to be synonymous with end of life care (which was often delivered in a hospice setting), it is now recognized that palliative care can be appropriately offered to patients at any time along the trajectory of any type of life-threatening illness, even concurrent with restorative, life-prolonging therapies”.
“Most serious, chronic illness in the United States, Europe, and other developed countries occurs in those aged 65 years and older. These older individuals often live with and die from chronic illnesses that are preceded by long periods of physical decline and functional impairment. Thus, providing medical care for the elderly often involves medically and ethically complex decision-making, requiring consideration of patients’ multiple comorbid conditions, their quality of life, and their wishes regarding treatments. Establishing the goals of care is of the utmost importance when treating older adults with life-limiting illnesses. Depending upon the circumstances, this may be done directly with the patient or may require a surrogate decision-maker. General aspects of palliative care relating to decision-making that are relevant to the geriatric population (eg, advance directives) and issues relevant to assessment and management of symptoms in palliative care patients are discussed separately” he added.
Speaking to me during tea-break, Er Jerardin D’souza-Founder of Mangalore Alzheimer’s Association said, “‘The Suffering Elders and their families need to be aware of the Medical Developments, be it Alzheimer’s or any Terminally disruptive disease, the Awareness of facilities available is paramount. Palliative Care is End of Life Care and our Focus is specially for the Elders, Old, Geriatric field. MAA is trying to create awareness of all the advancement in the medical field. International luminaries like Dr.Frank Elsner, Dr.Cordula Dietrich, add to our knowledge and we are grateful to them and Dr.Prabha Adhikari and KMC for bringing them to Mangaluru and enlightening us” .
Dr Cordula Dietrich from Germany, who will be conducting sessions on “Music Therapy in Palliative Care” tomorrow speaking to me said, ” Music Therapy with the Body Tambura is a new strategy in the holistic approach to treatment in Palliative Care. It has an intense effect on the physical, mental and spiritual dimensions of the patients. Music Therapy can bring relief to dying patients and is intensively used in Palliative Care. Music therapy with the Body Tambura is purely opening up new vistas and window of new strategic holistic approach to treatment in palliative care. It has an effect on Body, Mind and Spirit dimensions of the patient in terms of a deep holistic relaxation and significant reduction of physical pain. Music therapy can bring relief in dying patients. Music therapy is intensively used in Palliative Care”.
The key topics covered during the two-day program are : Introduction to Palliative Care-An International perspective; Problems with multi-drug use for pain relief in End of life care; Pain Management in Geriatric care; Dyspnea Management in Geriatric patients with end stage cardio-respiratory diseases; Breaking bad news; Wound Management; Music Therapy with Body Tambura; Multimorbidity and Polypharmacy; Palliative care needs in stroke and Alzheimer’s patients; and Handling Grief, Caregiver stress and family counselling.
Dr.Gayatri Bhat, Dr.Sheetal Raj, Dr.Mahesh Padyana, Dr Shyam Krishnan, Ms Smitha Pai and a whole lot of Eminent doctors participated in the CME. The vote of thanks was proposed by Dr Sheetal Raj-Assistant Prof. of Medicine-KMC, and the program was efficiently compered by Dr Mridula Laxman- Senior Resident-Dept.of Medicine-KMC.