African Palliative Care Association

Bridging the Gap

As a consequence of increased life expectancy, it is estimated that the number of older people (defined by the United Nations as those people aged 60 years and above), will more than triple globally by 2050, increasing from 606 million in 2000 to a projected 1.9 billion. Whereas 6 out of every 10 older people currently originate in resource-constrained regions of the world, by 2050 this will increase to 80 per cent. In these regions, the proportion of the population aged 60 years or over is estimated to rise from 8 per cent in 2000 to nearly 20 per cent in 2050.

Ageing is a process associated with various health-related complications that will increasingly bring important challenges to health care policy makers as the pattern of diseases evident within society change. More specifically, the epidemiological transition will result in an increased importance attached to diseases and deaths attributable to non-communicable diseases vis-à-vis infectious diseases.

In sub-Saharan Africa, there is a growing body of work that indicates that, not only do elderly Africans exhibit these debilitating diseases, but that the absence of national welfare programmes (e.g. pensions, benefits) and the trend toward urbanisation and serious economic stress among the younger adult population, is slowly eroding the extended family network. Moreover, older people are normally the primary carers for orphaned and vulnerable children affected by HIV/AIDS and those living with HIV/AIDS.

Significant linkages exist between palliative care and geriatrics. However, whilst there are positive developments occurring in palliative care in Africa, they are primarily associated with addressing the impact of the HIV/AIDS pandemic and with the non-aged. The specific requirements of the African aged (e.g. potentially enduring age-related conditions, compounded by HIV/AIDS, poverty, social isolation, bereavement and loss arising from their children’s premature death, and the burden of caring for their grandchildren and/or orphans and vulnerable children) are largely neglected.  In a region where finite national budgets face multiple pressing demands, the African aged remain a low priority.

This one-year qualitative exploratory study, conducted in Kenya and Uganda and funded by the UK-based Help the Aged, examines the potential for, and means by which, palliative care services can be integrated into existing services for the aged. The study objectives are to:

  • Describe the current life experiences of, and existing care services for, aged people and identify their unmet palliative care needs.
  • Provide evidence-based recommendations for the future effective integration of palliative care into existing services for the aged in Africa.
  • Highlight the key components of a provisional palliative care research agenda for older people in Africa.

As Mr Paul Cann, Director of Policy, Research and International Affairs at Help the Aged commented during his recent visit to Uganda: ‘Older people across the world are often neglected and sometimes abused. Any just society should be ensuring that people receive care, support and freedom from pain whatever their age or circumstances. My visit to Uganda, meeting pioneering leaders in the field of palliative care, convinced me that much more could be done to make dignity in dying a reality for everyone.’