A large Italian survey of 5,400 elderly people reveals that 58.3% of those hospitalized and 48% of residents in RSAs require palliative care. It’s not just about cancer patients or people at the end of their lives. Yet more than one facility in three does not offer this type of assistance.
Suffering does not begin in the last days of life. It can accompany a chronic illness, dementia or a progressive deterioration of physical conditions for months or years. And it can become part of the daily life of a person hospitalized or hosted in an RSA. Yet, when we talk about palliative care, our thoughts still turn to hospices and terminally ill cancer patients. It is an association that no longer corresponds to the reality of assistance and which risks leaving a significant part of the most fragile population without answers.
To remember him, on the occasion of National Palliative Care Dayare the results of a vast Italian survey promoted by the Italian Society of Gerontology and Geriatrics (SIGG), together with the main scientific societies and organizations in the sector. The photograph is eloquent: 58.3% of elderly people hospitalized and 48% of those residing in RSAs have a need for palliative care. Despite this, more than a third of the structures involved do not have services of this type. It is a care need that remains largely invisible. And which above all concerns a population destined to grow with demographic ageing: very elderly people, often suffering from multiple pathologies at the same time, with a progressive loss of autonomy and symptoms that heavily impact the quality of life. Not necessarily cancer patients, but people who need assistance capable of recognizing and treating suffering, without waiting for the disease to reach its final stage.
Palliative care, not just hospice: the photograph of 5,400 elderly people
The study, coordinated by Dario Leosco, president of SIGG, and Graziano Onder, professor of Medicine and Palliative Care at the Catholic University of the Sacred Heart of Rome, represents one of the largest Italian surveys on the need for palliative care in hospitals and residential facilities for the elderly. The results were published in the journal Aging Clinical and Experimental Research. The survey involved 235 structures distributed in 17 Italian regions and in the Republic of San Marino. The sample includes 100 internal medicine departments, 56 geriatrics departments and 79 residential facilities for the elderly. Approximately 5,400 patients were examined: over 3,300 hospitalized, with an average age of 81 years, and almost 2,100 residents in nursing homes, with an average age of 86 years.
The most significant fact is precisely the size of the phenomenon. Palliative care is not a necessity limited to cancer patientsbut they concern a very high share of elderly people with chronic pathologies and frail conditions. “Palliative care is traditionally associated with hospice care and cancer treatment. However, the majority of elderly people hospitalized and residing in RSAs very often present with multiple chronic diseases, mainly non-oncological, but very debilitating and with a high burden of suffering, which requires a palliative approach at any time during the course of the disease and not just in the last days of life”, explains Dario Leosco.
Dementia, pain and malnutrition: when fragility becomes suffering
The research also provides a picture of the clinical conditions that accompany the need for palliative care. Cognitive deterioration, nutritional problems, dysphagia and pain are common among older adults who require it.
The cognitive decline it affects 56.2% of hospitalized patients with palliative needs and 48.7% of residents of RSAs. The deterioration of nutritional status concerns 36.6% and 23.9% respectively. Dysphagia, i.e. difficulty swallowing, is present in 17.6% of elderly people in hospital and in 28.8% of those in residential facilities. Furthermore, pain affects approximately one in two patients.
The relationship with dementia is particularly relevant. The disease, present in approximately half of the sample, represents an important vulnerability factor. The need for palliative care concerns 65.6% of elderly people with dementiacompared to 44.9% of those who do not suffer from it.
The data draws attention to one of the major critical issues of geriatric care: recognizing suffering when the patient is no longer able to communicate it clearly. A person with cognitive impairment may have difficulty describing pain, reporting discomfort, or expressing needs. The risk is that some symptoms are underestimated or interpreted as inevitable manifestations of age or disease.
The law exists, but the right to palliative care is not yet universal
The problem is also organisational. More than a third of the hospital departments and residential facilities involved in the survey do not offer palliative care. A deficiency that makes it difficult to transform a widely documented need into concrete assistance. Yet, in Italy the right of access to palliative care is enshrined in the Law 38 of 2010which protects the dignity and autonomy of the sick person and recognizes the right to an individual treatment program, also extended to family support. The legislation provided for the development of a complex care network, not limited to hospices and home care.
In fact, the model also includes the hospital, through specialized teams and consultancy activities in the departments, clinics and residential facilities. Ministerial Decree 77 of 2022 further clarified this approach, indicating that palliative care can accompany chronic-degenerative diseases from the early stages. The distance between the regulatory framework and reality, however, remains significant. The 2023 Budget Law has set a precise objective: guarantee access to palliative care for 90% of the population in need by 2028. An ambitious goal, which requires regional strengthening plans and constant monitoring. Why Palliative care is not a medicine of the last days, but an essential part of the care of frail people. And the fact that almost one in two elderly people in RSAs and over one in two in hospital needs it requires us to rethink the organization of care. It is not enough to recognize the right on paper: we must ensure that it can also be exercised by those who are not in hospice, by those who do not have cancer and by those who are no longer able to ask for help.
