Jayalakshmi R, Chatterjee Suhita Chopra, Chatterjee Debolina
Department of Humanities and Social Sciences, Indian Institute of Technology, Kharagpur, West Bengal, India.
Indian J Palliat Care. 2016 Oct-Dec;22(4):491-498. doi: 10.4103/0973-1075.191857.
Home-based palliative services form the cornerstone of Kerala's palliative program. However, two issues need research: (a) whether family-homes can be considered as the locus of ageing and dying for marginal populations who experience deprivation and poverty and (b) whether the present delivery structure meets the needs of elderly population. These issues are examined in the context of two rural areas. The study explores end-of-life characteristics of the elderly - their sociodemographic status and living patterns, morbidity profile, and functional status. It also looks into the accessibility and utilization of palliative services and respondents' satisfaction with different components of the services.
A descriptive cross-sectional survey design is used. Data were collected based on the interviews of sixty service users sampled randomly from a roster of palliative care services. Semi-structured interviews were substantiated by personal field observations.
The study has found people living under extreme financial distress with inadequate shelter and poor social security provisions. The health profile is characterized by high level of functional dependence. Many dependent widowed women were living alone without appropriate care and shelter. The palliative program as perceived by the respondents is characterized by few doctor visitations and poor frequency.
The study concludes that home-based palliation in its present form does not promote good end-of-life care. It lacks an integrated approach with good service-mix. It raises serious questions on family-home as the locus of ageing and dying for marginal populations, and suggests need for restructuring of the palliative program.
居家姑息治疗服务是喀拉拉邦姑息治疗项目的基石。然而，有两个问题需要研究：（a）对于经历贫困和匮乏的边缘人群，家庭能否被视为衰老和死亡的场所；（b）当前的服务提供结构是否满足老年人群的需求。在两个农村地区的背景下对这些问题进行了研究。该研究探讨了老年人临终时的特征——他们的社会人口统计学状况和生活模式、发病情况以及功能状态。它还研究了姑息治疗服务的可及性和利用率以及受访者对服务不同组成部分的满意度。
采用描述性横断面调查设计。基于对从姑息治疗服务名册中随机抽取的60名服务使用者的访谈收集数据。半结构化访谈通过个人实地观察得到证实。
研究发现人们生活在极度经济困境中，住房不足且社会保障匮乏。健康状况的特点是功能依赖程度高。许多依赖他人的丧偶妇女独自生活，缺乏适当的照顾和住所。受访者认为姑息治疗项目的特点是医生出诊次数少且频率低。
研究得出结论，当前形式的居家姑息治疗并不能促进良好的临终关怀。它缺乏一种综合的方法和良好的服务组合。这对家庭作为边缘人群衰老和死亡场所提出了严重质疑，并表明需要对姑息治疗项目进行重组。
