Cure palliative e realtà epidemiologica

The world population is continuously aging. Among the 25 oldest countries around the world, 22 are in Europe: Italy and Germany hold the record. New demographic and epidemiological scenarios are going to occur, especially with regard to chronic diseases. Over 20,000 people died in Italy due to chronic respiratory diseases in 2014 (49% of all respiratory diseases) and in 2013 the mortality rate for Chronic Obstructive Pulmonary Disease (COPD) resulted in 3.4 deaths per 10,000 residents. Epidemiological studies of Pisa showed significant increases in the prevalence of COPD (from 2.1 in 1985-88 to 6.2% in 2009-2011), chronic cough (from 11.4 to 16.5%) and airway obstruction (from 10.8 in 1991-92 to 22.1% in 2009-2011). The admissions for respiratory failure increased from 12,103 in 1997 to 135,929 in 2014. Palliative Care (PC) has been established to meet the needs of patients with incurable diseases. However, in Italy over 60% of eligible patients do not use PC services (about 40% of cancer patients and over 80% of non-cancer patients). Most patients (88.2%), especially the oldest ones, do not know the regional centers for PC and the majority of deaths occur in hospitals for acute patients, although 76% of patients would prefer to die at home. Currently, in Italy there are 265 hospices, with 0.4 beds per 10,000 inhabitants (established standard, 0.6), and 544 centers for home PC, but it seems that only 311 are actually operating. PC needs to be implemented throughout Italy, because such a treatment, in addition to improving the end of life, is also cost-effective.