Although elderly and end-of-life care have been neglected in Turkey, because older people did not constitute a high percentage of the population, the proportion of citizens aged >65 years is now 7.5%, with this proportion expected to increase to 10.2% by 2023, 21% by 2050 and 28% by 2075.1 These estimates put Turkey as one of the most rapidly ageing populations in the world and have stimulated research and discussions around healthy ageing, chronic disease management and elderly care.
Turkey has also started to observe and analyse how other countries have managed this situation. Advance care planning has also been a topic of discussion for the older population. The UK has been one of the countries that have put efforts into better care of older people, and recent publications in the BJGP have inspired us.2,3
The family medicine model has been fully implemented in Turkey since 2010. The new model allows doctors to have their own registered patients and the most reliable data in Turkey relies on the medical records of these registries. The opportunity here lies in the recognition of the transitions in people’s lives, as described by Eynon et al.3 The unique relation of GPs with their patients and the enthusiasm of the new model facilitates communication and gives time to speak on the topics that were not previously touched.
When is the right time to discuss advance care planning? We think that earlier is better, when people are still healthy and can make sound decisions. For a population still young, but ageing very rapidly as in Turkey, discussions around advanced directives have already been started.4 Such a move is likely to overcome the challenges Sharp et al mention, such as families, time, patient reluctance, or dementia.2
It is not easy to talk on these topics. The fear and discomfort experienced by the GP might be added to the avoidance by the patient and care givers. We have very recently run a study to explore views of healthcare professionals and patients on end-of-life decisions, and found that both sides were not comfortable in talking about end-of life or even filling in a questionnaire on this topic. This remains as a challenge to overcome.
- © British Journal of General Practice 2014
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