Intended for healthcare professionals

Rapid response to:


Palliative care in chronic illness

BMJ 2005; 330 doi: (Published 17 March 2005) Cite this as: BMJ 2005;330:611

Rapid Response:

Palliative care and chronic illness in the elderly

Dear Sir,

We agree with Murray et al (1) that we must broaden the spectrum of palliative care to patients in the advanced stages of chronic illness, in whom we can establish in a relatively short time a drastic finale.

In geriatric medicine terminal illness care is an important aspect, maintaining us busy and worried day by day.The elderly frequently suffer from chronic illness that requieres palliative care, which can be accompanied by the "geriatric syndromes", also known in Anglosaxon literature as "The Four Giants" (inmobility, falls, incontinence and mental failure)(2).

These syndromes, in one form or another, and frequently in combination, are present in terminal elderly, thus complicating further the medical assistance of these patients (3).

Usually, in the case of geriatric patients with these syndromes we can identify with precision the presence of a terminal illness and establish an approximate prognosis. However, this is not quite effortless in frailty elderly with chronic illness such heart failure, in which palliative care can be applied (4), but also some beneficial therapeutic actions which can further prolong their lives.

Therefore, in concurrence with Murray et al, we find it neccessary to overcome therapeutic negligence in geriatric patients with chronic illness to destroy the paralytic prognosis, for there is always an elegible care plan.

In ultimate instance, we can comply with the saying "caring is best when there´s no curing" which closely approach us to the humanity of Medicine.

Yours faithfully,

AJ Romero, F Olascoaga


(1)Murray SA, Boyd K, Sheikh A. Palliative care in chronic illness. BMJ 2005; 330:611-612.

(2)Romero AJ, Nieto R. Theorical frame from terminal care in the elderly. Geriátrika 2004; 20(5): 198-205.

(3) Romero AJ. Síndromes geriátricos en el paciente anciano terminal. 2005; 7(1): 2-10.

(4)Stewart S, Mc Murray JJV. Palliative care for heart failure. BMJ 2002; 325: 915-916.

Competing interests: None declared

Competing interests: No competing interests

23 March 2005
Angel J. Romero
Professor of Internal Medicine
Francisco Olascoaga
"Dr. Gustavo Aldereguía" Hospital. Ave 5 de septiembre, esq. 51A. Cienfuegos, Cuba. CP: 55 100