America does a mediocre job caring for its sickest people. The nation, says a new report, gets a C.

There is an urgent need to improve end-of-life care for older people in the final stages of dementia, according to an international review published in the May issue of Journal of Clinical Nursing.

Supporters of legalising euthanasia and those who wish to develop better palliative care services can help each other, according to a study published today on bmj.com.

Palliative care was once reserved for patients when all curative options had been exhausted and death was imminent, but now it is considered an integral part of the care that should be available to patients with serious respiratory disorders and critical illnesses.

Advances in pain and palliative care for adults have been significant in the past decade due in part to increased recognition, support and use by caregivers and patients.

Researchers at the University of Rochester Medical Center have found that early palliative care interventions can reduce the length of stay for seriously ill patients in the medical intensive care unit (MICU) by more than seven days without having an impact on mortality rates.

The epidemic rates of chronic disease such as diabetes, stroke and heart disease, as well as cancer and HIV/AIDS in many low-middle income countries, means they are experiencing a greater need for palliative care than most western countries.