Intersection and Role of Palliative Care in Caring for Older Persons

Palliative care is the holistic approach to care for people with serious illnesses, regardless of their age. It focuses on improving the quality of life for patients and their caregivers by managing symptoms, providing emotional and spiritual support, and promoting autonomy and control.

India’s population is aging and the proportion of ailing elders among the elderly population is as high as 50%, with an estimated increase of 10.1% in 2021 to a projected increase to 13.1% in 2031 (similar trends in rural and urban population)¹. Older people are disproportionately affected by serious illnesses, as over 80% of people over the age of 65, live with at least one chronic condition. This aging population will have symptom exacerbation, increasing and frequent hospital admissions, increasing frailty, increased dependence on caregivers for support, and will also require advance directives to enable them with medical interventions backed by strong medical and ethical background.

All of these actions are impossible without the presence of a robust health policy and guidelines, which are supported by government agencies, palliative care specialists, geriatricians, family physicians, disease specific specialists, critical care specialists, medical healthcare workers and other civil society bodies.

Intersection of Palliative Care and Geriatrics

Both these disciplines focus on providing holistic care for patients with complex medical needs. Even though there might be few differences, the two specialties work hand-in-hand to support each other.

‘Geriatrics’ is a medical specialty that focuses on the care of older adults. Geriatricians therefore have expertise and in-depth knowledge of the unique medical and social needs of older people.

‘Palliative care’ plays a vital role in caring for older people by assisting in need assessment, prognostication and discussions about goals of care. Physicians with training in palliative care (generalist and specialist) work alongside these geriatricians to develop and implement care plans and ensure its adherence by facilitating shared decision making. Effective integration of palliative care services at the community level will also help in reducing the load at tertiary hospitals and most importantly also reduce the financial toxicity for patients and their caregivers caused due to unnecessary healthcare expenditures during the patient’s last few months and weeks of life.

Palliative care physicians can also provide support and guidance to caregivers and help them to manage and cope with the stress and challenges of caring for their loved one with a serious illness.

Geriatric Palliative Care in India

Though Geriatric Palliative Care is a relatively new field in India, it is growing rapidly due to the increasing number of older persons, the rise of chronic diseases, and the improved awareness of palliative care and its benefits.

The current need of the hour is to therefore focus on building the capacity of healthcare professionals, generating awareness within the community about the benefits of geriatric palliative care and ensuring the availability of such services.

The below are a few updates to showcase the current status of Geriatric Palliative Care in India.

In 2012, the Government of India launched the ‘National Program on Palliative Care’. This program aims to improve the availability and quality of Palliative Care services across India.²
In 2017, The Indian Council of Medical Research (ICMR) has given definitions of terms used in limitation of treatment and providing Palliative Care at the end of life³.
The ‘Delhi Declaration for Palliative Care and End of Life Care for Older People’ in 2018, jointly by The Indian Academy of Geriatrics (IAG), Alzheimer’s and Related Diseases Society of India (ARDSI), Help Age India (HAI) and Indian Association of Palliative Care (IAPC) urged the Indian Government to ensure that every older citizen with advanced life limiting diseases including cancer and various forms of dementia, is offered the best possible palliative and end of life care wherever they are cared for.⁴
A number of medical colleges and universities in India are now offering Post Graduate with specialization in Palliative Medicine, with topics in geriatric palliative care.
The guidelines for Advance Medical Directives (AMD’s) were amended in February 2023, states that AMD’s can now be notarised by a gazetted officer and thereby eliminates the need for it to be countersigned by the Magistrate. The other important and positive amendment for withdrawing life support is that now only two committees need to be constituted by the hospital where the patient is admitted instead of the earlier need for a District collector to be involved.

While there is still much work to be done, these developments suggest that Geriatric Palliative Care is becoming a more recognized and accepted field in India, and I cannot wait to be a part of this journey which has just begun to bloom.

I leave you with the below thoughts on Geriatric Palliative Care:

Caregiving for an elderly loved one can be a wonderful experience as it provides an opportunity to serve, and to look after the ones who made us what we are today. It creates an opportunity for us to pay back a little to the gentlemen and ladies who created the best memories of our lives.
Efforts must be directed towards empowering the elderly continue with their Activities of Daily Living (ADL) such as grooming, using the toilet, eating, dressing, bathing, etc. Additionally, we must also monitor their ability to perform Instrumental Activities of Daily Living (IADLs) such as using the telephone, shopping, preparing a meal, taking their own medications, and the ability to use transportation.⁵
We must support and encourage the elderly to build coping mechanisms for themselves such as allocating time for oneself, pursuing a hobby, be open and emotionally balanced to changing situations, being able to share their emotions with their friends and family, and have access to palliative care teams in case they need professional guidance or support.
Facilitate and encourage an elderly friendly community where the elderly can catch up with their peers over a cup of tea to discuss one’s health, family, finances, relationships, etc. Creating a compassionate community will also help the quality of life of the general community at large.

References:

NSO. Elderly in India, National Statistical Office, Ministry of Statistics & Programme Implementation, Government of India, New Delhi. 2021
NPPC National Health Mission MOHFW, GOI
Mathur P, Mathur R. Definition of terms used in limitation of treatment and providing palliative care at end of life.
Macaden S. C. Delhi Declaration for Palliative Care and End of Life Care for Older People. Available from https://ehospice.com/international_posts/delhi-declaration-for-palliative-care-and-end-of-life-care-for-older-people/. Oct 2018.
Eduardo Bruera et al, Textbook of Palliative Medicine and Supportive Care.
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