Palliative Care And The Elderly in India

Palliative care encompasses the physical as well as psychosocial and spiritual dimensions of a person. It is “total care”, delivered by a team of professionals, to keep the terminally ill elderly as functional as possible for as long as possible.

While we talk about the demographic dividend we enjoy in India, because of our young population, we often lose sight of the fact that, according to the WHO, there were 60 million people above 65 years of age in 2010 in our country and that this figure will increase to 227 million by 2050 (an increase of 280%). The question is how prepared are we to deal with the health problems of this ageing population?

The challenges will be plenty as the increase in life expectancy will bring with it a host of life-limiting and debilitating conditions such as cancer, dementia, frailty, and depression, besides social issues. Caring for these people at home will place an unacceptable burden on families while hospital stays will be costly and beyond the reach of most people. The answer is geriatric palliative care that is patient focused and family oriented and that is preferably delivered at home. The care offered under the CanSupport home care programme is an example of this care.

What is palliative care?

Palliative care encompasses the physical as well as psychosocial and spiritual dimensions of a person. It is “total care” and is delivered by a team consisting primarily of a doctor, nurse and counselor. The purpose is to keep the elderly as functional as possible despite their growing frailty caused by disease or by the aging process. Besides medications, it includes providing necessary walking and hearing aids, ensuring proper lighting, fixing handles in the bathroom, laying down non-slip floors, etc. Studies worldwide show that it is those who get isolated, usually because of loss of mobility, who suffer the most. A fall prevention strategy is therefore of utmost importance and adding a physiotherapist to the team can help.

Anemia is highly prevalent among the elderly – nearly 40% suffer from it. The causes are generally disease, poor diet and inadequate intake of food On the whole, eating a balanced diet, maintaining appropriate weight, exercising regularly, not smoking or drinking excessively, while getting enough sleep and taking a day time nap is the secret of good health at this age. As we are likely to see diabetes, coronary disease, cancer and stroke emerge more and more among the elderly, regular checkups, preventive measures and control of conditions like hypertension will be necessary.

Social and psychological needs of the elderly

The social and psychological needs of this population deserve special attention. Social interaction is the key to good mental health. For this, the elderly must have regular contact with family and friends. Ideally, they should get involved in the activities of their local community. It is necessary to plan to do something new every day and have fun. Joining a walking or singing group, solving puzzles, learning a new language, attending concerts, gardening, etc., are activities that are pleasurable and that can keep depression and dementia at bay. Volunteering for a cause and helping others also gives people a sense of purpose and worth.

Depression is usually neglected in the elderly. The symptoms include loss of confidence and feeling low, anxious or panicky all the time. People are unable to enjoy the things they usually did and have unexplained aches and pains. There is also a tendency to avoid people, even those close to them. Sleeping badly, loss of appetite and lack of interest in appearance and surroundings are all symptoms of depression to which family members must be alert. It is important to get medical help as otherwise quality of life can be severely compromised.

There are often practical tasks that need to be attended to such as making a will or registering advanced medical directives that will guide their loved ones when they are no longer able to make informed decisions for themselves. We should not shun discussing the preferred manner and place of death, as well as spiritual needs that will help give people a sense of closure at the end of life.

There is also the question of poverty among the older population that must be considered. It especially impacts women who become entirely dependent on the goodwill of their children. This has also become an issue among the middle class, many of whom retire at 60 and live on till 85 years of age. In India, there is negligible support for the poor and elderly from the government. It is a sad thing to see people lose their lives savings on expensive treatments or fall in debt at a time when they should be relaxing and enjoying the benefits of retirement with their families.

Planning for ageing

There is an urgent need, therefore, for each one of us to recognize that our plans for ageing must include an adequate health insurance cover for diseases like cancer. Once you are diagnosed with cancer no insurance company will come near you. You will be on your own, dependent on the goodwill and support of your family and friends. As time goes on, and most cancer treatments besides being expensive are also long term, even these sources of support may dry up. The situation becomes even more difficult when a couple is living alone and the elderly spouse is the main caregiver.

I believe hope rests in setting up more palliative care services which bring medical, nursing and emotional care to the doorstep of such families once their patients are discharged from cancer hospitals. These must be affordable services for the elderly who are today vulnerable to a new set of debilitating and life limiting diseases. Policy makers must be made to realize that the health needs of this section of society, which is currently underserved, should not be forgotten.

To conclude, illness and disability in the geriatric population will require special health services while their unique psychosocial needs and concerns will require a wider societal response. They will require long term care which can become a burden for families and lead to their neglect and abuse. There is a need to bring services to the bedside of elderly patients. Palliative care must become a part of the public health delivery system as only then will we be able to care for our elders with the love and respect they deserve.

(This article was co-authored with Dr. Ravinder Mohan)