Geriatrics and Palliative Care Bonhomie: A Geriatrician’s perspective

Geriatrics and Palliative Care Bonhomie: A Geriatrician’s perspective

– Dr. Dominic Benjamin, Bengaluru

The world is growing grey.

The life expectancy in India, at birth during 2009-13 was 69.3 for females as against 65.8 years for males. At the age of 60 years, the average remaining length of life was found to be about 18 years (16.9 for males and 19.0 for females) and that at age 70 was less than 12 years (10.9 for males and 12.3 for females)¹. The increasing life expectancy and the associated changes in end-of-life morbidity project a major threat for health care. Older adults who live longer tend to experience prolonged periods of morbidity and dependence, as most of their lives are stamped by an increasing burden of chronic multi-morbidity, functional dependency, frailty and cognitive decline mandating the need for a multidisciplinary approach to care.

An increased number of people are dying in the hospital and the process of dying has changed. Their sunset days are long phases and are often punctuated by challenging treatment decisions, demanding symptom management, an assortment of psychosocial problems and a discounted spiritual struggle. Thus, there is a compelling and an urgent need for holistic, hospice and palliative care that needs to be tailored to the needs and situations of the older adults².

Most Physicians in India are ignorant of this array of multifaceted challenges faced by older adults due to the lack of awareness, the lack of training, and the presence of an indifferent attitude. These factors amalgamate and manifests in their practice as ‘ageist under treatment or futile overtreatment’; the former stems from prejudice while the latter renegades evidence based medicine.

Poly-morbidity and complexity is one of the trademarks of Geriatric Medicine. Our Primary objective is to maintain and restore functional capabilities, thus improving one’s quality of life, their social participation and the continuance of independent living. Geriatric Medicine adopts a multifaceted and an interdisciplinary assessment and can therefore be considered as a meta-discipline. It advocates for collaboration across multiple health care professionals, while constructing the care approach around the patient’s concerns, issues and preferences. It is a holistic anthropology.

Palliative care is also grounded in, and echoes, the integration of the same level of physical, psychological, social, and spiritual dimensions of a human being; all of which are mirrored in the multi disciplinary team approach. Geriatrics and Palliative Care are very distinct but overlapping medical specialties.

The major challenge for us today is in making health care decisions for the severely unwell, both at the end of life and in anticipation thereof, the advanced care planning and the advanced directives. The time is now ripe for both specialities to collaborate in joint research, training and hosting of combined conferences. We must increase visibility of the complementary nature of our specialities to one another and to others. The unfortunate fact that the care pathway for older adults is usually delineated by multiple transitions between health care settings, leads to the lack of continuity of care. This lack of coordination in the continuity of care is the root cause for resource wastage and for older patients to receive poor quality of care.

In today’s hyper-specialized and increasingly fragmented medical care, we need an integrative and synergistic approach that will provide an all encompassing view of the patient’s life situation. The Geriatrics and Palliative Care bonhomie will be a wonderful example of collaborative and coordinated care that will mitigate suffering and improve the quality of life by doing a world of good for our older adults.

References:

1. Elderly in India -Policy and programmes 2016, www.mospi.gov.in
2. Van Den Block L, Albers G, Pereira SM, Onwuteaka-Philipsen B, Pasman R, Deliens L. Palliative care for older people : a public health perspective, first edition. Edn. Oxford: Oxford University Press; 2015.