When we think of healthcare, we often imagine it in binary terms – people are either sick and need to be cured, or they’re well and need to stay that way. But the reality, especially for older adults dealing with chronic conditions, is often much more complicated. In this space between illness and wellness lies palliative care — a form of medical support that prioritises comfort, dignity, and quality of life over aggressive interventions.
Contrary to popular belief, palliative care is not just ‘end-of-life’ care. It is a layered, holistic approach to managing age-related ailments like dementia, advanced heart disease, frailty, chronic obstructive pulmonary disease (COPD), cancer, and stroke. And as India’s elderly population grows, doctors say that understanding how palliative care works, and when to consider it, becomes more than a personal choice. It becomes a public health conversation.
Doctors explained that palliative care is about easing suffering — physical, psychological, emotional, and even spiritual. It’s a multidisciplinary approach that doesn’t seek to cure the illness but to improve the patient’s overall experience of living with it. This care is typically delivered by a team: doctors, nurses, social workers, physiotherapists, psychologists, and sometimes chaplains. Experts highlight that they coordinate with the patient’s regular physicians to manage pain, breathlessness, fatigue, anxiety, nausea, and the side effects of long-term medications.
Dr Raghavendra Ramanjulu, lead consultant, palliative medicine and rehabilitation at Aster RV Hospital, explained that palliative care is not exclusive to terminal illnesses. It can, and ideally should, begin early, alongside curative treatments, especially in elderly individuals with progressive, non-reversible conditions. Think of it as a parallel track that ensures the journey is not only longer but more bearable, he said.
Proactive vs reactive
Here’s where palliative care stands apart. Regular healthcare systems are often reactive — they respond to flare-ups, ER visits, or acute complications. Palliative care is proactive. It anticipates the decline, plans for it, and aims to minimise suffering before it escalates, Dr Ramanjulu said.
Explaining further, Dr Ramanjulu said, symptom management pain is often underreported by older patients – They may assume it’s a “normal” part of ageing. But untreated pain can affect appetite, sleep, and mood. Palliative teams use specialised protocols to address complex pain and other distressing symptoms like insomnia, shortness of breath, constipation, and confusion.
Palliative care includes counselling, support groups, and even respite services for family members, as coping with a progressive illness or cognitive decline can be isolating — not just for the patient, but also for caregivers. In cases like dementia, it helps caregivers understand behaviour changes and how to respond without panic or guilt.
One of the overlooked offerings of palliative care is advance care planning. It’s not just about Do-Not-Resuscitate (DNR) orders. It’s about what the person values most — staying at home? Avoiding ICU? Having familiar caregivers? These discussions ensure that future decisions align with the patient’s priorities, not just what the medical system is set up to deliver.
Another important aspect is continuity of care – Palliative services often offer home-based care, which is a huge advantage for elderly patients who find hospital visits taxing. Trained staff can assess changes in condition, adjust medication, and ensure dignity in care even in the last months or years of life.
The cost of palliative care depends on where you live, whether you’re accessing public or private services, and what level of care is needed, says Dr Ashwin Kulkarni, consultant, palliative care, at Ramaiah Memorial Hospital.
However, there are also non-profit organisations and government-run hospices offering subsidised or even free care. For instance, Kerala has integrated palliative care into its primary health system, and cities like Pune, Hyderabad, and Delhi are slowly following suit.