What is Palliative Care for Older Adults?

Palliative care is a medical specialty that addresses suffering caused by chronic diseases that may or may not be curable. Over the past few decades, palliative care has gained momentum, driven by families, healthcare professionals, and the general public, who have become more realistic about the limits of medicine. Instead of searching for and treating root causes, palliative care physicians focus on addressing a patient’s physical and emotional symptoms to alleviate discomfort and improve quality of life.

What Should You Know About Palliative Care?

• Palliative care is potentially useful for all patients suffering from a chronic disease: There’s a common misconception that palliative care is only for patients who are dying. This is not true; the principal focus of palliative care is improving the quality of life for those with chronic diseases. Anyone who is suffering from physical or emotional distress — think pain, shortness of breath, anxiety, and depression — could potentially benefit from a consultation with a palliative care physician.
• Palliative care is not just for older patients: Palliative care is age-agnostic. While older adults tend to have more medical conditions and associated symptoms, palliative care physicians treat patients of all ages, including children.
• Palliative care can be beneficial in a variety of different diseases and conditions: Many associate palliative care with cancer treatment, but any type of chronic disease — Alzheimer's Disease, multiple sclerosis, arthritis, ulcerative colitis, to name a few — can potentially benefit from the services of a palliative care physician. Cancer is one of the most common reasons to seek a palliative care consultation, but palliative care physicians can be helpful for suffering of every type.
• Palliative care physicians can help you clarify the goals for your care: Treating symptoms associated with chronic disease is only one part of a palliative care team’s expertise. Besides addressing symptoms that can cause distress (like breathlessness, nausea, or depression), palliative care physicians can also help you step back and clarify care goals. Sometimes, physicians involved in the day-to-day management of a patient might be too close to see “the big picture” and unable to hear a patient’s preferences to change gears, or they may be stuck in “cure mode” even when a cure is not possible. Palliative care physicians can offer a new perspective by listening carefully to each patient’s values, goals, and preferences.
• Palliative care does not mean hospice: Hospice is a service provided to patients at or near the end of life (Medicare defines end of life as an estimated prognosis as six months or less). Palliative care physicians can and do provide hospice care when appropriate, and are skilled at discussing this with patients and families at the right time. But patients and families often misconstrue palliative care and hospice care as the same thing, which can be a major barrier for some in seeking and accepting a palliative care consultation. Meeting with a palliative care physician does not mean the patient has “given up.” Many times, it’s the opposite: it’s an opportunity to improve the patient’s current situation by using every tool to treat discomfort.

Palliative Care Is Often too Little, too Late

One of the most common problems in palliative care is that it is requested too late in the course of a patient’s illness. As a result, palliative care teams may have less to offer than they would if they had been consulted sooner, and ongoing suffering could have been helped earlier.

In some instances, this delay is due to the preferences of the patient or their family, but a patient’s primary physician can also be slow to seek the help of a palliative care physician. This happens for a variety of reasons; sometimes, the doctor is so involved in the specific day-to-day management of a patient that they’re too close to realize the patient may need a different plan, or they may be unaware that a palliative care physician is available within their hospital or health care system. In other cases, they may be more fixated on the cure rather than the patient's symptoms.  

If you or a loved one is hospitalized with a serious illness causing troublesome symptoms, adopt a proactive approach and ask your attending physician about the possibility of a palliative care consultation. 

How Do You Get Palliative Care?

• First, find out if palliative care is available at your healthcare facility: While palliative care has grown immensely in the past two decades, hospitals have various capabilities. If you’re interested in a consult, the first step is to determine if the hospital has palliative care or similar services. If a formal palliative care service is not offered, other specialists with an interest may be able to help depending on the symptoms causing distress. Examples include geriatricians, pain management physicians, and psychiatrists.
• Nurses and social workers can also have information and facilitate consultations: While a consultation with a palliative care physician is typically ordered through the attending physician, other members of a patient’s care team can also be helpful because they're very familiar with minute-to-minute symptoms. In some hospitals, nurses and/or social workers can make palliative care consultations directly without needing a doctor’s orders. If not, they may still be able to advocate for a consultation on a patient’s behalf.

Pain Management Services Can Be an Alternative to Palliative Care

Many hospitals also offer pain management services, which can be inpatient, outpatient, or both. These programs are slightly different from palliative care, as they focus exclusively on pain. They’re typically run by anesthesiologists and/or neurologists, although geriatricians and palliative care specialists may participate. In general, these can be suitable adjuncts when the issue is only pain, but the larger issues of psychological distress and goals of care are best addressed by a palliative care team.