“How does old age come into the purview of palliative care?” The question was raised by a final year medical student from the USA who is spending a few months with us, helping us as well as undertaking a research project on psycho-social issues.
Her question was based on one of the patients in Pallium India’s inpatient unit, Shantha (not her real name), an elderly, bed-ridden woman whose family is abroad and who is cared for by a home nurse and our team. How does Shantha come into the purview of palliative care? By the World Health Organization’s definition, palliative care is for life-threatening diseases. Shantha has no disease; there is no diagnosis except old age.
Pallium India has always looked at the phrase “life-threatening” with the presumption that “life” means more than mere existence; that life confined to a bed or limited by four walls does threaten “life” in its real meaning. Unable to sit up by herself or even turn to a side, Shantha in her old age has her life threatened and reduced to mere existence. Does she not deserve physical, psychological, social and spiritual support? Treating her delirium alone improved her quality of life remarkably. What would be the justification in denying that care to her?
Perhaps the problem is that many diseases including cancer have been “branded” and they “sell” well. There is nothing glamorous about plain, simple old age, with physical debility. In this era of “business”, will the elderly have no support till their problem is “branded and sold”? If so, would some management experts come forward and advise us how to “brand” old age with debility and “sell” it well enough so as to get care across to the needy?