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Supportive and palliative care needs among older adults in India: an estimation using a nationally representative survey

BMC Palliative Care volume 23, Article number: 274 (2024) Cite this article

Abstract

Background

One in five people will be older than 60 by the year 2050 in India. This demographic transition demands integration of geriatric and palliative care. The national level burden of palliative and supportive care needs of the older population is largely unknown in India. This study estimates the burden of palliative care needs among the older population in India from a nationally representative survey - Longitudinal Ageing Study of India (LASI).

Methods

The general indicators of poor or deteriorating health from the Supportive and Palliative Care Indicator Tool for Low Income Setting were used to identify older adults with palliative care needs. These indicators were compared with the LASI data and matched with the appropriate variables. Descriptive statistical analysis, chi-square tests and multivariate logistic regression were done to estimate palliative care needs and its association with other characteristics.

Results

12.2% of Indian older adults have supportive and palliative care needs. Among Indian states, highest for West Bengal (17%), Madhya Pradesh (16.9%), and Bihar (16.3%) while lowest in Arunachal Pradesh (2.2%), Nagaland (2.4%), and Mizoram (3%). High needs were found among those aged 70 years and above (AOR-1.86), females (AOR-1.33), Muslim religion (AOR-1.24), rural residents (AOR-1.72), those who experienced ill-treatment (OR-1.75), with cancer (AOR-2.84), respiratory disease (AOR-3.14), and stroke (AOR-2.58). Lower needs were observed with higher education (AOR-0.43) and health insurance (AOR-0.83).

Conclusion

This is the first study in India that estimates the need for supportive and palliative care using a nationally representative sample. One among eight older adults in India has supportive and palliative care needs. The needs are higher among female older adults, rural residents, older adults with chronic diseases, and in poorer States. Screening and early integration of palliative care with routine healthcare care is essential to meet these needs.

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Background

The global transition in ageing demands the integration of geriatric care and palliative care [1]. Globally, the proportion of older adults aged 65 years and above is expected to rise to 16% in 2050 from 6% in 1990 [2]. Similarly, in India, the size of the older population aged 60 years and above is expected to increase to 20.8% by 2050, when one in five Indians will be older than 60 years of age [3]. In addition, the Lancet Commission reports that older adults will experience the most significant rise in serious health-related suffering (SHS) between 2016 and 2026. Given the significant increase in the older adult population and SHS related to ageing, palliative care should be an integral aspect of geriatric care [4].

Chronic diseases are the leading cause of disabilities and premature deaths among older adults [5]. More often these problems are found to be occurring together in older adults, presenting as complex health problems and multiple disabilities [6, 7]. As a consequence, the older adults suffer exacerbation of ongoing ailments, multiple hospitalizations, polypharmacy, decline in the Activities of Daily Living (ADL), decline in functional capacity, depression and other psychiatric morbidities, and poor quality of life (QOL) [6,7,8,9,10,11,12]. In the context of such complex needs, the World Health Organization (WHO) recommends integrating palliative care into the chronic disease management of older adults [4, 13].

Palliative care in geriatric practice aims to alleviate suffering, and improve quality of life through impeccable assessment, symptom control, goals of care discussions, shared decision-making, care coordination, and transition into community care settings wherever possible [1]. In India, access to palliative care is abysmally low [14]. One of the barriers to the integration of palliative care is that palliative care needs are not routinely screened and identified even in the presence of chronic life-limiting conditions [15]. In the context of poor screening and identification, the burden of palliative and supportive care needs is largely unknown in India. Though there are a few regional estimations of the burden of palliative care needs among the older population [16,17,18], a national-level estimation of the same is not available for India. This paper aims to estimate the burden of supportive and palliative care needs among the older population of India from the nationally representative LASI (Longitudinal Ageing Study of India).

Methodology

The study used the Supportive and Palliative Care Indicator Tool-Low Income Setting (SPICT-LIS) to identify older adults with palliative care needs. The tool was developed at the University of Edinburgh by the Primary palliative care research group [19]. The tool provides both general indicators of poor or deteriorating health and disease-specific indicators to identify palliative care needs. This study used the general indicators of poor or deteriorating health from SPICT-LIS to identify older adults aging 60 years and above with supportive and palliative care needs. Supportive care is defined as “the multi-disciplinary holistic care of patients with malignant and non-malignant chronic diseases and serious illness, and those that matter to them, to ensure the best possible quality of life [20]. Palliative care is “an approach that improves the quality of life of patients (adults and children) and their families who are facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and correct assessment and treatment of pain and other problems, whether physical, psychosocial or spiritual” [13]. The components of supportive care and palliative care includes, symptom control, physical, psychosocial and spiritual support, patient and family empowerment, optimising comfort, improving function and reducing the effects of debility [13, 21]. Due to these overlapping principles, components, and goals of care, the SPICT instrument captures supportive and palliative care needs as a whole.

LASI is a nationally representative population survey of older adults aged 45 years and above. The survey exercise is intended to be carried out every two years for 25 years. The first wave of the survey was cross-sectional by design and was conducted between 2017 and 19. This included 73,396 older adults aged 45 years and above selected by a multistage stratified area probability cluster sampling design from all the states and union territories of India. The survey was a collaborative effort by the International Institute for Population Sciences (IIPS), Mumbai; National Programme for Health Care of Elderly (NPHCE); Ministry of Health and Family Welfare, New Delhi; Harvard T. H. Chan School of Public Health (HSPH), Massachusetts; and the University of Southern California (USC). The survey instrument included individual schedule, household schedule and community schedule. The primary aim of the survey is to investigate the consequence of aging in the country in the light of health, social, and economic determinants. The current study used the data from individual schedule and household schedule. The data covered in these schedules include socio-demographic and socio-economic profile, work and retirement profile, disease profile, functional health, psychosocial and cognitive assessment, social activity profile, bio-marker profile and direct health examination. A detailed information on the LASI survey is available from Longitudinal Ageing Study in India Wave-1 India Report [22].

The framework for matching SPICT-LIS indicators with LASI data is provided in Fig. 1. The first SPICT-LIS indicator of identifying poor performance status was matched with the data of older adults who stayed in bed for half a day or more for two weeks or more [23]. The second indicator representing the need for support and help was matched with the older adults who required support for their Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL). The third indicator “Progressive weight loss; remains underweight; weight gain from persistent fluid retention” was matched with those who belonged to the underweight category of BMI assessment. Other aspects of this indicator could not be matched in LASI data. The fourth indicator of persistent symptoms was matched with older adults who reported three or more persistent symptoms. The fifth indicator of a person’s preference for palliative care could not be mapped on LASI data. The sixth indicator of unplanned hospital admissions and visits was matched in the older adults who had multiple hospital admissions and hospital visits due to complications of life-limiting conditions.

Fig. 1
figure 1

Framework for identifying elderly with supportive and palliative care needs using SPICT-LIS general indicators of poor and deteriorating health with LASI. Source: Authors’ mapping of SPICT-LIS criteria on Longitudinal Ageing Study in India questionnaire

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The primary outcome variable, i.e. the need for supportive and palliative care (yes/no) was computed after mapping the SPICT-LIS general indicators of poor and deteriorating health on LASI data. The identification of those with supportive and palliative care needs was done in two ways. In the first method, older adults with any one of the general indicators of poor and deteriorating health were identified as having palliative care needs. This provides a very sensitive estimate for supportive and palliative care needs among older adults in India. In the second method, older adults were identified to have supportive and palliative care needs when they had two or more general indicators of poor and deteriorating health. Most published literature on SPICT used the second method to identify palliative care needs [24,25,26]. Further, the exposure variables were identified and classified by biological, social, morbidity, and risk factors profiles of older adults (Tables 1 and 2). The respondent information with any missing data was removed before the analysis. Detailed information about the sample data selection along with the estimation process is depicted in Fig. 2.

Fig. 2
figure 2

Flow diagram representing sample selection. Source: Authors’ description of study flow

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Statistical analysis

The study used descriptive statistics to estimate the support and palliative care needs among older adults in India. The sampling weights were applied in the estimation process as the LASI employed a multistage stratified area probability cluster sampling design, hence all the percentages provided are weighted percentages. The chi-square test was used to confirm the disparities in the palliative care needs among different sub-groups. The Multivariate logistic regression (Odds Ratio) was used for inferential statistical analysis to identify the independent association between supportive and palliative care needs and background characteristics. All the statistical analyses were performed using the statistical software package STATA - BE—Basic Edition 17, developed by Stata Corp and located in Texas 77,845, USA (StataCorp, 2021). Besides, Data Wrapper, an online GIS software was used to visualize the state-wise need for supportive and palliative care in India.

Results

The background characteristics of older adults with supportive and palliative Care needs in India are depicted in Table 1. As shown in the table, out of 27,450 older adults aged 60 years and above considered for the analysis, 65.3% were aged between 60 and 70 years, 52.3% were females and 79.6% of them had education in primary education or below. About 43.4% of these older adults belonged to poorer or poorest quintiles while economically categorizing them into quintiles as per their household monthly per capita expenditure. Most of the older adults belonged to the Hindu religion (82.4%) and lived in rural areas (72%). Only 18.9% of the older adults had health insurance. Besides, the most common morbidity among them was hypertension (31.8%) followed by bone disease (arthritis, osteoporosis) 18.5% and diabetes (13.9%).

Supportive and palliative care needs of older adults in India

The estimation of supportive and palliative care needs showed that 42.7% of the older adults in India had at least one SPICT-LIS general indicator for supportive and palliative care needs and 12.2% of them had two or more SPICT-LIS general indicators for supportive and palliative care needs. The mapping of supportive and palliative care needs with two or more SPICT-LIS general indicators across the Indian states is shown in Fig. 3. Among the Indian states, West Bengal had the highest supportive and palliative care needs (17%), followed by Madhya Pradesh (16.9%), Bihar (16.3%) and Uttar Pradesh (15.6%). A lower percent was observed among North-Eastern states, namely Arunachal Pradesh (2.2%), Nagaland (2.4%), Mizoram (3%), and Sikkim (3.1%).

Fig. 3
figure 3

State-wise estimation of supportive and palliative care needs among older adults in India

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The univariate analysis of supportive and palliative care needs with two or more SPICT-LIS general indicators showed that the older adults aged 70 years and above had higher palliative care needs (18.4%) than those aged 70 years and below (9.2%) (Table 1). Similarly, higher palliative care needs were observed among females (13.2%) than males (11.2%). Among the education categories, higher palliative care needs were observed among those with primary education and below (13.7%) than those with higher secondary education and above (5.7%). There was no statistically significant difference in the palliative care needs between the economic categories. In the analysis of religions of older adults, a significantly higher palliative care need was observed among Muslims (15.2%) when compared with other religious categories. Higher supportive and palliative care needs were observed among the older adults who experienced ill-treatment (20.2%) and discrimination (13.9%) when compared to their counterparts.

The association between the need for supportive and palliative care with the background characteristics of older adults by the multivariate logistic regression analysis is depicted in Fig. 4. A statistically significant higher palliative care need with two or more SPICT-LIS indicators was observed among older adults aged more than 70 years [AOR = 1.86], females [AOR = 1.33], and those living in rural areas [AOR = 1.72]. The analysis also showed an association between the experience of ill treatment [AOR = 1.75], utilization of welfare schemes[AOR = 1.25], and palliative care needs. Older adults who belonged to the Muslim religion [AOR = 1.24] had higher palliative care needs when compared with those from the Hindu religion in reference category and older adults from the Christian religion [AOR = 0.50] had lower palliative care needs when compared with those in reference category. Among the morbidity profile, higher palliative care needs were observed among older adults with chronic life-limiting conditions when compared to those who did not have these diseases respectively (Table 2). The needs were more pronounce for those with chronic respiratory diseases [AOR = 3.14], cancers [AOR = 2.84] and stroke [AOR = 2.58]. On the other hand, the need for support and palliative care was found lower among those with Middle and secondary education [AOR = 0.68], and Higher secondary education and above [AOR = 0.43]) than those with primary education or below. The older adults covered by the health insurance scheme [AOR = 0.83] and those currently living with their spouses [AOR = 0.83] also had lower supportive and palliative care needs when compared with their counterparts.

Table 1 Background characteristics of older adults with supportive and Palliative Care needs in India
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Table 2 Regression analysis for supportive and Palliative Care needs among older adults in India
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Fig. 4
figure 4

Forest plot of Multivariate Logistic Regression for Supportive and Palliative Care Needs among older adults in India. Note: The x-axis represents the adjusted odds ratio (AOR) for Supportive and palliative care needs with two or more SPICT-LIS general indicators. Each plot represents AOR with 95% Confidence Interval (CI). Plots of variables that do not overlap the null value 1 are statistically significant. Reference categories are provided in Table 2. Source: Authors’ estimation using Longitudinal Ageing Study in India (LASI) data

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Discussion

The estimation of supportive and palliative care needs with any one of the SPICT-LIS general indicators of poor and deteriorating health as the identification criteria showed that 42.7% of the older adults have palliative care needs. This may be a very sensitive estimate as the threshold for supportive and palliative care needs was set at just one indicator. On reviewing the literature, only one study [27] using just one indicator to identify individuals with palliative care needs was found. The second method using two or more general indicators of poor and deteriorating health, the estimation showed that 12.2% of the Indian older adults have palliative care needs. This is a balanced estimate and most studies using SPICT used two or more general indicators to identify individuals with supportive and palliative care needs [24,25,26]. This estimate is similar to another study done in India that used SPICT-ALL to identify individuals with palliative care needs using a locally representative sample [24].

The current estimate shows that one in eight older adults in India have supportive and palliative care needs. As the population of older adults is projected to increase to 347 million by 2050 in India [3], this burden is likely to increase by severalfold. The healthcare providers attending to older adults at various chronic disease clinics, and geriatric clinics at all levels of the health system should screen for supportive and palliative care needs and integrate palliative care into patient care early in the course of their treatment [28,29,30,31]. To address this growing need, the Government of India launched the National Program for Palliative Care (NPPC) in the year 2012 which offers funding support for states to develop and implement palliative care programs [32].

Among the Indian states, a higher proportion of palliative care needs among older adults was observed in West Bengal, followed by Madhya Pradesh and Bihar. The LASI report shows that the frailty indicators such as restrictions in activities of daily living and being underweight were observed in higher numbers in these states [22]. In addition, West Bengal has the highest prevalence of stroke and neurological illnesses among the Indian states [33]. It is important to note that, among the 28 states and 8 union territories, a state palliative care policy is available only in states such as Kerala, Tamil Nadu, Karnataka, and Maharashtra [34].

This nationally representative sample shows that 72% of the older adults in India reside in rural areas, and 13.7% of them require palliative care, whereas only 8.4% of the older adults in urban areas have such needs. Other studies also show that the palliative care needs among rural areas in India are high [35,36,37]. Palliative care provisions in India are isolated [13] and in rural areas, they are severely limited [38]. Only the state of Kerala has successfully integrated palliative care services into rural panchayats (local government administration bodies) [39] showing integrating palliative care into primary health care could be a significant step towards bridging this gap [40].

Religion emerged as one of the variables that was independently associated with palliative care needs. Specifically, older adults who belonged to the Muslim community had higher palliative care needs when compared with the Hindu religion. The LASI report revealed a significantly higher proportion of older adults in this community had a higher prevalence of heart disease and lung disease and impairments in ADL and IADL requiring support from caregivers [22].

Supportive and palliative care needs were high for older adults with chronic life-limiting conditions. Among them, the needs were significantly higher for chronic respiratory diseases, followed by cancers and stroke. Palliative care needs in chronic respiratory conditions tend to become more pronounced with advancing age [13] it usually coexists with frailty [41] and higher symptom burden impairing QOL [42]. Similarly, older adults with stroke tend to have residual paralysis, cognitive impairment, and other deficits with high dependence [43, 44]. In India, stroke and its subsequent impairments emerged as significant contributors to palliative care needs [16, 24, 35].

The supportive and palliative care needs are higher among older adults who experienced ill-treatment and among those with major depression. Older adults with palliative care needs have a high level of dependency. In most cases, family members are the immediate care providers, and they are also the perpetrators of ill-treatment [22, 45]. Caregiver stress, burden, and anxiety are significant predictors of abuse [46]. Palliative care seeks not only to improve the QOL of the patients but also offers a strong support system for the family caregivers [13] and can play a pivotal role in addressing ill-treatment experienced by older adults. Furthermore, studies show that palliative care needs and major depression tend to coexist especially among older adults [47,48,49]. These findings underpin the importance of screening older adults for depression, especially the ones with palliative care needs [50, 51].

The current analysis showed significantly higher palliative care needs among older adults with primary level education or less when compared to those with higher education. A similar finding was reported in another community-based study [52]. In exploring the reasons, the LASI report revealed that the treatment rates for chronic life-limiting illnesses were significantly lower among those with lower levels of education [22]. Poor treatment rates in life-limiting illnesses increase the risk of complications [53] and can explain higher palliative care needs among older adults with lower education levels.

Strengths and limitations

This is the first study that provides a national-level estimate for supportive and palliative care needs among older adults in India using a nationally representative sample survey with good external validity. The SPICT-LIS is a validated instrument in identifying individuals with supportive and palliative care needs, this adds merit to the current estimate. Nevertheless, the LASI data does not have information on the fifth SPICT-LIS indicator “Person wishes to focus on quality of life; chooses to reduce, stop or not have treatment; asks for palliative care”, and the information regarding “progressive weight loss” and “persistent fluid retention” in the third indicator. The absence of this information may be a limitation of the current study. The limitations of the LASI survey such as respondent fatigue as a consequence of lengthy survey and local dialect challenges applies to the current paper.

Conclusion

One among eight older adults in India has supportive and palliative care needs. Palliative care needs among older adults are higher among females, those who live in rural areas, and those with lower education levels. Higher palliative care need was observed among older adults with chronic life-limiting conditions, yet the need was more pronounced among older adults with chronic respiratory conditions, stroke, and cancers. Older adults with major depression and who experienced ill treatment have higher palliative care needs. Screening for palliative care needs in geriatric practice and chronic disease clinics and early integration with palliative care services can help address these unmet needs. As the proportion of older adults in India is estimated to grow several folds along with the increase in serious health-related suffering among them, the integration of geriatric services, and palliative care services into primary health care is of paramount importance.

Data availability

The dataset used in the current study is available for download on request from the website of International Institute of Population Sciences, Mumbai. The data can be requested using the following link. https://www.iipsindia.ac.in/content/LASI-data.

Abbreviations

SHS:

Serious health–related suffering

ADL:

Activities of Daily Living

WHO:

World Health Organization

QOL:

Quality of Life

LASI:

Longitudinal Ageing Study of India

SPICT:

LIS–Supportive and Palliative Care Indicator Tool–Low Income Setting

IADL:

Instrumental Activities of Daily Living

IIPS:

International Institute for Population Sciences

NPHCE:

National Programme for Health Care of Elderly

HSPH:

Harvard T. H. Chan School of Public Health

USC:

University of Southern California

BMI:

Body Mass Index

CIDI:

SF–Short Form Composite International Diagnostic Interview

GIS:

Geographic Information System

OBC:

Other Backward Caste

AOR:

Adjusted Odds Ratio

MPCE:

Monthly per capita Expenditure

SC/ST:

Scheduled Caste/Scheduled Tribe

NPPC:

National Program for Palliative Care\

References

  1. Voumard R, Rubli Truchard E, Benaroyo L, Borasio GD, Büla C, Jox RJ. Geriatric palliative care: a view of its concept, challenges and strategies. BMC Geriatr. 2018;18:220.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. United Nations. Department of Economic and Social Affairs: Population Division. World Population Aging 2019. S.l.: United Nations; 2021.

    Google Scholar 

  3. International Institute for Population Sciences, United Nations Population Fund. India Ageing Report 2023, caring for our elders: institutional responses. New Delhi: International Institute for Population Sciences and United Nations Population Fund; 2023.

    Google Scholar 

  4. Sue Hall H, Petkova AD, Tsouros M, Costantini IJ, Higginson, editors. Palliative care for older people: better practices. Copenhagen: World Health Organization, Regional Office for Europe; 2011.

    Google Scholar 

  5. World Health Organization. WHO reveals leading causes of death and disability worldwide: 2000–2019. 2020. https://www.who.int/data/stories/leading-causes-of-death-and-disability-2000-2019-a-visual-summary. Accessed 17 Apr 2024.

  6. Chou C-Y, Chiu C-J, Chang C-M, Wu C-H, Lu F-H, Wu J-S, et al. Disease-related disability burden: a comparison of seven chronic conditions in middle-aged and older adults. BMC Geriatr. 2021;21:201.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Sharma P, Maurya P, Muhammad T. Number of chronic conditions and associated functional limitations among older adults: cross-sectional findings from the longitudinal aging study in India. BMC Geriatr. 2021;21:664.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Klompstra L, Ekdahl AW, Krevers B, Milberg A, Eckerblad J. Factors related to health-related quality of life in older people with multimorbidity and high health care consumption over a two-year period. BMC Geriatr. 2019;19:187.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Bortolani A, Fantin F, Giani A, Zivelonghi A, Pernice B, Bortolazzi E, et al. Predictors of hospital readmission rate in geriatric patients. Aging Clin Exp Res. 2024;36:22.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Dan G. Blazer. Depression in Late Life: Review and Commentary. J Gerontol. 2003;58A:249–65.

    Google Scholar 

  11. Pazan F, Wehling M. Polypharmacy in older adults: a narrative review of definitions, epidemiology and consequences. Eur Geriatr Med. 2021;12:443–52.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Admi H, Shadmi E, Baruch H, Zisberg A. From research to reality: minimizing the effects of hospitalization on older adults. Rambam Maimonides Med J. 2015;6:e0017.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Connor SR. Global Atlas of Palliative Care. 2nd edition. London, UK: Worldwide Palliative Care Alliance; World Health Organization; 2020.

  14. Rajagopal M. The current status of Palliative Care in India. Cancer Control. 2015;:57–62.

  15. Hawley P. Barriers to Access to Palliative Care. Palliat Care. 2017;10:1–6.

    CAS  Google Scholar 

  16. Chandra A, Bhatnagar S, Kumar R, Rai SK, Nongkynrih B. Estimating the need for Palliative Care in an Urban Resettlement Colony of New Delhi, North India. IJPC. 2022;28:434–8.

    Article  Google Scholar 

  17. Prasad P, Sarkar S, Dubashi B, Adinarayanan S. Estimation of need for palliative care among noncancer patients attending a tertiary care hospital. Indian J Palliat Care. 2017;23:403.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Daya Ap, Sarkar S, Kar S. Estimation of palliative care need in the urban community of Puducherry. Indian J Palliat Care. 2017;23:81.

    Article  Google Scholar 

  19. Highet G, Crawford D, Murray SA, Boyd K. Development and evaluation of the supportive and Palliative Care indicators Tool (SPICT): a mixed-methods study. BMJ Support Palliat Care. 2014;4:285–90.

    Article  PubMed  Google Scholar 

  20. Cramp F, Bennett MI. Development of a generic working definition of ‘supportive care’. BMJ Support Palliat Care. 2013;3:53–60.

    Article  PubMed  Google Scholar 

  21. Nicholson C, Morrow EM, Hicks A, Fitzpatrick J. Supportive care for older people with frailty in hospital: an integrative review. Int J Nurs Stud. 2017;66:60–71.

    Article  PubMed  Google Scholar 

  22. Longitudinal Ageing Study in India (LASI). Wave 1, 2017-18, India Report. Mumbai: International Institute for Population Sciences (IIPS), National Programme for Health Care of Elderly (NPHCE), MoHFW, Harvard T. H. Chan School of Public Health (HSPH) and the University of Southern California (USC) 2020; 2020.

  23. Marusic U, Narici M, Simunic B, Pisot R, Ritzmann R. Nonuniform loss of muscle strength and atrophy during bed rest: a systematic review. J Appl Physiol. 2021;131:194–206.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Sudhakaran D, Shetty RS, Mallya SD, Bidnurmath AS, Pandey AK, Singhai P, et al. Screening for palliative care needs in the community using SPICT. Med J Armed Forces India. 2023;79:213–9.

    Article  PubMed  Google Scholar 

  25. Bourmorck D, De Saint-Hubert M, Desmedt M, Piers R, Flament J, De Brauwer I. SPICT as a predictive tool for risk of 1-year health degradation and death in older patients admitted to the emergency department: a bicentric cohort study in Belgium. BMC Palliat Care. 2023;22:79.

    Article  PubMed  PubMed Central  Google Scholar 

  26. De Bock R, Van Den Noortgate N, Piers R. Validation of the supportive and Palliative Care indicators Tool in a Geriatric Population. J Palliat Med. 2018;21:220–4.

    Article  PubMed  Google Scholar 

  27. Van Wijmen MPS, Schweitzer BPM, Pasman HR, Onwuteaka-Philipsen BD. Identifying patients who could benefit from palliative care by making use of the general practice information system: the Surprise question versus the SPICT. Fam Pract. 2020;37:641–7.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Yen Y-F, Hu H-Y, Lai Y-J, Chou Y-C, Chen C-C, Ho C-Y. Comparison of intuitive assessment and palliative care screening tool in the early identification of patients needing palliative care. Sci Rep. 2022;12:4955.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Hiratsuka Y, Inoue A. Perspectives on screening tools to identify palliative care needs in patients with advanced cancer. Ann Palliat Med. 2023;12:13–5.

    Article  PubMed  Google Scholar 

  30. Davis MP, Bruera E, Morganstern D. Early Integration of Palliative and Supportive Care in the Cancer Continuum: Challenges and Opportunities. 2024.

  31. Kingston AE, Kirkland J, Hadjimichalis A. Palliative care in non-malignant disease. Medicine. 2020;48:37–42.

    Article  Google Scholar 

  32. Salins N, Bhatnagar S, Simha S, Kumar S, Rajagopal MR. Palliative Care in India: past, Present, and Future. Indian J Surg Oncol. 2022;13:83–90.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Singh G, Sharma M, Kumar GA, Rao NG, Prasad K, Mathur P, et al. The burden of neurological disorders across the States of India: the global burden of Disease Study 1990–2019. Lancet Global Health. 2021;9:e1129–44.

    Article  Google Scholar 

  34. Sushma Bhatnagar S, Butola A, Ganesh N, Krishnadas RR. Palliative Care Status Update in India. 2021. https://www.palliativecare.in/palliative-care-status-update-in-india/. Accessed 5 May 2024.

  35. Chandra A, Kumar R, Bhatnagar S, Nongkynrih B. Assessing awareness and Palliative Care needs in Rural Haryana, North India: A Community-based study. Cureus. 2023. https://doiorg.publicaciones.saludcastillayleon.es/10.7759/cureus.47052.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Kaur S, Kaur H, Komal K, Kaur P, Kaur D, Jariyal V, et al. Need of palliative care services in rural area of Northern India. Indian J Palliat Care. 2020;26:528.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Elayaperumal S, Venugopal V, Dongre A. Identifying people in need of palliative care services in rural Tamil Nadu: a survey. Indian J Palliat Care. 2018;24:393.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Jadhav A. Rural elderly and access to palliative care: a public health perspective. Indian J Palliat Care. 2020;26:116.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Raj PM. Local government-led community-based palliative care programmes in Kerala. Rajagiri J Social Dev. 2016;8(2):25–33.

  40. Pai RR, Nayak MG, Serrao AJ, Salins N. Integrating palliative care into primary health care: Indian perspectives. Progress Palliat Care. 2023;31:282–6.

    Article  Google Scholar 

  41. Brighton LJ, Bone AE, Maddocks M. Supportive and palliative care for people with chronic respiratory disease and frailty. Curr Opin Supportive Palliat Care. 2020;14:206–12.

    Article  Google Scholar 

  42. Gupta N, Garg R, Kumar V, Bharati S, Mishra S, Bhatnagar S. Palliative care for patients with nonmalignant respiratory disease. Indian J Palliat Care. 2017;23:341.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Robinson MT, Holloway RG. Palliative Care in Neurology. Mayo Clinic Proceedings. 2017;92:1592–601.

  44. Cowey E, Schichtel M, Cheyne JD, Tweedie L, Lehman R, Melifonwu R, et al. Palliative care after stroke: a review. Int J Stroke. 2021;16:632–9.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Maurya P, Chattopadhyay A, Rao S, Sharma P. Understanding elder abuse in India: contributing factors and policy suggestions. Popul Ageing. 2024;17:5–32.

    Article  Google Scholar 

  46. Orfila F, Coma-Solé M, Cabanas M, Cegri-Lombardo F, Moleras-Serra A, Pujol-Ribera E. Family caregiver mistreatment of the elderly: prevalence of risk and associated factors. BMC Public Health. 2018;18:167.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Wilson KG, Chochinov HM, Graham Skirko M, Allard P, Chary S, Gagnon PR, et al. Depression and anxiety disorders in Palliative Cancer Care. J Pain Symptom Manag. 2007;33:118–29.

    Article  Google Scholar 

  48. Fisher KA, Seow H, Brazil K, Freeman S, Smith TF, Guthrie DM. Prevalence and risk factors of depressive symptoms in a Canadian palliative home care population: a cross-sectional study. BMC Palliat Care. 2014;13:10.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Rayner L, Lee W, Price A, Monroe B, Sykes N, Hansford P, et al. The clinical epidemiology of depression in palliative care and the predictive value of somatic symptoms: cross-sectional survey with four-week follow-up. Palliat Med. 2011;25:229–41.

    Article  PubMed  Google Scholar 

  50. Lauren Rayner, Irene J, Higginson A, Price. Matthew Hotopf. The management of Depression in Palliative Care: European Clinical Guideline. London: European Palliative Care Research Collaborative; 2010.

    Google Scholar 

  51. Sewtz C, Muscheites W, Grosse-Thie C, Kriesen U, Leithaeuser M, Glaeser D, et al. Longitudinal observation of anxiety and depression among palliative care cancer patients. Ann Palliat Med. 2021;10:3836–46.

    Article  PubMed  Google Scholar 

  52. Kozlov E, Cai A, Sirey JA, Ghesquiere A, Reid MC. Identifying Palliative Care needs among older adults in nonclinical settings. Am J Hosp Palliat Care. 2018;35:1477–82.

    Article  PubMed  PubMed Central  Google Scholar 

  53. World Health Organization, editor. Adherence to long-therm therapies: evidence for action. Geneva: WHO; 2003.

    Google Scholar 

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Acknowledgements

The authors would like to acknowledge Ms. Kezia Angeline J for her input on the use of STATA software.

Funding

Open access funding provided by SRM Institute of Science and Technology for SRMIST – Medical & Health Sciences.

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Authors and Affiliations

  1. SRMIST (Deemed to be University), School of Public Health, Kattankulathur, Chennai, Tamil Nadu, 603203, India

    Terrymize Immanuel & Benson Thomas M

  2. Department of Palliative Medicine and Supportive Care, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, 576104, India

    Naveen Salins

  3. Department of Palliative Medicine, Christian Medical College, Vellore, Tamil Nadu, India

    Jenifer Jeba Sundararaj

  4. Department of Neurology, PD Hinduja National Hospital and Medical Research Centre, Veer Savarkar Marg, Mahim Mumbai, Maharashtra, 400016, India

    Roop Gursahani

Authors
  1. Terrymize Immanuel
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  3. Benson Thomas M
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  4. Jenifer Jeba Sundararaj
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Contributions

TI contributed to the conception, design, analysis, and interpretation of data and prepared the manuscript. NS contributed to the design, and interpretation of data and reviewed the manuscript. BTM contributed to the design, data acquisition, analysis, and interpretation of data and reviewed the manuscript. JJ contributed to the design, and interpretation of data and reviewed the manuscript. RG contributed to the design, and interpretation of data and reviewed the manuscript.

Corresponding authors

Correspondence to Terrymize Immanuel or Benson Thomas M.

Ethics declarations

Ethics approval and consent to participate

Not applicable. The current study is a secondary data analysis of this nationally representative survey data available from public domain. The ethical approval for Longitudinal Ageing Study in India (LASI) was obtained from the Indian Council of Medical Research.

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Not applicable.

Competing interests

The authors declare no competing interests.

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Immanuel, T., Salins, N., M, B.T. et al. Supportive and palliative care needs among older adults in India: an estimation using a nationally representative survey. BMC Palliat Care 23, 274 (2024). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12904-024-01604-2

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  • DOI: https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12904-024-01604-2

Keywords

BMC Palliative Care

ISSN: 1472-684X

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