Palliative care as treatment — the comfort-focused approach explained

This article provides information about palliative care for older adults. Palliative care can be offered alongside active treatment. Discuss whether palliative care might benefit your elder with their healthcare team.

Palliative care has a branding problem. Many people hear the word and think immediately of dying. They think it means giving up, accepting defeat, preparing for the end. But palliative care actually means something much broader: medical care focused on comfort and quality of life alongside whatever other treatments are being provided.

Your elder might benefit from palliative care whether they're facing a terminal illness or managing chronic disease that's limiting their quality of life. Palliative care isn't about stopping curative treatment. It's about adding comfort-focused treatment to whatever's already happening.

The distinction between palliative care and hospice confuses many people. They're related but different. Hospice is end-of-life care when curative treatment has been stopped. Palliative care is comfort-focused care that can happen anytime, alongside ongoing treatment. Think of it this way: all hospice is palliative, but not all palliative care is hospice.

Palliative care addresses suffering that regular treatment might not touch. If your elder is experiencing severe pain, shortness of breath, nausea, fatigue, or emotional distress related to their illness, palliative care specialists focus on these issues. They might adjust medications, recommend complementary therapies, coordinate care, and help your elder and family understand what's happening.

A palliative care team usually includes doctors, nurses, social workers, and sometimes chaplains or counselors. They work alongside your elder's existing doctors. The palliative team's job is to identify suffering and address it. The existing doctors continue doing what they do best. Both teams coordinate.

Your elder doesn't need to be dying to access palliative care. Someone with advanced cancer, serious heart disease, chronic lung disease, or other significant conditions might benefit. Someone with multiple competing medical problems who's overwhelmed by treatment burden might benefit. Someone with good prognosis but significant suffering might benefit.

One of the most valuable things a palliative team does is help families have hard conversations. They help clarify what your elder actually wants if they're facing limited time. They help think through tradeoffs between aggressive treatment that might help and comfort that's lost in the process. They help figure out what matters most.

Pain management is often a focus. If your elder is experiencing pain not controlled by current medications, palliative care doctors specialize in pain relief. They know medications, techniques, and approaches that other specialists might not use. They're comfortable with higher doses of pain medication than some doctors. They understand that quality of life matters more than living slightly longer in pain.

Shortness of breath, another common source of suffering, is also addressed. Palliative doctors can recommend medications, positioning, breathing techniques, and other approaches. For someone struggling to breathe, this relief is deep.

Nausea, loss of appetite, fatigue, constipation, difficulty sleeping—all of these might be addressed by the palliative team. Some of these are side effects of other treatments. The palliative team figures out how to manage them without making other problems worse.

The emotional and spiritual aspect of care is part of palliative care too. If your elder is anxious, depressed, or struggling with existential questions about meaning and mortality, palliative care addresses this. Social workers help your elder process what's happening. Counselors or chaplains help with spiritual concerns. Family support is included.

There's also the practical aspect. If your elder is facing complex medical decisions, the palliative team helps clarify options. If your elder is conflicted about what they want, they help explore that. If communication has broken down between your elder and their doctors, they can help rebuild it.

Getting palliative care usually requires a referral from your elder's doctor. Sometimes your elder or you can request it directly from their healthcare system. Some systems have palliative care teams. Some don't. If it's not available locally, ask your doctor about other options like telehealth palliative care consultations.

Insurance usually covers palliative care. Some insurance requires a referral. Some doesn't. Check with your elder's insurance about what's covered.

One concern some people have is whether palliative care will change treatment recommendations. Will they be pushed toward comfort care over curative treatment? The answer is that good palliative care does the opposite of pushing. It helps clarify what your elder actually wants and supports those preferences. If your elder wants aggressive treatment, palliative care supports that while managing suffering. If your elder wants to focus on comfort, they support that. If your elder wants something in between, they support that.

The integration of palliative care with other treatment is key. Your elder doesn't have to choose between curative treatment and comfort-focused treatment. They can have both. A cancer patient receiving chemotherapy might also use palliative care to manage side effects and suffering. An older adult with multiple chronic diseases might use both aggressive treatment for one condition and palliative support for the suffering caused by all the conditions together.

The timing of when to involve palliative care is worth discussing with your elder's doctor. There's no perfect moment. Earlier involvement helps your elder have more energy for important conversations. Later involvement means your elder might have less time to benefit. Most specialists suggest involving palliative care once serious diagnosis is made, rather than waiting until end of life.

Sometimes your elder resists palliative care because they interpret it as giving up. This is a conversation worth having. Explain that palliative care is about comfort and quality of life, not about stopping other treatment. Explain that some of the smartest, most aggressive cancer centers use palliative care. Explain that managing suffering doesn't mean the fight is over, it means fighting smarter.

Palliative care asks your elder to think about what matters most. If there's limited time, what wants to happen? What's most important? What would feel meaningful? These questions are hard. But having them with support often helps.

If your elder has been diagnosed with a serious illness or is experiencing significant suffering from their medical conditions, ask their doctor about palliative care. It can be offered alongside any other treatment. It's about improving comfort and quality of life alongside whatever medical care makes sense for your elder.