Burden of complex multimorbidity and disparities in care and support among older adults with palliative care needs in India- evidence from a nationally representative sample survey

Healthcare for complex multimorbidity (CMM) remains inadequately prioritised and poorly integrated. CMM is associated with significant palliative care needs. The burden of CMM among older adults with palliative care needs in India has not been studied. Using data from Wave 1 of the Longitudinal Ageing Study in India (LASI), 2,903 older adults with palliative care needs were identified using the Supportive and Palliative Care Indicator Tool for Low-Income Settings. CMM was defined as the concurrent presence of: (i) chronic morbidity, (ii) five or more functional limitations, and (iii) at least one geriatric syndrome. Healthcare utilisation and access to supportive or assistive devices among those with CMM were assessed. Chi-square tests and multivariate logistic regression were used to examine associated factors. Overall, 37.1% of older adults with palliative care needs had CMM. Prevalence was particularly high among those with cancer (90%), neurological disease (78%), chronic heart disease (66.9%), and chronic bone disease (65.6%). Among individuals with CMM, 47.45% utilised outpatient services in the past 30 days, and 19.64% had inpatient care in the past year. Private facilities were utilised more than public facilities. The availability of supportive and assistive devices was higher for richest quintile (AOR = 1.75; 95% CI:1.15–2.67) and lower for rural residents (AOR = 0.57; 95% CI:0.41–0.77). Nearly two in five older adults with palliative care needs have CMM. The observed socioeconomic disparities in the availability of supportive and assistive devices, with gaps in public healthcare provision are particularly concerning. Screening for CMM and ensuring access to multidisciplinary teams, and supportive devices are essential.