Palliative Care in Special Populations
Older adults
Apply geriatric pharmacology: start low, go slow, and review for anticholinergic burden and Beers-list drugs. Deprescribe statins, sulfonylureas, and sedative-hypnotics when goals shift. Screen for falls, delirium, sensory impairment, and elder mistreatment. Capacity is decision-specific. Ask about caregiver strain and financial toxicity; caregivers are part of the unit of care.
Children
Pediatric palliative care is family-centered and may begin at diagnosis alongside curative treatment. Use developmentally appropriate language; children often understand more than adults assume and benefit from honest, staged information. Assess pain with age-appropriate tools such as FLACC or Wong–Baker and dose opioids by weight with careful monitoring. Include siblings, school reintegration, and legacy work. Perinatal palliative care supports families facing lethal fetal diagnoses.
Vulnerable groups
Consider people experiencing homelessness, incarceration, serious mental illness, substance use disorder, LGBTQ+ patients, veterans, rural residents, undocumented immigrants, and those with limited English proficiency. Each faces access barriers, discrimination, or communication gaps. Use professional interpreters, trauma-informed approaches, and harm-reduction principles; do not withhold opioid analgesia solely because of a substance use history.
Worked example
An older adult with advanced dementia grimaces during repositioning. Rather than assuming she cannot feel pain, use a behavioral tool such as PAINAD, treat with scheduled acetaminophen and low-dose opioid, and reassess the behavior.
Trap: assuming cognitively impaired patients do not experience pain, or that children should be shielded from information about their own illness.