It is with immense pride and a profound sense of responsibility that we present the Inaugural Issue of the South Asian Journal of Geriatric Medicine, Surgery, Palliative Care, and Hospice (SAJoGM). This Journal is not only a new publication but also the culmination of a shared vision and a timely response to one of the most significant demographic shifts in human history: the rapid aging of the South Asian population. Our endeavor represents “a movement, a promise, and a vision for a better tomorrow” for the elderly in our region. THE UNPRECEDENTED DEMOGRAPHIC IMPERATIVE Population aging is a global triumph, a testament to improved living conditions, sanitation, and medical advancements. However, in South Asia – comprising Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka – this triumph presents a unique and urgent challenge. The region’s older population (aged 60 and above) is projected to reach over 300 million or 30 crores (8%–10% of the country’s population) by 2050. This rapid increase, occurring within a relatively short timeframe, means that our healthcare systems have little time to adapt. This demographic shift brings with it a complex burden of disease. Older adults in South Asia face a dual challenge: a high prevalence of both noncommunicable diseases (NCDs) such as hypertension, diabetes, and cardiovascular diseases, alongside the persistence of communicable diseases. Furthermore, geriatric syndromes such as frailty, falls, and cognitive decline, including dementia and depression, are prevalent but often remain undiagnosed and untreated due to a lack of understanding and specialized services. The traditional support systems, rooted in strong family structures, are also fast changing. An article in this inaugural issue by Khwaja Mir Islam Saeed et al. from Afghanistan has illustrated the NCDs in their country. THE EMERGING DISCIPLINE OF GERIATRIC MEDICINE Geriatric medicine is a distinct specialty that recognizes the unique physiological and pathological differences in older adults. It moves beyond treating single diseases in isolation to embrace a holistic, patient-centered approach that prioritizes function, independence, and quality of life. The core of geriatric care is the comprehensive geriatric assessment, a multidisciplinary evaluation that considers medical, functional, cognitive, and psychosocial domains to develop personalized care plans. This field is crucial because older adults often have multiple chronic conditions (multimorbidity) and experience altered responses to medications, which means that general medical guidelines based on younger populations may not be directly applicable. Specialized geriatricians, working within a multidisciplinary team (including nurses, therapists, social workers, and pharmacists), are essential for navigating these complexities and ensuring integrated, coordinated care. Research publications in geriatric medicine from Southeast Asia are scarce. Hospice care is a unique healthcare model that operates on a distinct philosophy focusing on comfort, dignity, and quality of life for individuals nearing the end of life, rather than pursuing curative treatments. Key unique features of hospice care include focus on comfort over cure by eminently managing symptoms and relieve pains sometimes stopping treatment aiming at cure. Prognosis-based eligibility for hospice admission is determined by individual assessment of life expectancy. A holistic, multidisciplinary team approach is the core of hospice service, which typically includes doctors, nurses, social workers, spiritual counselors/chaplains, home health aides, and trained volunteers. Dr Saraa Yoosuf from the Maldives has provided suggestions on hospice transfer of patients in their country in this issue. Family as the unit of care is recognised as the first step, and hospice care extends support to the patient’s family and educates them in the tender loving care of their elderly. Bereavement support is also provided to the family and helps them through the grieving process. Care “Where the Patient Calls Home” or hospice generally has facilities that extend to provide care on-site at the patient’s home, or wherever they reside (e.g., a nursing home or assisted living facility), allowing them to remain in a familiar environment surrounded by loved ones. 24/7 availability: the hospice team is available by phone 24 h a day, seven days a week, with on-call nurses for support and crisis management, providing a sense of security for patients and families. Inclusive coverage by providing necessary medical equipment (e.g., hospital beds, oxygen, and walkers) and medications related to symptom control and pain management for the terminal illness. Respite care is done by short-term inpatient care in the hospice to give caregivers a temporary break to rest and recharge. This issue includes an article by Dr Abhishek Shukla on feedback and family satisfaction with hospice care services. Geriatric surgery caters to the unique physiological, medical, and social needs of old people that significantly affect surgical outcomes, requiring specialized knowledge and a coordinated, multidisciplinary approach that differs substantially from general adult surgery. The aging process leads to a natural decline in the functional reserve of vital organs (e.g., heart, lungs, and kidneys), even in the absence of disease. This “decreased physiological reserve” means older patients are less equipped to handle the stress of surgery and anesthesia, making them more vulnerable to complications. Older patients frequently have multimorbidity and are on multiple medications (polypharmacy). Geriatric surgeons require expertise to manage these complex interactions and prevent adverse drug reactions during the perioperative period. There is also an increased risk of specific postoperative complications such as postoperative delirium, acute kidney injury, pneumonia, and functional decline/deconditioning. In the geriatric population, there is far greater importance of functional status and quality of life and not just survival. Atypical disease presentation, even in surgical conditions, may occur. For example, an older patient with an acute surgical issue might not present with classic symptoms, leading to delayed diagnosis and potentially worse outcomes. Those alerts will recognize these subtle signs of atypical presentation of illness. The complexities and potential risks of surgery in older adults necessitate in-depth discussions about prognosis, goals of care, and potential outcomes with patients and their families; thus, a shared decision-making is important. Research in these areas of geriatric surgery helps surgeons navigate these sensitive conversations effectively and compassionately. Geriatric surgery is not about operating on a specific body part; it is about applying general surgical principles with a deep understanding of the whole older patient, thereby improving outcomes and quality of life – the article by Kaushik Bhattacharya in this issue illustrates the holistic approach to inguinal hernia patients in the elderly. Palliative care is another area and scope of this Journal that extends into promulgating current research priorities and building evidence base for practice in palliative care-driven palliative medicine. Annum Ishtiaq from Pakistan has emphasized that the World Health Organization recognizes the ethical responsibility of the healthcare system to provide palliative care. He goes on to discuss the obstacles in implementing this service. Symptom management research heavily focuses on effective, evidence-based methods for managing physical symptoms such as pain, breathlessness, and nausea, as well as psychological and psychiatric aspects such as delirium, anxiety, and depression. This includes studies on opioid and, more recently, cannabinoid pharmacogenetics. Cancer cachexia remains a challenge in palliative care. We need to evolve service delivery models of palliative care that are integrated into existing health systems, particularly community and home-based models, which are more cost-effective and patient-preferred. Further, we may be lacking in communication skills and decision-making. Research in this area explores optimal strategies for communication between healthcare providers, patients, and families, particularly concerning prognoses, advanced care planning, and end-of-life decisions, while navigating diverse cultural and ethical considerations. Research recognizes the integral role of family caregivers and focuses on understanding their needs, reducing their burden, and developing effective support and bereavement programs. A significant body of research addresses disparities in access to palliative care based on diagnosis (noncancer conditions are often underserved), socioeconomic status, and geographical location like rural or urban. Challenges and opportunities in the South Asian context: only when services in geriatric medicine, hospice, and palliative care are well established, clinicians will focus on research. This is a unique challenge faced in limited-resource countries. Furthermore, cultural and social barriers, such as stigma around discussing death, cultural beliefs, and language barriers, often hinder the early introduction of palliative care services. Policy and resource gaps also exist, and politicians in these countries need to be sensitized toward geriatric medicine, surgery, hospice, and palliative care to improve funding and support. Restrictive regulations on essential pain medications (like opioids) impede care delivery and research capacity. Much of the research is based on descriptive or observational studies only. There is a need for more rigorous study designs like randomized controlled trials to generate high-quality evidence tailored to local settings. Moreover, there is a shortage of trained palliative care professionals and limited integration of palliative medicine into core medical and nursing curricula. Research in palliative care is vital for ensuring evidence-based practices that meet the growing global need, particularly in aging populations. By fostering collaborative networks and focusing on contextually relevant, rigorous research, the field can develop innovative, culturally appropriate solutions to alleviate suffering and enhance dignity at the end of life. A SOUTH ASIAN CONGLOMERATION FOR A SHARED FUTURE The vision of SAJoGM is to bridge the significant gap between global advancements in geriatric health care and the local realities of South Asia, where currently <1% of the population receives specialized geriatric care. Our Journal serves as a platform to foster collaboration, disseminate cutting-edge research, and promote innovation tailored to the unique cultural and socioeconomic contexts of our diverse region. The common challenges we face are inadequate healthcare infrastructure, shortage of trained professionals, financial barriers, and significant urban–rural disparities in access to care. By bringing together professionals, researchers, and thought leaders from Afghanistan, Bangladesh, Bhutan, India, the Maldives, Nepal, Pakistan, and Sri Lanka, SAJoGM provides a unified voice and a shared platform to address these challenges collectively. This journal will focus on several key areas to advance the field: Dissemination of Contextual Research: Publishing high-quality, peer-reviewed research that provides evidence-based solutions adaptable to South Asian cultural norms and healthcare systems Fostering Innovation and Best Practices: Encouraging the development and sharing of innovative models of care, such as the use of telemedicine to bridge rural–urban divides or cost-effective care models Promoting Palliative Care and Hospice Services: Emphasizing compassionate, end-of-life care as an integral component of geriatric medicine, an area that has been largely neglected in the region until now Advocacy and Policy Influence: Providing a resource base for policymakers to develop informed strategies, enhance financial support, and strengthen government programs for the elderly. A CALL TO ACTION The launch of SAJoGM marks a pivotal moment in South Asian health care. We invite all health care professionals, researchers, academics, and policymakers to contribute their expertise and insights. Your manuscripts, research articles, case reports, and commentaries will help shape the future of geriatric care in our region. Although the Journal is entitled South Asian Journal, we invite articles from each and every country of the world. The huge population of Latin America and Africa will have concerns about things with South Asian countries. On the other hand, there will be much to learn from countries with more advanced healthcare systems. Together, through collaboration and a shared commitment to compassionate, high-quality care, we can ensure that every older person in South Asia receives the dignity, respect, and specialized medical attention they deserve. The body is the means of fulfilment of duty “Sharirmadhyam Khalu Dharmasadhanam,” and it is our collective duty to support the well-being of our elders throughout their lives. Welcome to the inaugural issue of the South Asian Journal of Geriatric Medicine, Surgery, Palliative Care, and Hospice. Let us embark on this crucial journey together.
Kumar et al. (Thu,) studied this question.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: