Sociocultural beliefs and palliative care needs among older adults in low- and middle-income countries: A narrative review

Abstract

Palliative care is an integral component of comprehensive primary health care and is particularly relevant for older adults living with chronic and progressive illnesses. In low- and middle-income countries (LMICs), including many African settings, access to palliative care remains limited despite substantial need. Sociocultural beliefs shape perceptions of ageing, illness, suffering and death, and influence how palliative care needs are recognised and addressed within primary care and family medicine contexts. To synthesise existing evidence on how sociocultural beliefs influence palliative care needs and utilisation among older adults in LMICs, with implications for primary care and family practice. A narrative literature review was conducted using published qualitative, quantitative and mixed-methods studies identified through searches of major electronic databases and relevant grey literature. Evidence was synthesised thematically, focusing on sociocultural influences relevant to primary care settings. Key themes identified included cultural constructions of ageing and suffering, family-centred decision-making, religious and spiritual interpretations of illness, and misconceptions surrounding palliative care. These factors influence symptom reporting, care-seeking behaviour, referral patterns and utilisation of palliative care services at the primary care level. Sociocultural beliefs are fundamental to understanding palliative care needs among older adults in LMICs. To improve access and quality of care, culturally sensitive palliative care models that involve families, recognise spiritual concerns and dispel myths are crucial. More empirical research from under-represented LMIC regions is required to inform contextually appropriate policy and practice.