Year : 2017 | Volume
: 5 | Issue : 1 | Page : 112--114
Geriatric health care in India - Unmet needs and the way forward
Yenepoya Medical College, Yenepoya University, Mangalore, Karnataka, India
Yenepoya Medical College, Yenepoya University, Mangalore, Karnataka
India has nearly 120 million elderly people with various physical, psychosocial, economic, and spiritual problems. While the functionally and cognitively fit can access usual health-care facilities provided by the government, these people need active aging program to keep them independent. Health ministry has created geriatric centers and geriatric clinics in most of the states; however, these centers may not serve the functionally and cognitively impaired elderly. There is great need for mobile units, day-care centers and hospices, and need for training of personnel in home nursing. Routine care clinics cannot handle the burden of geriatric population to address their multimorbidity and several other age-related problems. There is a need for a rapid training of health-care professionals of various disciplines in geriatric care. Government must support nongovernmental organizations and other agencies which provide day care, home care, and palliative care so that these services become affordable to all the elderly.
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Adhikari P. Geriatric health care in India - Unmet needs and the way forward.Arch Med Health Sci 2017;5:112-114
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Adhikari P. Geriatric health care in India - Unmet needs and the way forward. Arch Med Health Sci [serial online] 2017 [cited 2020 May 28 ];5:112-114
Available from: http://www.amhsjournal.org/text.asp?2017/5/1/112/208215
India has 112 million elderly people with multiple physical, social psychological, and economic problems with unmet needs in all domains of health. If we look at the physical and psychological domain, we have the following figures from the previous studies conducted in India.
3.7 million suffer dementia40 million suffer from poor vision1.6 million annual stroke cases1 in 3 suffer from arthritis1 in 3 has hypertension1 in 5 has diabetes1 in 5 has auditory problems1 in 4 suffer from depression1 in 10 falls and sustains a fractureI in 3 bowel disorderCancer is 10 times more common.
In addition, we have data to show that Indian elderly face several social issues such as loneliness, elder abuse, neglect, lack of income security, and poor access to health care. We also have lack of policies on advanced directive, palliative care, and end-of-life care for the elderly. There is lack of data on the spiritual health of older people. With the growing senior population, is India prepared to face the challenge of providing health care? The purpose of this article is to sum up the efforts of the Government of India in this direction and gaps in implementation of the schemes.
Problems of the Elderly
We have to classify elderly into three groups. It is not correct to classify by their chronological age, but we have to classify them by functional status and cognitive status since health-care needs of the groups are going to be different. Stereotyping all elderly into one group is not correct.
Group i Elderly (Functionally and Cognitively Fit Elderly)
These are elderly who are physically and mentally fit to be independent. They may be fit enough to even work and earn. Most of these are young elderly in the age group of 60–70 years. These elderly need more of health promotional activities. These include nutrition, physical activity, social contact, psychological support, and activities for the brain. They can be gainfully employed. However, they may need special transport services and some relaxation in number of hours of working. They will be able to seek health-care facilities available in the village or city such as any other younger person. The goal for these elderly is to keep them physically active, mentally active, to screen for common diseases such as diabetes, hypertension, cancer, vision, hearing, promotion of bone health, and vaccination. Comprehensive geriatric assessment with a coordinated screening program and control of chronic diseases become important for his group so that they remain active and independent till their later ages.
Group ii Elderly (Mild Functional Limitations or Mild Cognitive Impairment)
Many of them are in the age group of 70–80 years. These need assistance for living. They need social support such as Meals on Wheels, special transport, need the help of social workers or children to assist them to visit hospital or get support for physical rehabilitation. This group can be made active and independent provided they are assessed comprehensively and rehabilitated. Their health-care needs are enormous. They need special geriatric clinics where they are comprehensively assessed and rehabilitated. They may need physiotherapy, psychological support, and constant medical help. They may need hospitalization for acute illness since their cognitive status and functional status will decline with each acute illness. The goal of care here is to help them live independently with assistance.
Group iii Elderly (Severe Functional Limitations or Cognitive Limitations)
This group needs home care or hospice care. There is a need for training of home members in caring for them and also there is a need for training hired home care providers. There is a need for home health care program for these people with doctors, nurses, physiotherapists, laboratory services, and pharmacy services reaching the houses of the people. There is a need for palliative care setup for such elderly. The goal of care is to keep them comfortable in their own surroundings or keep them comfortable in hospices.
How Much of These Needs Are Met Through National Programs in India?
National health care program for the older people in India
The national policy on older persons was announced in January 1999 to reaffirm wellness of older people National Policy on Senior Citizens which is ready from March 30, 2011, is under implementation stage. The ministry implemented the National Programme for the Health Care of the Elderly (NPHCE) from the year 2010 to 2011. NPHCE forms a part of the Noncommunicable Division in the Ministry with the following objectives.
To provide preventive, curative, and rehabilitative services to the elderly at various levels of health-care delivery system of the countryTo strengthen referral systemTo develop specialized workforceTo promote research in the field of diseases of the old age.
To establish geriatric departments in all the existing eight Regional Geriatric CentersTo strengthen health-care facilities for elderly at various levels of 100 identified districts in 21 states of the countryRegional institutions to provide technical support to geriatric units at district hospitals whereas district hospitals will coordinate and supervise activities at Community Health Centers (CHC), Primary Health Centre, and subcenters.
Action Taken by the Government in That Direction
Ministry of health and Family Welfare has provided the following benefits
Separate queues for older persons in government hospitalsGeriatric clinic in several government hospitalsA total of 104 districts of 24 states/union territories and eight Regional Geriatric Centres have been covered under the programSo far, 930 CHCs, 4438 Primary Health Care Centers, and 28,767 subcenters have been covered under the program.
Gaps and Way Forward
These subcenters and clinics cater to the needs of elderly who can access health-care facilities. Majority of Group I and a small portion of Group II elderly who are fortunate to have assistance of the kith and kin or neighbors can access these facilities even these centers are so crowded with other programs that elderly do not get enough time to get completely assessed. Hardly any rehabilitative facilities such as occupational therapy is available even in district hospital.
Health Promotional Activities
Thanks to the implementation of noncommunicable disease (NCD) program at least in some districts, elderly are getting screened for diabetes and hypertension regularly and getting medications free of cost. NCD clinics are equipped with staff to counsel on healthy diet and exercise. However, vaccination for older people is still in its infancy and is an unmet need.
Mobile Units - Unmet Needs
Although some of the nongovernmental organizations (NGOs) such as Help Age India have started Mobile health-care Units including physiotherapy services, health ministry is yet to provide care through mobile geriatric care units. Kerala Government has set up several palliative care units which has mobile services. However, at the national level, it is an unmet need.
Workforce Development (unmet needs)
National Institute of Social Defence is giving training to the employees of the voluntary organizations caring for the elderly. NISD is running 3-month training program, 6-month certificate course, and postgraduate diploma courses on old age care issues under project NICE.
One-year PG Diploma in Integrated Geriatric CareThree-month basic course for caregivers/bed assistantsOne-month course on basic issues in Geriatric careTwo-to-five-day program on thematic issues such as Geriatric Counseling, Management of Dementia.
However, the demand for home care personnel is so high that untrained persons are getting into jobs. There is no time for training. Several NGOs have developed home care facilities in Metros. However, these are too expensive and not affordable to common man.
Hospices (unmet needs)
The category three elderly with severe functional and/or cognitive impairment cannot be managed at home unless they hire home nurses or trained home people are available. At this moment, hospitalization becomes mandatory. They need palliative care. There is a need for hospices that provide palliative care. Although palliative care homes exist in some places, they accept only cancer patients but not geriatric patients. There is a need to create more hospices which cater to the needs of elderly. There is a need for separate facilities for dementia care.
Day care centers (unmet needs)
Prevention is better than cure. If we have to keep our elderly active and independent, we need an active aging program for the elderly. Day-care centers for active aging may be utilized for group exercise, to provide at least one nutritious meal, for recreational activities such as library, adult learning, and development of new hobbies and also for income generating activities. It will prevent loneliness, poverty, and will also improve psychological health. Every village and city should have centers which cater to the needs of 100–500 elderly. Active aging makes a difference investment on preventive program may yield dividend years later. The national program has scope for day-care centers.
Health Care of the Older people cannot be achieved unless we address total health, i.e., physical, social, economic, psychological, and spiritual aspects. Unless we address all these issues, geriatric health cannot be ensured. The governmental facilities alone may not be sufficient to cater to the needs of this huge population. By 2050, India is going to have 20% of the population as Geriatric Population. NGOs have to come forward to create help. The government should give some aid to NGOs so that they provide services at low cost. All the Medical Colleges, all the private health-care institution have to join hands with the government to create geriatric health-care facilities. The national program has to be implemented all over the country urgently. Mobile units, day-care centers, active aging centers, and hospices have to be created urgently at every village and city.
The biggest aspiration of the elderly in India is to live independently with dignity. It is the duty of every citizen of India to help our elderly achieve this.
Senior Citizen's Guide Revised Edition 2016 complied and published by Policy Research and Development Department (www.helageindia.org)Aspirations for the elderly in India – a consultative report – An India Backbone Implementation Network and Planning Commission Initiative.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.