GERIATRIC CARE IN INDIA:

GERIATRIC CARE IN INDIA:      M.V.Ruparelia.

There is a general impression that diseases and disability are part of old age. This is not very true. According to Dr Deepak Chopra, body is ageless. Medical Science is progressing towards very long life span! WHO defines health as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. The concept of Active and Healthy Ageing needs to be promoted among the elderly, which includes promotional, preventive and rehabilitative aspects of health. Although one cannot reverse the aging process, one can find effective ways to cope with it.  The promotion of “aging well” and improved well-being may reduce lifetime health care expenditure. People who get the right start in life, follow healthy lifestyles and take good care of their health can expect to remain active during their eighth, ninth and even tenth decade of life," said Dr Margaret Chan, director-general of WHO.

According to the World Health Organization, India has just 6.5 physicians to every 10,000 patients. By comparison, China has 14.2 doctors, while Britain has 27.4 physicians for the same
number of patients. At present, more than half of the elderly have one or more chronic disease and disability. The ten most common diseases are:  hypertension, cataract, osteoarthritis, chronic obstructive pulmonary disease, ischemic heart disease, diabetes, benign prosthetic hypertrophy, dyspepsia, constipation and depression. The five most frequent causes of death in the elderly are bronchitis and pneumonia, ischemic heart disease, stroke, cancer and tuberculosis. There is special need for health care of oldest old (80+); Elderly Women and Rural Poor Elders. One-third of Indian women are tobacco users. Nearly 14 percent of older Indians are suffering from depression. The Health ministry's own data says that one out of every four elderly persons in India is depressed; one in three suffers from arthritis while one in five cannot hear. While one in three suffers from hypertension, almost half have poor vision. The elderly population will increase to 12% of the total population by 2025, 10% of which would be bedridden, requiring utmost care. According to the 2006 World Population Prospects, by 2050, the number of Indians aged above 80 will increase more than six times from existing 78 lakh to about 5.14 crore.

The United Nations Office on Ageing and the International Association of Gerontology have jointly developed the Research Agenda on Ageing for the 21st Century. Initiated mainly to support the implementation of the International Plan for Action on Ageing, the research agenda was adopted by the Second World Assembly on Ageing at Madrid, Spain, in 2002. It aimed to elaborate and implement public policies on ageing and influence the direction and priorities for scientific gerontology in the coming decades. This was built on the substantial body of knowledge and expertise regarding gerontology and related fields accumulated over time.

An ideal preventive geriatric scheme should include various components such as knowledge and awareness about disease conditions and steps for their prevention and management; good nutrition and balanced diet and physical exercise. For the promotion of a positive mindset and to create a feeling of well being, meditation, prayer, and strategies for motivation should also be included. Home service is very important for senior citizens. Unless a problem is serious and calls for hospitalization, the elderly are best treated at home. India was among the first countries to ratify UN Convention on the Rights of Persons with Disabilities (UNCRPD) which have come into effect from 3rd May, 2008. As per the provisions under Article 25 of UNCRPD, the health services needed by persons with disabilities should be provided as close to people’s own communities, including in rural areas. In addition, at present there is huge shortage of manpower of doctors in geriatrics in the country. At present, elderly health care is part of the general health care system. As the elderly suffer from multiple chronic and disabling diseases, it becomes difficult for them to run from pillar to post to get appropriate health care. Moreover the general health care system is not adequately sensitized to the health needs of elderly.

At a recent seminar organized by the World Health Organization, Dr Giridhara R Babu, associate professor, Public Health Foundation of India, pointed out that 40 per cent of hospitalized persons borrowed money, mortgaged property or sold assets to bear hospital expenses annually. Dr Babu feels insufficient funds and lack of accountability in the public health sector drive millions of Indians into poverty every year.

The need of the hour therefore is to set up geriatric wards that would fulfill the specific needs of the geriatric population. Professional training in Geriatrics and Gerontology needs to be promoted. Research in Geriatrics and Gerontology needs is to be encouraged. Improving the quality of life of the elderly calls for a holistic approach and concerted efforts are required to be made by the health and health-related sectors. Government has come up with a very comprehensive scheme to meet all health requirements of senior citizens. The National Programme for the Health Care for the Elderly (NPHCE) is an articulation of the International and national commitments of the Government as envisaged under the UN Convention on the Rights of Persons with Disabilities (UNCRPD), National Policy on Older Persons (NPOP) adopted by the Government of India in 1999 & Section 20 of “The Maintenance and Welfare of Parents and Senior Citizens Act, 2007” dealing with provisions for medical care of Senior Citizen. The Vision of the NPHCE is:

i)                To provide accessible, affordable, and high-quality long-term, comprehensive and dedicated care services to an Ageing population;

ii)               Creating a new "architecture" for Ageing;

iii)             To build a framework to create an enabling environment for "a Society for all Ages";

iv)              To promote the concept of Active and Healthy Ageing;

v)                Convergence with National Rural Health Mission, AYUSH and other line departments like Ministry of Social Justice and Empowerment.

The NPHCE expects to have 20 institutions with strength to produce 40 post-graduates in geriatric medicine per year, additional 6,400 beds in district hospitals and 1,000 beds in medical colleges for the elderly by 2017. India recently joined 10 other south-east Asian countries to adopt the Yogyakarta Declaration on Ageing and Health, committing to improving national response to the health of ageing population.

At District level, NPHCE is presently being implemented in 100 selected districts of 21 states and at tertiary level, 8 Regional Geriatric Centres (RGCs) are being developed at identified major medical institutions at various regions of the country for referral treatment, research and man power development etc. As regards progress at district level, most of the districts have started Geriatric OPDs with 10 beded geriatric wards. Bi-weekly clinics & Weekly Geriatric Clinics have been started at various CHCs & PHCs respectively. In addition, many districts have reported opening of daily geriatric physiotherapy clinics. At the RGCs, Geriatric OPDs have been started in all 8 RGCs-Regional Geriatric Centres  viz: 1. All India Institute of Medical Science, New Delhi. 2. Madras Medical College, Chennai.  3. Grant Medical College & J.J. Hospital, Mumbai. 4. Sher-I- Kashmir Institute of Medical Sciences, (SKIMS), J&K. 5.  Government Medical College, Thiruvanthapuram. 6. Guwahati Medical College, Assam. 7. Dr S N Medical College, Jodhpur.8. Banaras Hindu University, U.P.

Indoor services with 30 bedded wards have also been established in most of the Regional Geriatric Centres.

Since inception of NPHCE in 2010-11, expenditure incurred is Rs 4115.46 lakh during 2010-11, Rs 7170.27 lakh during 2011-12 and Rs 6855.84 during 2012-13. The provision made for 2013-14 is Rs 15000 lakh.

NCD cell will sensitize public about the Health Care of the Elderly promotion of healthy life style and services made available under the programme. Mass media through Radio, Television, Print media will be used for public awareness using the most effective channels that have reach to the community. Mid media and locally prevalent folk media may also be used to reach the targeted. Recently “Swasth Bharat Programme” has been launched which is being telecast from 30 Regional Centres of Doordarshan and 28 Regional Centres of All India Radio respectively five days a week on Non-Communicable Diseases (NCDs) and other diseases in India including chronic kidney disease. 

Other measures needed are: i) Supervision of the elderly health facilities available in their areas by Active Senior Citizens and their Associations and to connect elderly to such healthcare system. ii) Training of local supervisors by health and social experts.iii) Provide orientation and guidance to families of elderly. iv) Incorporate  group activities and foster capable leaders as local supervisors amongst elderly community and encourage social networking.

A review conducted by the Union health ministry before some time has however found that most states have failed to honour or execute the much-touted National Programme for Healthcare of Elderly (NPHCE). Of the 91 districts expected to start a geriatric clinic by now, only 22 have managed to do so. Worse, just a dozen districts have set up a 10-bed geriatric ward. Only three districts — Mewat and Yamunanagar in Haryana and Leh in Jammu & Kashmir — have started running a bi-weekly geriatric clinic in a community health centre. And, only two districts - Mewat and Leh — have started a weekly geriatric clinic in a primary health centre. In Punjab, a geriatric clinic and geriatric ward will come up in Bhatinda, Gurdaspur and Hoshiarpur soon. Ministry officials say none of the steps - setting up of a geriatric clinic, ward or holding bi-weekly clinics — have been rolled out in states like Andhra Pradesh, Assam, Bihar, Tamil Nadu, West Bengal, Kerala, Karnataka, Jharkhand and Chhattisgarh. A ministry official said, "We have released funds under the NPHCE for creating the stipulated wards and running the clinics in 91 districts across 21 states. Initially, we sent the funds to 30 districts by March, 2011, and then to the rest by March, 2012. However very few states have done any work. In the 12th Plan, we intend to take NPHCE to all the districts in the country. Our target is to reach 100 districts every year." This position may change, if Active Senior Citizens and their Associations continuously represent and agitate to get these facilities provided in their areas for which funds are available from Ministry of Health and Planning Commission.