GERIATRIC CARE

WHY IN NEWS:

• With demographic transition underway in India, the elderly population is projected to rise to 12% of the total population by 2025.
• The ever-increasing elderly population poses social and financial challenges and puts immense strain on the health system due to marked shift toward chronic non-communicable diseases.

STATISTICS:

• The elderly population (aged 60 years or above) in India accounted for 8.6% of the total population in 2011. Of which 53 million are females and 51 million are males.
• It has been projected to increase to 19% (300 million) by the year 2050.

BACKGROUND:

• UNFPA Report titled ‘Caring For Our Elders: Early Responses’, finds out three key demographic patterns related to elderly population in India:
  • Ruralisation of Elderly:
    • It was observed that as many as 71% of elderly persons in India were living in rural areas.
  • The Old-age Dependency Ratio
    • It has climbed from 10.9% in 1961 to 14.2% in 2011 for India as a whole
  • Feminisation of Aging:
    • The sex ratio of the elderly has increased from 938 women to 1,000 men in 1971 to 1,033 in 2011 and is projected to increase to 1,060 by 2026.

CHALLENGES:

• Lack of physical infrastructure:
  • Most spaces in homes and public spaces are insensitive to elderly needs. Lack of access to assistive equipment makes the thing worse.
• Changing family structure:
  • The emerging prevalence of nuclear family set-ups in recent years, the elderly is likely to be exposed to emotional and physical insecurity in the years to come.
  • There is an upward trend in the number of elderly staying alone or with spouse only from 9.0% in 1992 to 18.7% in 2006.
• Lack of Social Support:
  • The elderly in India are much more vulnerable because of the less government spending on social security system.
  • Insurance cover that is elderly sensitive is virtually non- existent in India and in addition, the pre-existing illnesses are usually not covered.
  • Pension and social security is also restricted to those who have worked in the public sector or the organized sector of industry.
• Social Inequality:
  • Elderly are a heterogeneous section with an urban and rural divide where they are less vulnerable in rural areas. There is also a divide on account of gender.
  • In a case study, it was found that a major proportion of the elderly women were poorer; received the lowest income per person; had the greatest percentage of primary level education; recorded the highest negative affective psychological conditions; were the least likely to have health insurance coverage and they recorded the lowest consumption expenditure.
• Availability, Affordability and Accessibility of Health Care:
  • Geriatric care is relatively new in many developing countries like India with many practicing physicians having little knowledge of the clinical and functional implications of aging
  • Most of the government facilities such as day care centres, old age residential homes, counselling and recreational facilities are urban based.
• Economic Dependency:
  • About 85% of the aged had to depend on others for their day to day maintenance. The situation was even worse for elderly females. (52nd round of NSSO). Poverty act as a multiplier of the risk of abuse.
• Issues of the public health system
  • Lack of infrastructure, limited manpower, poor quality of care and overcrowding of facilities affects a focussed elderly care in our public health systems

GOVERNMENT INITIATIVES:

• National Policy on Older People (NPOP):
  • It envisages State support to ensure financial and food security, health care, shelter and other needs of older persons, equitable share in development, protection against abuse and exploitation, and availability of services to improve the quality of their lives.
  • The policy also covers issues like social security, intergenerational bonding, family as the primary caretaker, role of Non-Governmental Organizations, training of manpower, research and training.
• National Programme for Health Care of Elderly (NPHCE):
  • It 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)
  • Components:
    • Access to promotional, preventive, curative and rehabilitative services to the elderly through community based primary health care approach
    • Build capacity of the medical and paramedical professionals as well as the care-takers within the family for providing health care to the elderly.
    • Provide referral services to the elderly patients through district hospitals, regional medical institutions
    • Convergence with National Rural Health Mission, AYUSH and other line departments like Ministry of Social Justice and Empowerment.
• National Social Assistance Programme (NSAP)
  • Under which old-age pensions and family benefits are provided to BPL families.
• Maintenance and Welfare of Parents and Senior Citizens Act 2007:
  • Elderly who cannot support themselves can demand maintenance for their children.
  • Also, the Act legally empowers the elderly to claim their property back from their children if the condition of maintenance is not satisfied.
• National Institute of Social Defence (NISD)
  • It undertakes the development of a cadre of geriatric caregivers in the family and community for the welfare of older persons.
  • Certificate course on geriatric bedside assistance and care-giving, certificate course in geriatric care for voluntary agencies, dementia-care programmes
• Recent Initiatives of the Government
  • Atal Pension Yojana:
    • The subscribers would receive the fixed pension of ? 1,000 – ? 5,000 per month from the age of 60 years onward, depending on their contribution.
    • This would prevent the economic compulsion to work in the later years of life.
  • Health Insurance for Senior Citizens:
    • ? 100 billion of unclaimed funds under EPFO and Small Savings would be utilised for providing health insurance cover to the elderly.
• South Asia Partnership on Ageing:
  • The Kathmandu Declaration 2016 (under SAARC) reaffirms commitments to the Older Peoples’ Rights enshrined in the Vienna International Plan of Action on Ageing, the United Nations Principles for Older Persons.

BEST PRACTICE:

• ‘Vayomithram’ by Governmnet of Kerala:
  • This scheme aims to provide health care and support to elderly residents in the corporation/municipal areas.
  • The project mainly provides free medicines through mobile clinics, palliative care and a help-desk to the old.
  • The project is implemented in collaboration with the urban local bodies (municipalities).
• Kerala Police Janamaithri Suraksha:
  • The police help to monitor the senior citizens by interacting with them on phone, visiting them regularly, organizing field visits and advising them on their personal problems.

EXAMPLES OF NGOs IN GERIATRIC CARE:

• Agewell Foundation
• Ekal Nari Shakti Sangathan
• HelpAge India

WAY FORWARD:

• Platform for community interaction:
  • Increase the avenues for older people to participate in local issues, in resident associations, set up and manage spaces for community interaction, to leverage their knowledge and experience as a resource.
• Capacity building:
  • Peripheral health workers and community health volunteers should also be trained to identify and refer elderly patients for timely and proper treatment
• Regulation:
  • The growing informal industry of home care providers urgently needs regulation.
  • There should be mandated guidelines so that a large pool of certified and affordable trained home care givers can help provide basic support, prevent unnecessary hospital admissions, and keep the elderly in the familiar environs of their homes as far as possible
• Medical education:
  • Geriatric pharmacotherapy needs to be included as a component of undergraduate and postgraduate education in medicine as well as in other disciplines like nursing and pharmacy
• Infrastructure:
  • Creation of a network of old age homes, both in the private and public sector
  • Guidelines for making public infrastructure accessible to old age people with necessary assistive supports
• Value education:
  • To inculcate the moral obligation upon the children to take care of their parents, we need to incorporate values and ethics in school curriculum

PRACTICE QUESTION:

Q. “Rapid urbanization and rise of nuclear families in India requires more focus on geriatric issues”. Comment.