LETTER TO EDITOR
Geriatric care in India: A long way to go Dear Editor, With demographic transition underway in India, the elderly population is projected to rise to 12% of the total population by 2025.[1] The ever-increasing elderly population poses social and financial challenges and puts immense strain on the health system due to marked shift toward chronic noncommunicable diseases. Besides, social factors like fewer children in each family, increased employment opportunities for women, who were traditionally taking care of the old in India, rapid urbanization and rise of nuclear families call for more focus on geriatric issues, both medical and socio-economic. The elderly in India are a heterogeneous population with variations in morbidity across several variables like gender, location and socioeconomic status, as well as wide diversity in culture and religion. At least 65% of India’s old live in rural areas and are illiterate and economically dependent.[2,3] Thus, there is a need to address the medical and socio-economic problems of this vulnerable group and promote healthy ageing. In India, the elderly suffer from dual burden of communicable and non-communicable diseases besides impairment of special sensory functions like vision and hearing and other degenerative diseases. Poor geographical access and high cost of treatment also lead to poor utilization of health care especially among the elderly. The elderly are also prone to abuse in their families or in institutional settings. A study in Chennai among 400 community-dwelling elderly aged 65 years and above found the prevalence rate of mistreatment to be 14%. Chronic verbal abuse was the most common followed by financial abuse, physical abuse and neglect.[4] Geriatric care is conspicuously missing from the medical education curriculum. Similarly the nursing and other paramedical staff members are not formally trained in providing care for elderly patients. There is no specialized training in geriatrics in most medical schools in India. Geriatrics is a low-profile specialty that lacks visibility in academia and finds least favor among the medical students. [5] Only selected facilities have a dedicated geriatric unit, but concentrated in urban areas and highly expensive.[6] Very few hospitals provide inpatient geriatric care. Although, there are hundreds of old-age homes, day-care centers and mobile medicare units that provide care to the elderly population, these facilities are managed by NGOs or funded partially by government, but are Journal of Mid-life Health ¦ Oct-Dec 2014 ¦ Vol 5 ¦ Issue 4
urban-based, expensive or focused on tertiary as opposed to primary care. Recently, the Government of India has taken significant strides towards securing the rights of the elderly. In 2007, Indian parliament passed a bill known as Maintenance and Welfare of Parents and Senior Citizens Act, which made maintenance of parents or senior citizens by children or relatives obligatory and justifiable and also provided penal provision for their abandonment.[7] Government of India formulated the National Program for the Health Care of Elderly in 2011 to provide easy access to preventive, promotive, curative and rehabilitative services to the elderly at all levels of health care delivery system along with specialized long-term and short-term training of health professionals to address the growing health needs of the elderly.[1] The National Policy on Senior Citizens in 2011 recognizes senior citizens as a valuable resource for the country and ensures their full participation in society. It aims at providing socio-economic support through incomegenerating activities, insurance and pension schemes, and promoting care of senior citizens within the family.[8] With a strong network of public health infrastructure in place, focus should be on building human resource capacity through specialized education and training opportunities. There are few broad areas in aging research that need immediate attention in the Indian context. These include etio-pathological mechanisms of aging, socio-economic support mechanisms for aging, mechanisms to promote healthy and active aging process, efficient models of geriatric health care delivery, research in alternative medicine and the study of age-related disorders. While we depend on domiciliary model of elderly care, we lack scientific models of care in different settings. We should look for cost-effective feasible models of geriatric care that is acceptable and based on our cultural practices and traditions. We should also build new models for long-term medical care. Apart from medical care models, we should also explore innovative models of economic support and insurance. Although health insurance sector is on a rise in India, the insurance policies tend to exclude those who need the most, especially the elderly. A comprehensive preventive package should be delivered, including knowledge and awareness regarding common geriatric problems and their prevention, healthy nutrition, physical exercise, yoga and meditation, and promotion of mental well-being. 205
Letter to Editor
Laws and policies cannot teach us family values and respect for elders. Thus, parents have a major role to play toward fostering respect for elders at a tender age. The government should focus on raising the capacity of health professionals in geriatric care through specialized courses and trainings and develop socio-economic support mechanisms for the elderly in the community.
Jaya Prasad Tripathy Department of Community Medicine, School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India E-mail: [email protected]
4. Chokkanathan S, Lee AE. Elder-mistreatment in urban India: A community based study. J Elder Abuse Negl 2005;17:45-61. 5. Beck JC, Butler RN. Physician recruitment into geriatricsfurther insight into the black box. J Am Geriatr Soc 2004;52:1959-61. 6. Gangadharan KR. Geriatric hospitals in India, today and in the future. J Aging Soc Policy 2003;15:143-58. 7. Maintenance and welfare of parents and senior citizens act. Ministry of social justice and empowerment, government of India. Available from: http://socialjustice.nic.in/oldageact. php [Last accessed on 2013 Sept 30]. 8. National policy for senior citizens. ministry of social justice and empowerment, government of India. Available from: http://pib.nic.in/newsite/erelease.aspx?relid=77868 [Last accessed on Sept 30 2013].
REFERENCES 1. Operational Guidelines: National Programme for Health Care of the Elderly (NPHCE). Ministry of Health and Family Welfare; New Delhi, Government of India. 2. Ingle G, Nath A. Geriatric health in India: Concerns and solutions. Indian J Community Med 2008;33:214-8. 3. Government of India: Morbidity¸ health care and the condition of the aged. National Sample Survey Organization 60th round (January-June 2004); 2006.
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Website: www.jmidlifehealth.org
DOI: 10.4103/0976-7800.145176
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Journal of Mid-life Health ¦ Oct-Dec 2014 ¦ Vol 5 ¦ Issue 4
Copyright of Journal of Mid-life Health is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
Geriatric care in India: A long way to go Dear Editor, With demographic transition underway in India, the elderly population is projected to rise to 12% of the total population by 2025.[1] The ever-increasing elderly population poses social and financial challenges and puts immense strain on the health system due to marked shift toward chronic noncommunicable diseases. Besides, social factors like fewer children in each family, increased employment opportunities for women, who were traditionally taking care of the old in India, rapid urbanization and rise of nuclear families call for more focus on geriatric issues, both medical and socio-economic. The elderly in India are a heterogeneous population with variations in morbidity across several variables like gender, location and socioeconomic status, as well as wide diversity in culture and religion. At least 65% of India’s old live in rural areas and are illiterate and economically dependent.[2,3] Thus, there is a need to address the medical and socio-economic problems of this vulnerable group and promote healthy ageing. In India, the elderly suffer from dual burden of communicable and non-communicable diseases besides impairment of special sensory functions like vision and hearing and other degenerative diseases. Poor geographical access and high cost of treatment also lead to poor utilization of health care especially among the elderly. The elderly are also prone to abuse in their families or in institutional settings. A study in Chennai among 400 community-dwelling elderly aged 65 years and above found the prevalence rate of mistreatment to be 14%. Chronic verbal abuse was the most common followed by financial abuse, physical abuse and neglect.[4] Geriatric care is conspicuously missing from the medical education curriculum. Similarly the nursing and other paramedical staff members are not formally trained in providing care for elderly patients. There is no specialized training in geriatrics in most medical schools in India. Geriatrics is a low-profile specialty that lacks visibility in academia and finds least favor among the medical students. [5] Only selected facilities have a dedicated geriatric unit, but concentrated in urban areas and highly expensive.[6] Very few hospitals provide inpatient geriatric care. Although, there are hundreds of old-age homes, day-care centers and mobile medicare units that provide care to the elderly population, these facilities are managed by NGOs or funded partially by government, but are Journal of Mid-life Health ¦ Oct-Dec 2014 ¦ Vol 5 ¦ Issue 4
urban-based, expensive or focused on tertiary as opposed to primary care. Recently, the Government of India has taken significant strides towards securing the rights of the elderly. In 2007, Indian parliament passed a bill known as Maintenance and Welfare of Parents and Senior Citizens Act, which made maintenance of parents or senior citizens by children or relatives obligatory and justifiable and also provided penal provision for their abandonment.[7] Government of India formulated the National Program for the Health Care of Elderly in 2011 to provide easy access to preventive, promotive, curative and rehabilitative services to the elderly at all levels of health care delivery system along with specialized long-term and short-term training of health professionals to address the growing health needs of the elderly.[1] The National Policy on Senior Citizens in 2011 recognizes senior citizens as a valuable resource for the country and ensures their full participation in society. It aims at providing socio-economic support through incomegenerating activities, insurance and pension schemes, and promoting care of senior citizens within the family.[8] With a strong network of public health infrastructure in place, focus should be on building human resource capacity through specialized education and training opportunities. There are few broad areas in aging research that need immediate attention in the Indian context. These include etio-pathological mechanisms of aging, socio-economic support mechanisms for aging, mechanisms to promote healthy and active aging process, efficient models of geriatric health care delivery, research in alternative medicine and the study of age-related disorders. While we depend on domiciliary model of elderly care, we lack scientific models of care in different settings. We should look for cost-effective feasible models of geriatric care that is acceptable and based on our cultural practices and traditions. We should also build new models for long-term medical care. Apart from medical care models, we should also explore innovative models of economic support and insurance. Although health insurance sector is on a rise in India, the insurance policies tend to exclude those who need the most, especially the elderly. A comprehensive preventive package should be delivered, including knowledge and awareness regarding common geriatric problems and their prevention, healthy nutrition, physical exercise, yoga and meditation, and promotion of mental well-being. 205
Letter to Editor
Laws and policies cannot teach us family values and respect for elders. Thus, parents have a major role to play toward fostering respect for elders at a tender age. The government should focus on raising the capacity of health professionals in geriatric care through specialized courses and trainings and develop socio-economic support mechanisms for the elderly in the community.
Jaya Prasad Tripathy Department of Community Medicine, School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India E-mail: [email protected]
4. Chokkanathan S, Lee AE. Elder-mistreatment in urban India: A community based study. J Elder Abuse Negl 2005;17:45-61. 5. Beck JC, Butler RN. Physician recruitment into geriatricsfurther insight into the black box. J Am Geriatr Soc 2004;52:1959-61. 6. Gangadharan KR. Geriatric hospitals in India, today and in the future. J Aging Soc Policy 2003;15:143-58. 7. Maintenance and welfare of parents and senior citizens act. Ministry of social justice and empowerment, government of India. Available from: http://socialjustice.nic.in/oldageact. php [Last accessed on 2013 Sept 30]. 8. National policy for senior citizens. ministry of social justice and empowerment, government of India. Available from: http://pib.nic.in/newsite/erelease.aspx?relid=77868 [Last accessed on Sept 30 2013].
REFERENCES 1. Operational Guidelines: National Programme for Health Care of the Elderly (NPHCE). Ministry of Health and Family Welfare; New Delhi, Government of India. 2. Ingle G, Nath A. Geriatric health in India: Concerns and solutions. Indian J Community Med 2008;33:214-8. 3. Government of India: Morbidity¸ health care and the condition of the aged. National Sample Survey Organization 60th round (January-June 2004); 2006.
Access this article online Quick Response Code:
Website: www.jmidlifehealth.org
DOI: 10.4103/0976-7800.145176
Announcement
“QUICK RESPONSE CODE” LINK FOR FULL TEXT ARTICLES The journal issue has a unique new feature for reaching to the journal’s website without typing a single letter. Each article on its first page has a “Quick Response Code”. Using any mobile or other hand-held device with camera and GPRS/other internet source, one can reach to the full text of that particular article on the journal’s website. Start a QR-code reading software (see list of free applications from http://tinyurl.com/yzlh2tc) and point the camera to the QR-code printed in the journal. It will automatically take you to the HTML full text of that article. One can also use a desktop or laptop with web camera for similar functionality. See http://tinyurl.com/2bw7fn3 or http://tinyurl.com/3ysr3me for the free applications.
206
Journal of Mid-life Health ¦ Oct-Dec 2014 ¦ Vol 5 ¦ Issue 4
Copyright of Journal of Mid-life Health is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
