Medico social problems of elderly

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  • Article 41 of the Constitution provides that the State shall, within the limits of its economic capacity and development, make effective provision for securing the right to work, to education and to public assistance in cases of unemployment, old age, sickness & disablement, & in other cases of undeserved want.Further, Article 47 provides that the State shall regard the raising of the level of nutrition and the standard of living of its people and the improvement of public health as among its primary duties….
  • This Act includes the following aspects:- a) Senior Citizens can claim maintenance from children/grand children. b) Tribunal shall decide such claims expeditiously. c) Property of Senior Citizens shall be protected from forcible transfer. d) A Geriatric Ward shall be provided in every District Level Hospital. e) An Age Old Home shall be available in each District. f) Abandoning a Senior Citizen shall be punishable with imprisonment of 3 months or fine up to Rs 5000 or both.
  • Maintenance and Welfare of Parents and Senior Citizens Act, 2007:The Act has to be brought into force by individual State Government. As on 3.2.2010, the Act had been notified by 22 States and all UTs. The Act is not applicable to the State of Jammu & Kashmir, while Himachal Pradesh has its own Act for Senior Citizens.The remaining States yet to notify the Act are - Bihar, Meghalaya, Sikkim and Uttar Pradesh.
  • Implementation Strategy adopted for operationalisation of National Policy envisages the following:Implementation Strategy :Preparation of Plan of Action for operationalisation of the National policy.Setting up of separate Bureau for Older Persons in Ministry of Social Justice & Empowerment.Setting up of Directorates of Older Persons in the States.Three Yearly Public Review of implementation of policy.
  • Setting up of a National Council for Older Persons headed by Ministry of Social Justice & Empowerment from Central Ministry, states, Non-Official members representing NGOs, Academic bodies, Media and experts as membersEstablishment of Autonomous National Association of Older PersonsEncouraging the participation of local self-government
  • I. Ministry of Health & Family WelfareSeparate queues for older persons in government hospitals.Two National Institute on Ageing at Delhi and Chennai have been set upGeriatric Departments in 25 medical colleges have been set up.National Programme For Health Care Of The Elderly (NPHCE)
  • II. Ministry of Rural DevelopmentImplemented the National Old-age Pension Scheme (NOAPS)For persons above 65 years belonging to a household below poverty line,Central assistance is given towards pension @ Rs. 200/- per month, which is meant to be supplemented by at least an equal contribution by the States so that each beneficiary gets at least Rs.400/- per month as pension.The Ministry has lowered the age limit from the existing 65 years to60 years and the pension amount for senior citizens of 80 years and abovehas also been enhanced from Rs. 200/- to Rs. 500/- per month with effectfrom 1.4.2011. It is estimated that there are about 72.29 lakh additionalpersons living below the poverty line, who would become eligible to receivecentral assistance under IGNOAPS in the age group of 60-64 years andthere are 26.33 lakh persons above the age of 80 years living below thepoverty line, who would become eligible to receive enhanced centralassistance @ 500 per month. The number of beneficiaries is expected toincrease from 171 lakh to 243 lakh. The decision of the Government of Indiaregarding lowering the age limit from 65 to 60 years along with the revisedguidelines have been issued to all States/ UTs vide letter no.J-11015/1/2011-NSAP dated 30th June 2011.
  • The Programme has been formulated in pursuance to:National Policy on Older Persons (1999)The Maintenance and Welfare of Parents and Senior Citizens Act, 2007.
  • Objectives :To provide an easy access to promotional, preventive, curative and rehabilitative services to the elderly through community based primary health care approachTo identify health problems in the elderly and provide appropriate health interventions in the community with a strong referral backup support.To build capacity of the medical and paramedical professionals as well as the care-takers within the family for providing health care to the elderly.To provide referral services to the elderly patients through district hospitals, regional medical institutionsConvergence with National Rural Health Mission, AYUSH and other line departments like Ministry of Social Justice and Empowerment.
  • PPP:- (Source :- The Technopak report on Age-Sensitive Hospitals June 2012 ) http://pharmabiz.com/NewsDetails.aspx?aid=69430&sid=1In the corporate sector, Apollo Hospital, Chennai has a department of Geriatric Medicine. Hyderabad-based Heritage Hospitals also have a separate geriatric department. Many hospitals in the metro cities including Max, Fortis, Rockland, Pushpanjali, Crosslay and Jaipur Golden in Delhi have started programmes targeting geriatric care. Small standalone geriatric hospitals such as Vindhya Geriatric hospital in Bangalore and Aastha Hospital in Lucknow have been started. There is a huge scope for medical entrepreneurs to look at setting up more, stated Dr PratibhaDabas, principal consultant, Healthcare, Technopak.
  • IGNOU offer a one year part-time, Post Graduate Diploma in Geriatric Medicine (PGDGM) and IMA AKN Sinha Institute offers a certificate in geriatrics.Source :- The Technopak report on Age-Sensitive Hospitals June 2012
  • Package of Services at different levels (SC/PHC/CHC/RGC)Institutional framework for implementationIntegration with NRHMState Health SocietyDistrict Health SocietyC. Management StructureNational/ State / District NCD cell composition & responsibilitiesD. Activities at various levels (SC/PHC/CHC/RGC)
  • Package of Services: The range of services will include Health promotion Preventive services Diagnosis and management of geriatric medical problems (out and in-patient)Day care servicesRehabilitative servicesHome based careDistricts will be linked to Regional Geriatric Centers for providing tertiary level care.Integration with existing primary health care delivery system and vertical at district and above as more specialized health care are needed for the elderly.
  • Services at Sub-centre:Health Education related to healthy ageingDomiciliary visits to home bound / bedridden elderly persons .Arrange for suitable calipers and supportive devices.Linkage with other support groups and day care centers.Services at PHC:Weekly geriatric clinic by a trained Medical OfficerConducting a routine health assessment (eye, BP, blood sugar & record keeping).Provision of medicines and proper advice on chronic ailmentsPublic awareness on Geriatrics health Referral services.Services at District Hospital :Geriatric Clinic for regular dedicated OPD services to the Elderly with Lab facility & adequate medicine.10 bedded Geriatric Ward with existing specialtiesProvide services to patients referred by the CHCs/PHCs etc.Conducting camps in PHCs/CHCs and other sites.Referral services to tertiary level hospitalsServices at Regional Geriatric Centre:Geriatric Clinic (Specialized OPD)30-bedded Geriatric Ward.Laboratory investigation with a special sample collection centre in OPD block.Tertiary health care to the cases referred from medical colleges, district hospitals and below.
  • Funds from Government of India will be released to the State Health Society.State Health Society will retain funds for state level activity and release GIA to the District Health Societies. NPHCE would operate through NCD cells under the programme constituted at State and District levels and also maintain separate bank accounts at each level. Funds from Health Society will be transferred to the Bank accounts of the NCD cell after requisite approvals at appropriate stage.This system will ensure both convergence as well as independence in achieving programme goals through specific interventions. It is envisaged to merge the programme at State and District into the SHS and DHS respectively in order to ensure sustaining the current momentum and continued focus.
  • State Health Society (SHS):Under the NRHM framework different Societies of national programmes such asReproductive and Child Health Programme, Malaria, TB, Leprosy, NationalBlindness Control Programme have been merged into a common State HealthSociety is chaired by Chief Secretary/Development Commissioner. Principal/Secretary (Health & Family Welfare) is the vice chair person and mission directoris the Member -Secretary of the State Health Society.
  • District Health Society (DHS)At the district level all programme societies have been merged into the DistrictHealth Society (DHS).The Governing Body of the DHS is chaired by the Chairmanof the ZilaParishad / District Collector. The Executive Body is chaired by theDistrict Collector (subject to State specific variations).The CMHO is the Member-Secretary of the District Health Society. District health society will pass on thefunds to the RogiKalyanSamities of Block level for the activities under theprogramme. District Health society will monitor the utilization of funds and submitquarterly the financial management report (FMR) of the programme to StateHealth Society.
  • Responsibilities of the State/UTAppoint a State Nodal officer for liaison with Central Government, various State & District authorities as well as Regional Medical Institutes.Contribution of state share of 20%Provision of land/space for the Geriatric ward & OPDSetting up of State NCD Cell.The NCD Cell will be responsible for overall planning, implementation, monitoring and evaluation of the different activities, and achievement of physical and financial targets planned under the programme in the State.The Cell shall function under the guidance of State programme Officer (SPO-NCD) and will be supported by the identified officers/officials from the Directorate /Director General of Health Services.SPO (NCD) will be a State level health official identified by the State government.Supplementing the expenditure on equipments, drugs and consumablesStarting P.G. Course in Geriatric Medicine @ 2 seats per year Regional Medical Institutes (by the States in which the Regional Medical Institutes is located)Setting up of rehabilitation unit at CHCs falling within the identified districtsTaking over the responsibility from central Govt. once the units are fully functional.Provision of supportive faculty in specialties other than Internal MedicineProvision of diagnostic support services like Laboratory, Radiological and other investigational facilities.
  • Responsibilities of the State/UTAppoint a State Nodal officer for liaison with Central Government, various State & District authorities as well as Regional Medical Institutes.Contribution of state share of 20%Provision of land/space for the Geriatric ward & OPDSetting up of State NCD Cell.The NCD Cell will be responsible for overall planning, implementation, monitoring and evaluation of the different activities, and achievement of physical and financial targets planned under the programme in the State.The Cell shall function under the guidance of State programme Officer (SPO-NCD) and will be supported by the identified officers/officials from the Directorate /Director General of Health Services.SPO (NCD) will be a State level health official identified by the State government.Supplementing the expenditure on equipments, drugs and consumablesStarting P.G. Course in Geriatric Medicine @ 2 seats per year Regional Medical Institutes (by the States in which the Regional Medical Institutes is located)Setting up of rehabilitation unit at CHCs falling within the identified districtsTaking over the responsibility from central Govt. once the units are fully functional.Provision of supportive faculty in specialties other than Internal MedicineProvision of diagnostic support services like Laboratory, Radiological and other investigational facilities.
  • Responsibilities of the State/UTAppoint a State Nodal officer for liaison with Central Government, various State & District authorities as well as Regional Medical Institutes.Contribution of state share of 20%Provision of land/space for the Geriatric ward & OPDSetting up of State NCD Cell.The NCD Cell will be responsible for overall planning, implementation, monitoring and evaluation of the different activities, and achievement of physical and financial targets planned under the programme in the State.The Cell shall function under the guidance of State programme Officer (SPO-NCD) and will be supported by the identified officers/officials from the Directorate /Director General of Health Services.SPO (NCD) will be a State level health official identified by the State government.Supplementing the expenditure on equipments, drugs and consumablesStarting P.G. Course in Geriatric Medicine @ 2 seats per year Regional Medical Institutes (by the States in which the Regional Medical Institutes is located)Setting up of rehabilitation unit at CHCs falling within the identified districtsTaking over the responsibility from central Govt. once the units are fully functional.Provision of supportive faculty in specialties other than Internal MedicineProvision of diagnostic support services like Laboratory, Radiological and other investigational facilities.
  • Responsibilities of the State/UTAppoint a State Nodal officer for liaison with Central Government, various State & District authorities as well as Regional Medical Institutes.Contribution of state share of 20%Provision of land/space for the Geriatric ward & OPDSetting up of State NCD Cell.The NCD Cell will be responsible for overall planning, implementation, monitoring and evaluation of the different activities, and achievement of physical and financial targets planned under the programme in the State.The Cell shall function under the guidance of State programme Officer (SPO-NCD) and will be supported by the identified officers/officials from the Directorate /Director General of Health Services.SPO (NCD) will be a State level health official identified by the State government.Supplementing the expenditure on equipments, drugs and consumablesStarting P.G. Course in Geriatric Medicine @ 2 seats per year Regional Medical Institutes (by the States in which the Regional Medical Institutes is located)Setting up of rehabilitation unit at CHCs falling within the identified districtsTaking over the responsibility from central Govt. once the units are fully functional.Provision of supportive faculty in specialties other than Internal MedicineProvision of diagnostic support services like Laboratory, Radiological and other investigational facilities.
  • At PHC level:The weekly geriatric clinic by trained medical officer.Coordination with CHC, district hospital, sub centers, other National Health Programmes/ Departments for medicines, ambulancesTraining of manpower & Separate registration counter for elderly. Public awareness during health and village sanitation day/camps.Provision of medicine to the elderly for their medical ailments.
  • At PHC level:The weekly geriatric clinic by trained medical officer.Coordination with CHC, district hospital, sub centers, other National Health Programmes/ Departments for medicines, ambulancesTraining of manpower & Separate registration counter for elderly. Public awareness during health and village sanitation day/camps.Provision of medicine to the elderly for their medical ailments.
  • At PHC level:The weekly geriatric clinic by trained medical officer.Coordination with CHC, district hospital, sub centers, other National Health Programmes/ Departments for medicines, ambulancesTraining of manpower & Separate registration counter for elderly. Public awareness during health and village sanitation day/camps.Provision of medicine to the elderly for their medical ailments.
  • At PHC level:The weekly geriatric clinic by trained medical officer.Coordination with CHC, district hospital, sub centers, other National Health Programmes/ Departments for medicines, ambulancesTraining of manpower & Separate registration counter for elderly. Public awareness during health and village sanitation day/camps.Provision of medicine to the elderly for their medical ailments.
  • At PHC level:The weekly geriatric clinic by trained medical officer.Coordination with CHC, district hospital, sub centers, other National Health Programmes/ Departments for medicines, ambulancesTraining of manpower & Separate registration counter for elderly. Public awareness during health and village sanitation day/camps.Provision of medicine to the elderly for their medical ailments.
  • At PHC level:The weekly geriatric clinic by trained medical officer.Coordination with CHC, district hospital, sub centers, other National Health Programmes/ Departments for medicines, ambulancesTraining of manpower & Separate registration counter for elderly. Public awareness during health and village sanitation day/camps.Provision of medicine to the elderly for their medical ailments.
  • Geriatric Clinic with Specialized services: It will be the responsibility of the concerned regional institutions to organize specialized OPDs in all the specialties available with them for the benefit of the Elderly. Staff for the newly created Geriatric Clinic will be funded under NPHCE. All the other specialists will be from existing human resources of the institution. The Institution shall not wait for the commissioning of the building for provision of OPDs. They will have to start OPDs immediately on launch of this programme from within existing infrastructure.Deployment of Specialists: Keeping in view the scarcity of specialist in geriatric field, the existing specialist in various fields who are either trained in geriatric or interested in the field be utilized for managing geriatric OPD and geriatric wards. Details of additional contractual staff for Regional Geriatric Centre supported under the programme are given below. Their recruitment will be made by the Medical InstitutionInvestigations: It will be the responsibility of the concerned regional institutions to provide for lab services, x-ray and other special investigation services for elderly. A special collection centre will be provided in the OPD block.Drugs and Consumables: A provision of Rs 20 lakh per annum has been made for each Regional Geriatric Centre for Drugs and Consumables under the Programme. Any further expenses on this count shall be borne from the institutions/states own resources.Referral Services: The institution will be responsible to provide tertiary health care to the referral cases from the medical colleges, district hospitals and below.Training: Infrastructure and facilities, including audio-visual aids available in the institution will be utilized for various training courses envisaged under NPHCE.Post-graduation in Geriatric Medicine: The institution will be responsible for initiating process for creating 2 post graduate seats for MD in Geriatric Medicine with affiliated Universities.Research: The department will undertake clinical, epidemiological and applied research in the field of gerontology and geriatrics from the available grant under the programme. Areas of research will be finalized in consultation with National NCD Cell. Multi-centric studies will be encouraged for programme related research.Guidelines have been developed in collaboration with WHO for management of 30 bedded geriatric ward and may be perused for running the Centre.
  • Geriatric Clinic with Specialized services: It will be the responsibility of the concerned regional institutions to organize specialized OPDs in all the specialties available with them for the benefit of the Elderly. Staff for the newly created Geriatric Clinic will be funded under NPHCE. All the other specialists will be from existing human resources of the institution. The Institution shall not wait for the commissioning of the building for provision of OPDs. They will have to start OPDs immediately on launch of this programme from within existing infrastructure.Deployment of Specialists: Keeping in view the scarcity of specialist in geriatric field, the existing specialist in various fields who are either trained in geriatric or interested in the field be utilized for managing geriatric OPD and geriatric wards. Details of additional contractual staff for Regional Geriatric Centre supported under the programme are given below. Their recruitment will be made by the Medical InstitutionInvestigations: It will be the responsibility of the concerned regional institutions to provide for lab services, x-ray and other special investigation services for elderly. A special collection centre will be provided in the OPD block.Drugs and Consumables: A provision of Rs 20 lakh per annum has been made for each Regional Geriatric Centre for Drugs and Consumables under the Programme. Any further expenses on this count shall be borne from the institutions/states own resources.Referral Services: The institution will be responsible to provide tertiary health care to the referral cases from the medical colleges, district hospitals and below.Training: Infrastructure and facilities, including audio-visual aids available in the institution will be utilized for various training courses envisaged under NPHCE.Post-graduation in Geriatric Medicine: The institution will be responsible for initiating process for creating 2 post graduate seats for MD in Geriatric Medicine with affiliated Universities.Research: The department will undertake clinical, epidemiological and applied research in the field of gerontology and geriatrics from the available grant under the programme. Areas of research will be finalized in consultation with National NCD Cell. Multi-centric studies will be encouraged for programme related research.Guidelines have been developed in collaboration with WHO for management of 30 bedded geriatric ward and may be perused for running the Centre.
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  • Objects of the trust - A brief note1) To provide shelter, conducive food, clothes, bed, medicines & other facilities to elderly men & women who are bereft of shelter, and without support and near-relatives, irrespective of caste, religion or creed. To formulate and execute schemes for the welfare of the old and personality development of such people. The executive committee of the trust is empowered to make exceptions, if any, in respect of beneficiaries & the services being provided to them.2) To extend co-operation to like minded institutions in pune or outside to enable them carry out the objectives enumerated in para. 1. Further if needed, to accept the management of such like minded institutions on the condition which are appropriate and in keeping with the objectives of the trust.3) To arrange entertainment programs for the inmates who have been given shelters by the trust and to arrange for their orientation and training so that their inherent capacities and qualities are fastened and enhanced.4) To make efforts for rehabilitating the inmates among their relatives if such possibilities are appearing and extend all possible help in this direction.5) To undertake training and consultative programs for the elderly so that they become needed and welcome in their homes only and new generation understand and welcome them in the homes. To institute a family consultation centered with this end and view.6) To extend necessary co-operation & help in the event of undertaking some programs irrespective of the problems of the elderly both on government level or on behalf of public/ private institution working in this field.7) To arrange and monitor studies and research regarding the issues of the old men and women or to extend helping hand in this regard.Institution established on 9th Aug 1863. Before that we met Mr. DevidSasoon on 4th Aug 1863.Institution got the land possession legally on 3rd Feb 1864 and Mr. DevidSasoon donated Rs.25000 on 20th Jul 1864. Due to that institution was named as on his name.Mr. DevidSasoon has given written permission for his name to institute on 21st Aug 1864.
  • Medico social problems of elderly

    1. 1. Medico-social problems of elderly and National Programmes for elderly Speakers Capt Dr Naveen Phuyal Dr Amol
    2. 2. Medico social problems of the elderly
    3. 3. • There's one advantage to being 102. There's no peer pressure. Dennis Wolfberg • I truly believe that age – if you're healthy -- age is just a number. Hugh Hefner • If I knew I was going to live this long, I'd have taken better care of myself. Mickey Mantle
    4. 4. And now the end is near And so I face the final curtain, I’ll state my case of which I’m certain. I’ve lived a life that’s full, I traveled each and ev’ry highway, And more, much more than this. I did it my way.
    5. 5. 200 kms and 3 weeks long walk at the age of 61 is not impossible for the fight of freedom.
    6. 6. Was Not 92 when he passed away but 10 years old with 82 years of experience
    7. 7. Top of the world ??? No big deal !!! We were just 73 and 76 years old when we climbed it.
    8. 8. Old People ROCK
    9. 9. Olga Kotelko , 92 Super Athlete Who says I can’t play?
    10. 10. Daphne Selfe 83, Worlds Oldest Supermodel
    11. 11. Scheme of Presentation 1. Introduction 2. 10 Facts on ageing (WHO) 3. The epidemiology of population ageing (WHO) 4. Situation analysis of ageing in India 5. Demography of ageing population in India 6. Studies on ageing in India 7. Fighting stereotypes 8. Challenges and opportunities
    12. 12. Introduction • Ageing is a natural process that begins at birth, or to be more precise, at conception, a process that progresses throughout one’s life and ends at death.
    13. 13. Who are the elderly or aged? United Nations Organization (UNO) > 65 years of age as senior citizens. The Indian Census >60 years and above as old.
    14. 14. Population 2012 Total >65 yrs Global > 7 billion >56 million India >1.2 billion 7 million (United states population bureau) India population > 60 > 10 million Population proportion above 60 8% (WHO)
    15. 15. 10 facts on ageing 1. The world population is rapidly ageing. 2. The number of people aged 80 and older will quadruple in the period 2000 to 2050. 3. By 2050, 80% of older people will live in low and middle-income countries. Ref: WHO Fact File 2012
    16. 16. 10 facts on ageing 4. The main health burdens for older people are from non-communicable diseases. 5. Older people in low- and middle-income countries carry a greater disease burden than those in the rich world. 6. The need for long-term care is rising. 7. Effective, community-level primary health care for older people is crucial. Ref: WHO Fact File 2012
    17. 17. 10 facts on ageing 8. Supportive, “age-friendly” environments allow older people to live fuller lives and maximize the contribution they make. 9. Healthy ageing starts with healthy behaviors in earlier stages of life. 10. We need to reinvent our assumptions of old age. Ref: WHO Fact File 2012
    18. 18. 1. Add Life to Years (1982) 2. Healthy Living: Everyone a winner (1986) 3. Active ageing makes the difference (1999) 4. Good Health adds life to years (2012) WHO and Geriatric Health
    19. 19. The epidemiology of population ageing • Life expectancy • Years lost due to premature death • Years lost due to disability • Disability adjusted life years
    20. 20. Life expectancy at birth WHO Region Male ( Years) Female ( Years) World 66 71 Africa 52 56 Americas 73 79 Eastern Mediterranean 64 67 Europe 71 79 South – East Asia 64 67 Western Pacific 72 77 Ref:World health statistics 2011. Geneva, WHO
    21. 21. Life expectancy at age 60 WHO Region Male ( 2009) Female ( 2009) World 18 21 Africa 14 16 America 21 24 Eastern Mediterranean 16 18 Europe 19 23 South- East Asia 15 18 Western Pacific 19 22 Ref: World health statistics 2011. Geneva, WHO
    22. 22. Premature Death Fig: Years of life lost due to death per 100000 adults aged 60 yrs and older by country income group Ref: World health statistics 2011. Geneva, WHO Yearslostduetoprematuredeath Diseases
    23. 23. Disability Fig: Years Lost due to Disability (YLDs) per 100 000 adults over age 60 by country income group Yearslostduetodisability Ref: World health statistics 2011. Geneva, WHO Disability causes
    24. 24. Disability High Income countries Low Income Countries Visual Impairment 15.0 94.2 Hearing Loss 18.5 43.9 Osteoarthritis 8.1 19.4 Ischemic Heart Disease 2.2 11.9 Dementia 6.2 7.0 COPD 4.8 8.0 Cerebrovascular Disease 2.2 4.9 Depression 0.5 4.8 Rheumatoid Arthritis 1.7 3.7 Ref: World health statistics 2011. Geneva, WHO
    25. 25. Total burden of Death and Disability DALY Fig: Disability Adjusted Life years ( DALYs) per 100000 adults over age 60 by country income group Ref: World health statistics 2011. Geneva, WHO Diseases
    26. 26. Other health problems • Approximately 28-35% of people over the age of 65 fall each year. • Falls may lead to post-fall syndrome, which includes increased dependence, loss of autonomy, confusion, immobilization and depression. • Within the year following a hip fracture from a fall, 20% of older people will die.
    27. 27. Other health problems • Around 4-6% of elderly people have experienced some form of maltreatment at home. • While depression is identified as a significant cause of disability and a likely problem in older age, social isolation and loneliness are not recorded in these databases. Ref: World health statistics 2011. Geneva, WHO
    28. 28. Situation analysis of elderly in India
    29. 29. Situation analysis of elderly in India • Majority population aged less than 30 • The problems and issues of its grey population has not been given serious consideration • Focus - on the children and the youth • Rapid changes in the social scenario -nuclear families • Elderly - emotional, physical and financial insecurity
    30. 30. Situation analysis of elderly in India • Ageing of population - downward trends in fertility and mortality. • Low birth rates coupled with long life expectancies, push the population to an ageing humanity. • Mounting pressures on various socio economic fronts including pension outlays, health care expenditures, fiscal discipline, savings levels etc.
    31. 31. Demography of ageing population in India Ref: Situation analysis of the elderly in India, 2011 Fig: Age distribution of population in India over decades
    32. 32. Fig 3: More Older parents to support Fig 2: Dependency ratios, India 1961-2026 Fig 1: Population by broad age groups, India, 1961-2026 Ref: Situation analysis of the elderly in India, 2011
    33. 33. Studies on ageing in India
    34. 34. Studies on ageing in India • Economic aspects of ageing • Social aspects of ageing • Psychological aspects of ageing • Health conditions of elderly • Malnutrition in elderly • Mental Health in elderly • Elder Abuse • Crime in elderly
    35. 35. Economic aspects • Are elderly a burden on the family and the nation? • 40 % of the elderly > 60 are working. • While adults (in the age group 15-59) who are not working and are dependants. • Inadequate income is a major problem of the elderly in India .
    36. 36. Economic aspects • Nearly 90 per cent of total workforce employed in the unorganized sector. • Retire without any financial security like pension and other post- retirement benefits. • Women depend more on others.
    37. 37. Social aspects • Individualism in modern life • Materialistic thinking among young generation • Greater alienation and isolation of the elderly • Decline in value system, respect, honor, status and authority for elderly • Elderly relegated to an insignificant place in our society
    38. 38. Social aspects • The loss of the decision-making power by those who have surrendered their property in favor of younger members. • The loss of status and decision-making power is felt more by ageing women than men.
    39. 39. Social aspects Provide support Aid relationship building Maintenance, fa cilitate coping with stress Issues in relation to death and dying. Religiosity seems to have increase with age. Spirituality was perceived to
    40. 40. Psychological aspects The prominent thrust areas resulting in socio-psychological frustration among the elderly are • Attitude towards old age • Degradation of status in community • Problems of isolation • Loneliness • Generation gap
    41. 41. Psychological aspects Shortage of money Passing time Widowhood Feeling of physically weak Fear of death Mental tension Feeling of social neglect The problems of retirees mainly include:
    42. 42. Health conditions of elderly • More and more susceptible to chronic diseases, physical disabilities and mental incapacities in their old age. • Illnesses are multiple and chronic in nature. • Arthritis, rheumatism, heart problems and high blood pressure are the most prevalent chronic diseases affecting them.
    43. 43. How elderly describe their disease? Elderly Poor Upper-class elderly Describe their health problems, on the basis of easily identifiable symptoms, like chest pain, shortness of breath, prolonged cough, breathlessness/ asthma, eye problems etc. In view of their greater knowledge of illnesses, mention blood pressure, heart attacks, and diabetes which are largely diagnosed through clinical examination.
    44. 44. Malnutrition in elderly • 50 % are at risk in low income group • Both macro and micronutrient deficiencies are common in elderly • Malnutrition is due to a. Lack of financial resources b. Reduced ability to go to market c. Reduced ability to cook nutritious meals d. Difficulty in mastication
    45. 45. Mental health in elderly The worries among the poor are usually about: Inadequate economic support Poor health Inadequate living space Loss of respect Unfinished familial tasks Lack of recreational facilities and The problem of spending time
    46. 46. Multiplicity of disease • Multiplicities of diseases are normal among the elderly and that a majority of the old are often ill with  Chronic bronchitis  Anemia  Hypertension Digestive troubles Rheumatism
    47. 47. Health, Literacy and Income • Elderly members are confronted with various nutritional, physiological and other general problems. • The men are more literate, economically independent and face less physiological and nutritional problems as compared to their female counterparts.
    48. 48. Illness and treatment • Most of the ailments of the elderly are not medically treated. • The two most important reasons for not seeking care were 1.Financial problems 2.Perception that the ailment was not serious.
    49. 49. Elder abuse A female of very advanced age Role-less in family Functionally impaired Lonely The most likely victim of elderly abuse is a
    50. 50. Elder abuse • The prevalent patterns of elder abuse include 1. Psychological abuse in terms of verbal assaults 2. Threats and fear of isolation 3. Physical violence 4. Financial exploitation • More women than men complain of maltreatment in terms of both physical and verbal abuse.
    51. 51. Elder abuse • Person suffering from physical or mental impairment and dependent on the caretakers for most of his or her daily needs is likely to be the victim of elder abuse. • Old people with high educational background and sufficient income are also found to be subjected to abuse.
    52. 52. Elder abuse • Who are the abuser? • Factors for Abuse Son and daughter in law Daughter in law and spouse Spouse Dependent position of the older Perceived powerlessness Social isolation Drug or alcoholic addiction Anti-social behavior of the abusers
    53. 53. Crime against elderly • These crimes range from hurt, robbery, murder and even sexual assault. • Most remain unreported. • Female victims outnumber male victims • More in urban areas as compared to rural areas. • 60 per committed indoors during the day. • 25 percent by family members.
    54. 54. Elderly are heterogeneous group • Rural elderly • Urban Poor elderly • Urban Middle Income and well to do elderly • Female elderly
    55. 55. Rural elderly Unorganized sector. Insecure employment Insufficient income. Lack access to any form of social security and good quality or reasonably priced health care Have to pay more for even the most basic healthcare services.
    56. 56. Urban poor elderly Poor Infrastructure Poor physical condition Low income levels High rates of unemployment /underemployment Crime, alcoholism, mental illness Lack of public and community facilities Lack of access to affordable healthcare services.
    57. 57. Urban middle income and well-to-do elderly • The impact of urbanization has touched many a life leading to migration of children to cities or abroad. • Many elderly are well-off due to their prosperous children but are left alone to take care of themselves.
    58. 58. Female elderly • Feminization of later life. The female elderly are more likely to be Widowed Have low economic security Lower educational attainment More care giving responsibilities than their male counterparts.
    59. 59. Female elderly • The absence of gender-specific health services • Poor health due to child bearing • Less nutrition • Economic deprivation throughout their lives
    60. 60. Female elderly • The loss of status at the death of their husband only increases the situation of dependency in old age. • This dependency can become more complex as the woman grows older • Her relationship with her son and daughter-in- law decides her fate in old age
    61. 61. Fighting stereotypes
    62. 62. Common stereotyping of elderly 1. Older people are "past their sell-by date“ 2. Older people are helpless . 3. Old people are afraid of dying. 4. Older people will eventually become senile . 5. Older women have less value than younger women . 6. Older people don't deserve health care
    63. 63. 1.Older people are "past their sell-by date" • On 16 October 2011, Fauja Singh became the first 100 year-old to complete a marathon by running the Toronto Waterfront Marathon in Canada.
    64. 64. 2.Older people are helpless • 2007 Cyclone in Bangladesh • Older people’s committees disseminated early warning messages to people and families most at risk • Identified who were worst hit • Compiled beneficiary lists and notified them when and where to receive relief goods
    65. 65. 3.Old people are afraid of dying • 2011 earthquake and Tsunami in Japan • Older people and retirees came forward to volunteer at the nuclear disaster sites
    66. 66. 4.Older people will eventually become senile • Occasional memory lapses occur at any age • Some types of our memory stay the same or even continue to improve with age • Our semantic memory, which is the ability to recall concepts and general facts that are not related to specific experiences
    67. 67. 5.Older women have less value than younger women • People often equate women’s worth with beauty, youth and the ability to have children. • The role older women play in their families and communities, caring for their partners, parents, children and grandchildren is often overlooked. • Women tend to be the family caregivers. • Many take care of more than one generation.
    68. 68. 6.Older people don't deserve health care • Treatable conditions -often overlooked or dismissed as being a "normal part of ageing". • Age does not necessarily cause pain, and only extreme old age is associated with limitation of bodily function. • The right to the best possible health does not diminish as we age.
    69. 69. • It is not age that limits the health and participation of older people. • It is individual and societal misconceptions, discrimination and abuse that prevent active and dignified ageing. 6.Older people don't deserve health care
    70. 70. Challenges and opportunities • Elderly people are a heterogeneous group. • It is essential to recognize this heterogeneity in defining need, assessing the effects and relevance of intervention, and planning for the future. • Ageing population will change society at many levels and in complex ways, creating both challenges and opportunities.
    71. 71. Opportunities of ageing • Older people already make a significant contribution to society, whether it is through the formal workforce, through informal work and volunteering or within the family. • We can foster this contribution by helping them maintain good health and by breaking down the many barriers that prevent their ongoing participation in society.
    72. 72. Challenges of ageing • Towards the end of life, many older people will face health problems and challenges to their ability to remain independent. • We need to address these too, and do it in a way that is affordable and sustainable for families and society.
    73. 73. • Good health must lie at the core of any successful response to ageing. • If we can ensure that people are living healthier as well as longer lives, the opportunities will be greater and the costs to society less. Challenges of ageing
    74. 74. • Recognize them as a resource group • Develop suitable policies
    75. 75. National Policies & Programmes for the Welfare of the Elderly
    76. 76. National Policies & Programmes for the Welfare of the Elderly: Introduction 1. Majority (80%) of them are in the rural areas, thus making service delivery a challenge 2. Feminization of the elderly population ( 51% of the elderly population would be women by the year 2016), 3. Increase in the number of the older-old ( persons above 80years) and 4. A large percentage (30%) of the elderly are below poverty line.
    77. 77. National Policies & Programmes for the Welfare of the Elderly 1. Administrative set-up 2. Relevant Constitutional Provisions 3. Legislations 4. National Policy on Older Persons (NPOP), 1999 5. National Council for Older Persons 6. Inter-Ministerial Committee on Older Persons
    78. 78. National Policies & Programmes for the Welfare of the Elderly 7. Central Sector Scheme of Integrated Programme for Older Persons (IPOP) 8. Schemes of Other Ministries I. Ministry of Health & Family Welfare – National Programme For Health Care Of The Elderly (NPHCE) II. Ministry of Rural Development III. Ministry of Railways IV. Ministry of Civil Aviation V. Ministry of Finance VI. Department of Pensions and Pensioner Grievances Ref: Situation Analysis Of The Elderly in India, June 2011, Ministry of Statistics & Programme Implementation, GOI
    79. 79. 1.Administrative set-up  Ministry of Social Justice & Empowerment  Nodal Ministry which focuses on policies & programmes for the Senior Citizens in close collaboration with State governments, NGOs and Civil society. Ref: Situation Analysis Of The Elderly in India, June 2011, Ministry of Statistics & Programme Implementation, GOI
    80. 80. 2.Relevant Constitutional Provisions  Article 41 of the Constitution provides that the State shall, within the limits of its economic capacity and development, make effective provision for securing the right to work, to education and to public assistance in cases of unemployment, old age, sickness & disablement, & in other cases of undeserved want. Ref: Situation Analysis Of The Elderly in India, June 2011, Ministry of Statistics & Programme Implementation, GOI
    81. 81. 3.Legislations Maintenance and Welfare of Parents and Senior Citizens Act, 2007:  To ensure need based maintenance for parents and senior citizens and their welfare. The Act provides for:-  Maintenance of Parents/ senior citizens by children/ relatives made obligatory and justiciable through Tribunals  Revocation of transfer of property by senior citizens in case of negligence by relatives  Penal provision for abandonment of senior citizens  Establishment of Old Age Homes for Indigent Senior Citizens  Adequate medical facilities and security for Senior Citizens Ref: Situation Analysis Of The Elderly in India, June 2011, Ministry of Statistics & Programme Implementation, GOI
    82. 82. 3.Legislations Maintenance and Welfare of Parents and Senior Citizens Act, 2007: – The Act has to be brought into force by individual State Government. – As on 3.2.2010, the Act had been notified by 22 States and all UTs. – The Act is not applicable to the State of Jammu & Kashmir – The remaining States yet to notify the Act are - Bihar, Meghalaya, Sikkim and Uttar Pradesh. Ref: Situation Analysis Of The Elderly in India, June 2011, Ministry of Statistics & Programme Implementation, GOI
    83. 83. 4.National Policy on Older Persons (NPOP), 1999 Ref: National Policy on Older Persons (NPOP), 1999 Ministry of Social Justice & Empowerment, GOI
    84. 84. 4.National Policy on Older Persons (NPOP), 1999  Announced in January 1999 to reaffirm the commitment to ensure the well-being of the older persons.  Envisages State support to ensure – financial and food security, – health care, – shelter, – equitable share in development, – protection against abuse and exploitation, – availability of services to improve the quality of their lives Ref: National Policy on Older Persons (NPOP), 1999 Ministry of Social Justice & Empowerment, GOI
    85. 85. 4.National Policy on Older Persons (NPOP), 1999 Objectives:  To encourage individuals to make provision for their own as well as their spouse’s old age;  To encourage families to take care of their older family members;  To enable and support voluntary and non-governmental organizations to supplement the care provided by the family;  To provide care and protection to the vulnerable elderly people; Ref: National Policy on Older Persons (NPOP), 1999 Ministry of Social Justice & Empowerment, GOI
    86. 86. 4.National Policy on Older Persons (NPOP), 1999 Objectives:  To provide adequate healthcare facility to the elderly;  To promote research and training facilities to train geriatric care givers and organizers of services for the elderly;  To create awareness regarding elderly persons to help them lead productive and independent live. Ref: National Policy on Older Persons (NPOP), 1999 Ministry of Social Justice & Empowerment, GOI
    87. 87. 4.National Policy on Older Persons (NPOP), 1999 Implementation Strategy :  Preparation of Plan of Action for operationalisation of the National policy.  Setting up of separate Bureau for Older Persons in Ministry of Social Justice & Empowerment.  Three Yearly Public Review of implementation of policy. Ref: National Policy on Older Persons (NPOP), 1999 Ministry of Social Justice & Empowerment, GOI
    88. 88. 4.National Policy on Older Persons (NPOP), 1999 Implementation Strategy:  Setting up of a National Council for Older Persons  Establishment of Autonomous National Association of Older Persons  Encouraging the participation of local self-government Ref: National Policy on Older Persons (NPOP), 1999 Ministry of Social Justice & Empowerment, GOI
    89. 89. 5. National Council for Older Persons(NCOP)  Constituted in 1999  Under the Chairpersonship of the Minister for Social Justice & Empowerment to oversee implementation of the Policy  Highest body to advise the Government in the formulation and implementation of policy and programmes for the aged  Last re-constituted in 2005 with members comprising Central and State governments representatives, representatives of NGOs, citizen’s groups, retired person’s associations, and experts in the field of law, social welfare, and medicine  With a view to have a more definite structure, the Council was reconstituted and renamed as National Council for Senior Citizens (NCSrC) vide a Resolution dated 17.02.2012 to this effect which was published in the Gazette of India on 22.02.2012. Ref: Situation Analysis Of The Elderly in India, June 2011, Ministry of Statistics & Programme Implementation, GOI
    90. 90. 6.Inter-Ministerial Committee on Older Persons  Comprises of twenty-two Ministries/Departments,  Headed by the Secretary, Ministry of Social Justice & Empowerment  Another coordination mechanism in implementation of the NPOP.  Considers Action Plan on ageing issues for implementation by various Ministries/ Departments concerned, from time to time Ref: Situation Analysis Of The Elderly in India, June 2011, Ministry of Statistics & Programme Implementation, GOI
    91. 91. 7.Central Sector Scheme of Integrated Programme for Older Persons(IPOP)  Implemented since 1992  Objective of improving the quality of life of senior citizens by providing basic amenities like – shelter, – food, – medical care and – entertainment opportunities Ref: Situation Analysis Of The Elderly in India, June 2011, Ministry of Statistics & Programme Implementation, GOI
    92. 92. 7.Central Sector Scheme of Integrated Programme for Older Persons(IPOP)  Encouraging productive and active ageing through providing support for capacity building of Government/ Non- Governmental Organizations/Panchayati Raj Institutions/ local bodies and the Community at large.  Under the Scheme, financial assistance up to 90% of the project cost is provided to nongovernmental organizations for establishing and maintaining old age homes, day care centres and mobile medicare units Ref: Situation Analysis Of The Elderly in India, June 2011, Ministry of Statistics & Programme Implementation, GOI
    93. 93. 7.Central Sector Scheme of Integrated Programme for Older Persons(IPOP) Other projects for Financial Assistance under revised scheme from 2008: – Maintenance of Respite Care Homes; – Running of Day Care Centres for Alzheimer’s Disease Patients, – Physiotherapy Clinics for older persons; – Sensitizing programmes for children particularly in Schools & Colleges; – Training Centres of Caregivers to the older persons; – Awareness Generation Programmes for Older Persons & Care Givers; – Formation of Senior Citizens Associations etc Ref: Situation Analysis Of The Elderly in India, June 2011, Ministry of Statistics & Programme Implementation, GOI
    94. 94. 8.Schemes of Other Ministries I. Ministry of Health & Family Welfare – Separate queues for older persons in government hospitals. – Started Geriatric clinic in several Govt. hospitals – National Programme For Health Care Of The Elderly (NPHCE) Ref: Ministry of Health & Family Welfare, GOI
    95. 95. 8.Schemes of Other Ministries II. Ministry of Rural Development – Implementing Indira Gandhi National Old-age Pension Scheme. – For persons above 60 years belonging to a household below poverty line, – Central assistance @ Rs. 200/- per month, which is meant to be supplemented by at least an equal contribution by the States so that each beneficiary gets at least Rs.400/- per month as pension. Ref: Ministry of Rural Development, GOI
    96. 96. 8.Schemes of Other Ministries III. Ministry of Railways – Separate ticket counters for senior citizens of age 60 years and above at various (Passenger Reservation System) PRS centres – Provision of lower berth to male passengers of 60 years and above and female passengers of 45 years and above. – 40% and 50% concession in rail fare for male passengers aged 60years and above and female passengers aged 58 years and above respectively. – Wheel chairs at stations for old age passengers. Ref: Ministry of Railways, GOI
    97. 97. 8.Schemes of Other Ministries IV. Ministry of Civil Aviation – Air India provides concession up to 50% for male senior citizens of 65 years and above, and female senior citizens of 63 years and above in air fares. Ref: Ministry of Civil Aviation, GOI
    98. 98. 8.Schemes of Other Ministries V. Ministry of Finance – Income tax exemption for senior citizen of 65 years and above up to Rs. 2.50 lakh per annum. – Deduction of Rs 20,000 under Section 80D is allowed to an individual who pays medical insurance premium for his/ her parent or parents, who is a senior citizens of 65 years and above. – An individual is eligible for a deduction of the amount spent or Rs 60,000, whichever is less for medical treatment (specified diseases in Rule 11DD of the Income Tax Rules) of a dependent senior citizen of 65 years and above Ref: Union Budget 2012-13, Ministry of Finance, GOI
    99. 99. 8.Schemes of Other Ministries VI. Department of Pensions and Pensioner Grievances • A Pension Portal has been set up to enable senior citizens to get information regarding the status of their application, the amount of pension, documents required, if any, etc. • The Portal also provides for lodging of grievances. As per recommendation of the Sixth Pay Commission, additional pension to be provided to older persons Age Group % pension to be added 80+ 20 85+ 30 90+ 40 95+ 50 100+ 100
    100. 100. National Programme For Health Care Of The Elderly (NPHCE)
    101. 101. National Programme For Health Care Of The Elderly (NPHCE) NPHCE 2010
    102. 102. The Vision Ref: National Programme For Health Care Of The Elderly (NPHCE),Operational Guidelines, MOHFW, GOI To provide accessible, affordable, and high-quality long- term, comprehensive and dedicated care services to an Ageing population; Creating a new “architecture” for Ageing; To build a framework to create an enabling environment for “a Society for all Ages”; To promote the concept of Active and Healthy Ageing;
    103. 103. Objectives • Provision of dedicated health care facilities at various level of State health care delivery system with referral support • Human resource development in geriatric Health • Strengthening of preventive, promotive and rehabilitative services. • Promotion of Research in geriatric health care • Convergence with NRHM, AYUSH & all other dept. Ref: National Programme For Health Care Of The Elderly (NPHCE),Operational Guidelines, MOHFW, GOI
    104. 104. Strategies Core Strategies Community level - domiciliary visits by trained health care workers. PHC/CHC level - equipment, training, additional human resources (CHC), IEC, District Hospital - 10 bedded wards, additional human resources, 8 RMC - PG courses in Geriatric Medicine, and training IEC using mass media, folk media and other communication Ref: National Programme For Health Care Of The Elderly (NPHCE),Operational Guidelines, MOHFW, GOI
    105. 105. Supplementary Strategies Promotion of public private partnerships in Geriatric Health Care. Mainstreaming AYUSH and convergence with programmes of Ministry of Social Justice and Empowerment in the field of geriatrics. Reorienting medical education to support geriatric issues. Ref: National Programme For Health Care Of The Elderly (NPHCE),Operational Guidelines, MOHFW, GOI
    106. 106. Major Components: 1. Geriatric Department in 8 Regional Medical Institutions/ State Medical Colleges 2. Dedicated Health Care in 100 Districts(21 states)  Geriatric unit at District hospitals  Rehabilitation Units at CHCs  Weekly Geriatric Clinic at PHCs  Provision of supportive devices/equipments at Sub centers Ref: National Programme For Health Care Of The Elderly (NPHCE),Operational Guidelines, MOHFW, GOI
    107. 107. Operational Guidelines A. Package of Services at different levels B. Institutional framework for implementation C. Management Structure D. Activities at various levels Ref: National Programme For Health Care Of The Elderly (NPHCE),Operational Guidelines, MOHFW, GOI
    108. 108. A. Package of Services Health promotion Preventive service Diagnosis & management Day care services Rehabilitative services Home based care Ref: National Programme For Health Care Of The Elderly (NPHCE),Operational Guidelines, MOHFW, GOI
    109. 109. A. Package of Services Organizational Structure: Ref: National Programme For Health Care Of The Elderly (NPHCE),Operational Guidelines, MOHFW, GOI
    110. 110. B. Institutional Framework for the Implementation of NPHCE Funds from Government of India (80%) State Health Society District Health Society (NCD Cell) CHC / PHC /SC State Level Activity District Level Activity Funding for Program: Ref: National Programme For Health Care Of The Elderly (NPHCE),Operational Guidelines, MOHFW, GOI
    111. 111. B. Institutional Framework for the Implementation of NPHCE State Health Society (SHS): Under the NRHM framework different Societies of national programmes such as RCH, Malaria, TB, Leprosy, NBCP have been merged into a common State Health Society. – Chairperson- Chief Secretary/Development commissioner – Vice chair person -Principal Secretary (H&FW) – Mission director - Member –Secretary of SHS Ref: National Programme For Health Care Of The Elderly (NPHCE),Operational Guidelines, MOHFW, GOI
    112. 112. B. Institutional Framework for the Implementation of NPHCE District Health Society (DHS):  All programme societies have been merged into the District Health Society (DHS).  The Governing Body – Chairperson - Chairman of the Zilla Parishad. – Member -Secretary - DHO  The Executive Body – Chair person - District Collector – Member -Secretary - DHO. Ref: National Programme For Health Care Of The Elderly (NPHCE),Operational Guidelines, MOHFW, GOI
    113. 113. C. Management Structure National NCD Cell State NCD Cell District NCD Cell Ref: National Programme For Health Care Of The Elderly (NPHCE),Operational Guidelines, MOHFW, GOI
    114. 114. C. Management Structure National NCD Cell:  The NCD Cell constituted at the central level for planning, monitoring and implementation of the National Programme for Prevention and Control of Cancer, Diabetes, CVD and Stroke (NPCDCS) will also be responsible for NPHCE. Main functions:  MOU with the States/UTs.  Preparation and dissemination of operational guidelines.  Plan for capacity building of health functionaries.  Monitoring and review of programme activities at each level.  Release of funds and monitoring of expenditure under NPHCE Ref: National Programme For Health Care Of The Elderly (NPHCE),Operational Guidelines, MOHFW, GOI
    115. 115. C. Management Structure 20% of the total expenditure Provision of land Support of lab services Additional support for medicines Maintenance of equipments, wards and OPD Ref: National Programme For Health Care Of The Elderly (NPHCE),Operational Guidelines, MOHFW, GOI State contribution:
    116. 116. C. Management Structure State Programme Officer Programme Assistant Finance cum Logistics Officer Data Entry Operators (2) Ref: National Programme For Health Care Of The Elderly (NPHCE),Operational Guidelines, MOHFW, GOI State NCD Cell: Composition: State NCD Cell will be supported by following contractual staff:
    117. 117. C. Management Structure State NCD Cell: Role and responsibilities of the State NCD Cell: Preparation of State action plan for implementation. Organize State & district level trainings for capacity building Liaison with Regional Geriatric Centre for tertiary Care, Training & Research. Monitoring of the programme Ref: National Programme For Health Care Of The Elderly (NPHCE),Operational Guidelines, MOHFW, GOI
    118. 118. C. Management Structure District Programme Officer Programme Assistant Finance cum Logistics Officer Data Entry Operators Ref: National Programme For Health Care Of The Elderly (NPHCE),Operational Guidelines, MOHFW, GOI District NCD Cell: Composition: District NCD Cell will be supported by following contractual staff:
    119. 119. C. Management Structure District NCD Cell: Role and responsibilities of the District NCD Cell:  Preparation of District action plan.  Engage contractual personnel sanctioned for various facilities in the district  Maintain fund flow  Convergence with NRHM activities & Other Depts.  Ensure availability of rehabilitative services for the Elderly. Ref: National Programme For Health Care Of The Elderly (NPHCE),Operational Guidelines, MOHFW, GOI
    120. 120. D.Activities under NPHCE at Various levels At Sub Centre level:  Provision of walking sticks, calipers & other supportive equipments to the needy elderly  Information on healthy diet, yoga, and life style diseases through charts, pamphlets  Domiciliary visit to the house of elderly by ANM/ Male worker and maintenance of record  Arrangement of ambulance for disabled bed ridden elderly for referral to PHC/CHC. Ref: National Programme For Health Care Of The Elderly (NPHCE),Operational Guidelines, MOHFW, GOI
    121. 121. D.Activities under NPHCE at Various levels At PHC level: The weekly geriatric clinic. Coordination with CHC, district hospital, sub centers, other National Health Programmes/ Departments for medicines, ambulances Training of manpower & Separate registration counter for elderly.  Public awareness during health and village sanitation day/camps.  Provision of medicine to the elderly for their medical ailments. Ref: National Programme For Health Care Of The Elderly (NPHCE),Operational Guidelines, MOHFW, GOI
    122. 122. D.Activities under NPHCE at Various levels At PHC level: Following items will be made available at the PHC: • Nebulizer • Glucometer • Shoulder Wheel • Walker (ordinary) • Cervical traction (manual) • Exercise Bicycle • Lumbar Traction • Gait Training Apparatus • Infrared Lamp etc. . Ref: National Programme For Health Care Of The Elderly (NPHCE),Operational Guidelines, MOHFW, GOI
    123. 123. D.Activities under NPHCE at Various levels At RH/CHC level:  First level referral centre for medical care and rehabilitation services  Twice weekly health clinics for the elderly persons  Rehabilitation unit  Domiciliary visits for disabled persons by Multi rehabilitation worker  Referral Services to DH /RGC Ref: National Programme For Health Care Of The Elderly (NPHCE),Operational Guidelines, MOHFW, GOI
    124. 124. D.Activities under NPHCE at Various levels At RH/CHC level: Following additional items will be made available at the CHC: • ECG Machine • Pulse Oximeter • Defibrillator • Multi - Channel Monitor • Shortwave Diathermy • Cervical traction (intermittent) • Walking for gait training equipment • Walking Sticks • Pulley Ref: National Programme For Health Care Of The Elderly (NPHCE),Operational Guidelines, MOHFW, GOI
    125. 125. D.Activities under NPHCE at Various levels At District Hospital level:  Regular Geriatric OPD with Specialty Care for Elderly.  Geriatric Ward (10-bedded) for in-patient care to the Elderly.  Training to the Medical officers and paramedical staff of CHC’s and PHC’s  Camps for Geriatric Services in PHCs/CHCs and other sites  Referral services for severe cases to tertiary level hospitals/ Regional Geriatric Centers Ref: National Programme For Health Care Of The Elderly (NPHCE),Operational Guidelines, MOHFW, GOI
    126. 126. D.Activities under NPHCE at Various levels At District Hospital level: Following additional items will be made available at the District Hospital: • Multi-channel Monitor • Non invasive Ventilator • Ultrasound Therapy • Pelvic traction (intermittent) • Trans electric Nerve stimulator (TENS) • Adjustable Walker. Ref: National Programme For Health Care Of The Elderly (NPHCE),Operational Guidelines, MOHFW, GOI
    127. 127. D.Activities under NPHCE at Various levels At Regional Geriatric Centers level:  Provide tertiary level services for complicated/serious Geriatric Cases.  Post graduate courses in Geriatric Medicine.  Training to the trainers of identified District hospitals and Medical Colleges.  Specialized OPDs in all the specialties available with them for the benefit of the Elderly30 bedded geriatrics ward Ref: National Programme For Health Care Of The Elderly (NPHCE),Operational Guidelines, MOHFW, GOI
    128. 128. D.Activities under NPHCE at Various levels At Regional Geriatric Centers level: Following additional items will be made available at the RGC: • Interferential therapy for pain • Continuous passive Motion units for Shoulder • Knee Modular monitor • Aero beds, Non-invasive ventilator • Invasive ventilator • Emergency trolleys (with multichannel monitors) • Portable X-ray unit, Portable ultrasound • Provision of Video conferencing unit Ref: National Programme For Health Care Of The Elderly (NPHCE),Operational Guidelines, MOHFW, GOI
    129. 129. Regional Geriatrics Centers Sr No Regional Institutes States Linked 1 All India Institute of Medical Sciences, New Delhi Delhi, Haryana, Uttarakhand, Punjab Himachal Pradesh, M.P. 2 Institute of Medical Sciences, Banaras Hindu University, Uttar Pradesh Uttar Pradesh, Bihar, Jharkhand, West Bengal 3 Grant Medical College & JJ Hospital, Mumbai, Maharashtra, Maharashtra, Goa, Northern Districts of Karnataka,Chattisgarh 4 Sher-e-Kashmir Institute of Medical Sciences, Srinagar, Jammu & Kashmir Jammu & Kashmir 5 Govt. Medical College, Tiruvananthapuram, Kerala, Kerala, Southern Districts of Karnataka & Tamil Nadu 6 Guwahati Medical College, Guwahati, Assam Assam & NE States 7 Madras Medical College, Chennai, TN. Tamil Nadu, Andhra Pradesh, Orissa 8 SN Medical College, Jodhpur, Rajasthan Rajasthan & Gujarat
    130. 130. Developing Geriatric Department in Medical college of each States/UTs It is proposed to develop 12 additional Regional Geriatric Centers in selected Medical Colleges of the country 132 Sr No State Medical College 1 Punjab PGIMER, Chandigarh 2 Uttar Pradesh KGIMS, Lucknow 3 Jharkhand Ranchi Medical College, Ranchi 4 West Bengal Kolkatta Medical College, Kolkata 5 Andhra Pradesh Nizam Institute of Medical Sciences, Hyd. 6 Karnataka Bangalore Medical College, Bangluru 7 Gujarat B.J.Medical College, Ahmadabad 8 Maharashtra Government Medical College, Nagpur 9 Orissa S.C.B.Medical College, Cuttack 10 Tripura Agartala Medical College, Agartala 11 Madhya Pradesh Gandhi Medical College, Bhopal 12 Bihar Patna Medical College, Patna
    131. 131. Phasing of physical targets Physical target 2010-2011 2011-2012 Establishment of Geriatric Department at 8 Regional Inst. 8 Regional Inst. Construction & Manpower deployment etc. Fully functional Geriatric Dept in 8 Regional Inst. Setting up of Geriatrics Unit at 100 District Hospitals 30 Districts Construction and equipment & Manpower deployment etc 30 Districts Fully functional Geriatric Unit 70 Districts Construction and equipment -Manpower deployment
    132. 132. Identified States and 30 districts (2010-11) States Districts Andhra Pr. Nellore, Vijayanagram Assam Dibrugarh, Jorhat Bihar Vaishali, Rohtas CH Bilaspur Gujarat Gandhi Nagar, Surendranagar Haryana Mewat HP Chamba J&K Leh, Udhampur Jharkhand Bokaro Karnataka Shimoga, Kolar Kerala Pathanathitta States Districts Madhya Pr. Ratlam Maharashtra Washim, Wardha Sikkim East Sikkim Orissa Naupada Punjab Bhatinda Rajasthan Bhilwara, Jaisalmer Uttrakhand Nainital Tamil Nadu Theni Uttar Pr. Rae Bareli, Sultanpur West Bengal Darjeeling
    133. 133. 70 districts added in 2011-12 States Districts Andhra Pr. Srikakulam, Chittoor, Cuddapah, Krishna, Kurnool, Prakasham Assam Lakhimpur, Sibsagar, Kamrup Bihar Muzaffarpur, Paschim Champaran, Poorva Champaran, Keimur CH Jashpur Nagar, Raipur Gujarat Rajkot, Jam Nagar, Porbandar, Junagarh Haryana Yamuna Nagar, Kurukshetra , Ambala HP Lahaul & Spiti , Kinnaur J&K Kupwara, Doda (Erstwhile), Kargil Jharkhand Ranchi, Dhanbad Karnataka Udupi, Tumkur, Chikmagalur Kerala Kozikode (Calicut), Allappuzha, Idukki , Thrishur States Districts Madhya Pr. Hoshangabad, Chindwara, Jhabua , Dhar Maharashtra Gadchiroli, Bhandara, Chandrapur, Amaravati Sikkim South Sikkim Orissa Balangir, Nabrangpur, Koraput, Malkangiri Punjab Gurdaspur, Hoshiarpur Rajasthan Jodhpur, Ganga Nagar, Bikaner, Barmer, Nagaur Uttrakhand Almora Tamil Nadu Coimbatore, Virudhnagar, Toothukudi, Tirunelveli Uttar Pr. Jhansi, Lakhimpur Kheri, Farookhabad, Firozabad, Etawah, Lalitpur, Jalaun West Bengal Jalpaiguri, Dakshin Dinajpur
    134. 134. Proposed Monitoring Strategy  Integrated monitoring by NCD Cells at centre , States, districts and CHCs.  Monthly Progress Report to be submitted by NCD cells.  Half yearly progress review meeting for assessing the status of implementation of the programme activities.  Yearly Combined field visit by Central and State Cells for on the spot assessment of progress of the activities. Ref: National Programme For Health Care Of The Elderly (NPHCE),Operational Guidelines, MOHFW, GOI
    135. 135. Achievements  Developed operational guidelines  1st installment released to 27districts in 2010-11 and 48 districts in 2011-12  1st installment released to all the 8 RMI  MOU signed with – 18 States  Submitted 12th plan proposal- all the States/districts proposed to be covered Ref: Two years (2009-2011) Achievements and New Initiatives. , Ministry of Health and Family Welfare, GOI
    136. 136. Achievements Release of Funds: Year No. of districts Amount released (crore) No. of RMI Amount released (crore) 2010-11 27 60 4 41.15 2011-12 48 75 4 30.31 Total 75 135 8 71.46
    137. 137. Issues for consideration  Create awareness among policy makers & programme officers  Training of manpower  Utilization of released Budget  Monitoring & Maintenance of database
    138. 138. NGOs
    139. 139. NGOs for Older Persons in India  HelpAge India  Agewell Foundation  Maitri  GiveIndia  India Sponser
    140. 140. HelpAge India - 33 offices across India. Mission:  HelpAge India's mission is to work for the cause and care of disadvantaged Older Persons, in order to improve the quality of their lives. Objectives : • To foster the welfare of the aged in India especially the needy aged • To raise funds for projects which assist the elderly irrespective of cast or creed • To create in the younger generation and in society an awareness about the problems of the elderly in India today
    141. 141. HelpAge India Activities: • Focuses on – improved access to health and – eye care facilities, – community-based services, and – livelihood support for the elderly. – Support-A-Grandparent scheme. • Acts as the voice of the elderly and promotes their cause with the central and state governments. • Endeavors to influence decision-makers to formulate policy that is beneficial to the elderly.
    142. 142. NGOS for Older Persons in Pune • Adhar Sevavrat Old Age Home • Apala Ghar Old Age Home • Apulaki Vriddhashram • Arpan Old Age Home • Goldage Ashram & Hospital • Janseva Foundation Destitute Rehabilitation Centre • Jiwhala Vriddhashram • Matoshri Vriddhashram • Niwara • Olava Senior Citizens Home • Pitashri-old Age Home • Sahjeevan Ashram • Sankalp Sevadham • Savali • Tapodham • Umed Care Centre For Old Age • Vanaprastha Ashram
    143. 143. NIWARA  Niwara means ‘loving home’  Founded on 9th of August 1863, by visionaries & eminent citizens of Pune • ‘Niwara’ – David Sasoon Anath Pangu Gruha Charitable Trust devoted wholly & entirely to the welfare of old men & women, who – do not have near relatives like spouse, son/daughter, – have no home to live in & – have no source of livelihood.  ie. offers home to the real destitutes in the society  Take care of inmates till the end of journey; the Vaikuntha crematorium ironically enough, just beyond the boundary walls!
    144. 144. NIWARA Objectives of the trust : 1) To provide shelter, conducive food, clothes, bed, medicines & other facilities to elderly men & women 2) To extend co-operation to like minded institutions in pune or outside 3) To arrange entertainment programs for the inmates and to arrange for their orientation and training so that their inherent capacities and qualities are fastened and enhanced. 4) To make efforts for rehabilitating the inmates among their relatives if possible 5) To undertake training and consultative programs for the elderly. 6) To arrange and monitor studies and research regarding the issues of the old men and women.
    145. 145. NIWARA Current No. of Inmates: 43 male & 84 female Facilities:  Rehabilitation centre  Physiotherapy  Homeopathy clinic  Gymnasium  Meeting Hall Activities:  Festivals  Trips & Excursions  Entertainment
    146. 146. REFERENCES • National Program for Health Care of the Elderly (NPHCE) : Towards active and healthy ageing. Operational Guidelines. Director General of Health Services, MOHFW, Government of India. • Situation Analysis of The Elderly In India, June 2011. Central Statistics Office, Ministry of Statistics & Programme Implementation, Government of India • Rajan SI. Population ageing and health in India. The Centre for Enquiry into Health and Allied Themes (CEHAT), Mumbai. July 2006. • National Policy on Older Persons (1999). Ministry of Social Justice and Empowerment, Government of India, Shastri Bhawan, New Delhi. • Maintenance and Welfare of Parents and Senior Citizens Act – 2007, Ministry of Social Justice and empowerment Government of India • Morbidity, Health care and the Condition of the aged. NSSO (64th round)Jan-June 2004, National Sample Survey Organization, Ministry of Statistics and Programme Implementation, Government of India, March 2006.
    147. 147. • Two years (2009-2011) Achievements and New Initiatives. NRHM, Ministry of Health and Family Welfare, Government of India. • Ingle GK, Nath A. Geriatric Health in India: Concerns and Solutions. Indian J Comm Med, 2008; 33 (4); 214-18. • Prevention & Control of Non-Communicable Diseases (NCDs): Proposal for the 12th Plan, Report of the Working Group on Disease Burden: Non-Communicable Disease (NCDs), Director General of Health Services, MOHFW, Government of India. • Planning Commission. 11th five year plan (Draft), Government of India; http://www.planningcommission.nic.in
    148. 148. Thank you!

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