Geriatric health needs and gaps


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Geriatric health needs and gaps

  1. 1. Geriatric Health in IndiaNeeds and Gaps Dr. Bireshwar Sinha Moderator: Dr. SK Rasania Facilitator: Dr. Niraj Roy
  2. 2. Plan of presentation • • • • Definition of elderly Demography : geriatric population Socio-economic profile of the elderly Health issues: to be addressed – – – – – Social issues Psycho-emotional aspects Financial issues Issues related to health care system Medical problems • Need for dedicated health programmes in the elderly and the major constraints
  3. 3. Plan of presentation • Major Govt. initiatives for elderly • Other schemes and benefits • Strategies & Recommendations: to fill the gaps related to geriatric health • Conclusion • References
  4. 4. Definition of elderly • According to WHO ,most developed countries have accepted the chronological age of 65 years and above as a definition of 'elderly' or older persons. • According to UN : 60+ years will be referred as the older population or elderly. • In India ,"senior citizen" means any person being a citizen of India, who has attained the age of sixty years or above* * National Policy for Older Persons Year 1999 .Ministry of Social Justice and Empowerment.GOI.
  5. 5. Definition of elderly (cont..) 1. Age group 60-69 years -Young old or 'not so old' 2. Age group 70-79years -Old old 3. Age group 80 years and over -'older old' or 'very old' category  The medical study of the ageing process is called gerontology  The study of diseases that afflict the elderly is geriatrics National Policy for Older Persons Year 1999 .Ministry of Social Justice and Empowerment.GOI.
  6. 6. Demography: Geriatric population • Advances in medicine have increased the life expectancy resulting in an increase in the geriatric population and their proportion will only continue to rise in the coming years. • Globally, elderly constitute 11% of total population (United Nations Population Division report, 2010) • In India : adults over 60 years constitute 8 percent of total.(census 2011) • In the years 2000-2050, the overall population in India will grow by 55%, whereas population growth of elderly people above 60 years - 326% and those in the age group of 80+ by 700%,- the fastest growing group. [World population aging: 1950-2050.United Nations: Population Division, Department of Economic and Social Affairs, United Nations 2002]
  7. 7. Demography: Geriatric population (contd..) Situation Analysis of The Elderly in India, 2011.Central Statistics Office,Ministry of Statistics & Programme Implementation,Government of India
  8. 8. States with more than 8% elderly population ( SRS 2010) India : elderly population constitute 8 percent of total.
  9. 9. Proportion of Elderly aged 60 yrs and above in India Geriatric population (millions) 350 300 300.96 (20%) 250 236 Geriatric population(millions) 200 178.59 150 133.2 100 96.3 77.1 50 24.71 43.17 (8.2%) 56.68 0 1961 1981 1991 2001 2011 2021 2031 2041 2051
  10. 10. Socio-economic profile of the elderly in India. 75% Elderly persons lives in rural area. 48% Women 73% Illiterate and dependent on physical labor 66% BPL; vulnerable situation and without sufficient food. 90% Unorganized sector: irregular income; no pension Source : Census 2001 & NSSO,2004
  11. 11. Socio- economic profile (contd..) • Feminization of the elderly population (currently 48.2% are women, out of whom 55% are widows; and by 2016 they will constitute 51% of the elderly population.)  The sex ratio among elderly people was 1028 in 1951 but reached 972 in 2001.  Life expectancy (at birth) for women is 67.57 yrs as against 65.46 yrs for men. Life expectancy at age 60 was found to be about 18 years (16.7 for males, 18.9 for females) • Increase in the number of the “older-old” (above 80 years)
  12. 12. Health issues of the elderly- Needs to be addressed • Health problems in the elderly cannot be seen in isolation. • Wide gamut of social, psycho-emotional and financial correlates determine the medical problems - Needs to be addressed.
  13. 13. Social issues • As industrialization progresses- children move out and take up the vocation in other places the problems of isolation and lack of physical support of the old parents.  Disintegration of joint family support systems. • Societal modernization - elderly abuse leading to a host of psychological illnesses. • Lack of social security and inadequate facilities for health care, rehabilitation, and recreation.
  14. 14. Psycho-Emotional Aspects • • • • • • One of the Spouses may pass away Friend circle gets restricted Retirement - worsens isolation Negligence by younger generation the old persons find it difficult to keep themselves occupied. This complex interplay: – increase the risk of mental stress – also aggravate the impact of stress related diseases as IHD and hypertension.
  15. 15. Financial Issues • Old Dependency Ratio: increasing over time. Currently : every 8 working individuals have to take care of 1 elderly but by 2050 every 3 have to take care of 1 elderly.
  16. 16. Financial Issues (contd..) • 70% of the elderly women and 30% of the elderly men are totally dependant on others economically. • Inadequate financial savings or pension plans- 90% of the working individuals are not covered under any old-age income security plan. • Pension and social security is restricted to those who worked in the public / organized sector of industry. • Urbanization, migration – further economic insecurity for the elderly.
  17. 17. Issues Related to Health care System • The current health care system lacks adequate number of trained medical, paramedical personnel in geriatric medicine - adversely affect the health care of the elderly. • Mobile health services for the elderly and ambulance services are limited in the rural & peripheral areas making the health care facilities difficult to reach. • Not a very effective health insurance system in our country. • At present, most of the geriatric OPD services are available at tertiary care hospitals and are urban based. At the primary care level, the infrastructure is grossly deficient. • Low awareness regarding the services available.
  18. 18. Medical Problems of the Elderly • The burden of morbidity in old age is enormous. • Non-communicable diseases (life style related and degenerative) are extremely common in elderly irrespective of SE status. • In population over 70 years, ≥50% suffer from one or more chronic conditions- hypertension, coronary heart disease, cancer & joint problems. [Reddy PH. The health of the aged in India. Health Transit Rev. 2006;6:233–44.] • The treatment/ management of these chronic diseases is also expensive (e.g. cancer treatment, joint replacements, heart surgery). • Decline in immunity as well as age-related physiologic changes leads to an increased burden of communicable diseases in the elderly. (e.g. TB)
  19. 19. • Disabilities are very frequent which affect the functionality in old age compromising the ability to pursue the activities of daily living. • Among the elderly, 10% suffer from impaired physical mobility and 10% are hospitalized at any given time, both proportions rising with increasing age. [Reddy PH. The health of the aged in India. Health Transit Rev. 2006;6:233–44] • Over 10% of India’s elderly suffers from depression and 4050% requires psychiatric or psychological intervention at some point in their twilight years- due to ageing of the brain, socio-economic factors such as breakdown of the family support systems, and decrease in economic independence.
  20. 20. Health Problems Important for Both Genders • • • • • • • • • • • • • Ocular Diseases: Cataract, Glaucoma, Presbyopia Reduced Muscular Strength and Coordination Accidents and Injuries Cardiovascular Diseases: IHD, Stroke and Hypertension Chronic respiratory illness: COPD, Asthma, bronchitis Mental problems: dementia, depression and mood disorders. Complication of Diabetes Cancers : Oral, gastric, lung and colorectal cancers Nutritional Deficiencies Dental Problems Hearing Defects Increased Susceptibility to Infections : RTI, UTI Degenerative Neurological Diseases: Alzheimer’s disease and Parkinsonism
  21. 21. Problems which mainly affect the Elderly Male • Benign Prostatic Hypertrophy (BPH) • Prostatic Cancer • Male Sexual Dysfunction : libido, erectile or ejaculation problems.
  22. 22. Problems mainly concerning Elderly Females • Menopausal Problems: Atrophic vaginitis, Dysparuenia, Pruritis vulvae, hot flushes • Urinary Incontinence • Cancers and Other Disease of Female Genital Tract : breast, uterine (endometrial), ovarian, cervical cancers, Prolapsed uterus. • Osteoporosis: Osteoporosis occurs in both sexes (Type-II Osteoporosis) but the incidence as well as the impact is much higher among females especially after menopause (Type-I osteoporosis). -Weight of <58 kg may indicate risk. -In fact, a rough guide is to calculate an index as {0.2 X (Body weight in Kg - Age in years)}; if the result is less than 2, the same indicates increased risk.
  23. 23. COMMON MORBIDITIES IN ELDERLY IN INDIA Cataract &Visual impairment- 88% Arthritis & locomotion disorder-40% CVD &HT – 18% Neurological problems- 18% Respiratory problems including Chronic bronchitis- 16% GIT problems 9% ICMR report- survey 1984-85 Psychiat ric problem s- 9% 23
  24. 24. Number of persons aged 60 years and above reporting a chronic disease (per 1,000 persons) NSSO, 2004
  25. 25. Number of disabled per 100,000 elderly persons for different types of disability NSSO, 2004
  26. 26. Need for Dedicated Health care programme for elderly Decrease in physical ability / Economic inadequacy Increase vulnerability to diseases Chronic, disabling and multiple Health problems Different approach and management Degradation in family values Rising Population
  27. 27. Major constraints for geriatric health care Lack of specialized and trained manpower No dedicated health care infrastructure Geriatrics not yet a popular specialty 27
  28. 28. Major Govt. initiatives National Policy On Older Persons (NPOP) -1999 Recommendations by working group of planning commission -2006 for national programme Maintenance and Welfare of Parents and Senior Citizens Act – 2007 Announcement of National programme for Health Care of Elderly during Budget speech (2008-09) Approval of “National programme for Health Care of Elderly” by Ministry of Finance - June 2010 28
  29. 29. GOVT. STRATEGIES FOR ELDERLY Ministry of Social Justice & Empowerment National Policy on Older Persons (NPOP), 1999 The Policy 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.
  30. 30. Maintenance and Welfare of Parents and Senior Citizens Act, 2007 • A senior citizen including parent who is unable to maintain himself from his own earning or property owned by him, then it is an obligation of the children or relative, to maintain his needs so that he / she may lead a normal life. • If children or relatives, neglect or refuse- Tribunal may order them to make a monthly allowance which shall not exceed 10,000/month. • Establishment of old age homes- one must accommodate minimum of 150 senior citizens. • Separate beds for elderly in all Govt. hospitals. • Separate queue for the elderly in hospitals. • Treatment facilities for chronic degenerative diseases & research
  32. 32. Ministry of Health & Family Welfare National Programme for the Health Care of Elderly (NPHCE)-2010 Objectives • Easy access to promotional, preventive, curative and rehabilitative services - through community based primary health care approach. • Identify health problems - provide appropriate health interventions in the community & strong referral support. • Capacity building- medical and paramedical professionals; the care-takers within the family for providing health care. • Referral services through district hospitals, regional medical institutions
  33. 33. Strategies for NPHCE 2010 PHC/CHC level equipment, traini ng, additional human resources (CHC), IEC, Community level - domiciliary visits by trained health care workers. District Hospital 10 bedded wards, additional human resources, Core Strategies 8 RMC - PG courses in Geriatric Medicine, and training IEC using mass media, folk media and other communication 33
  34. 34. Supplementary Strategies for NPHCE 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. 34
  35. 35. 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 35
  36. 36. Schemes under other Ministries Ministry of Railways • Separate ticket counters for senior citizens at various (Passenger Reservation System) PRS centres if the average demand per shift is more than 120 tickets • Concession in rail fare for male-30% and female-50% Ministry of Civil Aviation Air India provides concession up to 50% - male (65 years and above) - female ( 63 years and above) in air fares.
  37. 37. Ministry of Finance Some of the facilities for senior citizens of 65 years and above • Income tax exemption up to Rs. 2.40 lakh per annum. •Deduction of Rs 20,000 (Section 80D) is allowed to an individual who pays medical insurance premium for his/ her parent or parents, who is a senior citizen. •An individual is eligible for a deduction of the amount spent or Rs 60,000, whichever is less for medical treatment of a dependent senior citizen . • Extra 0.5% interest for the elderly on fixed deposit.
  38. 38. Privileges and Benefits Annapurna Scheme  Launched 2000-2001  By Ministry of Rural Development  10 kgs of food grains per month is provided free of cost to the person >65 yrs but not getting pension under IGNOAPS  4,66,286 beneficiaries-in year 2011-2012 Indira Gandhi National Old Age Pension Scheme (IGNOAPS)  Launched in 2007  Beneficiaries: ≥ 60 years and belonging to BPL family  Pension amount : Rs 400 (Rs 200 from central and 200 from state govt.)
  39. 39. Strategies & Recommendations to fill the Gaps in Geriatric health Geriatric care – as a part of primary health services • Care at rural areas should be strengthened. • Training of Medical Officers, Peripheral health workers & volunteers • Screening camps & mobile clinics for reaching out to the elderly population- particularly focussing on NCD’s and chronic diseases of the elderly. • Involve NGO’s particularly in difficult to reach areas. • Conduct a comprehensive baseline morbidity survey- Ensure good quality geriatric health care services according to felt needs in the area concerned.
  40. 40. Strategies & Recommendations Primary health services (contd..) • “Community Geriatric Health Workers” may be trained to provide home care to the disabled elderly population. (e.g. community based project in Cochin, known as “Urban Community Dementia Services”) • Employment of a trained female medical officer to address the increasing health problems of elderly women. • Strengthening the elderly in the process of self-help by means of physical, psychosocial, and vocational rehabilitation • Capacity building of the community leaders
  41. 41. Strategies & Recommendations Strengthen secondary level health facilities • Set up geriatric wards • Distinct OPD services providing screening services as well as curative and rehabilitative services At the tertiary care level • Set up a comprehensive multidisciplinary team- providing specialist services. • Separate facility: Everything under one roof
  42. 42. Strategies & Recommendations Prevention of health problems • Geriatric health problems must be addressed at all three levels of prevention. • Health promotion measures (such as avoidance of alcohol and smoking, physical activity, immunization for influenza, tetanus, and injury prevention); • screening for noncommunicable diseases, such as diabetes, hypertensions, cancers, psychiatric disorders, nutritional anemia, and tuberculosis; • rehabilitation: visual aids/mobility aids , physiotherapy
  43. 43. Strategies & Recommendations • Focus on vulnerable groups - Below Poverty Line or other marginalized sections of the society. • Professional training in Geriatrics and Gerontology needs to be promoted – gross lack of expertise in the field. • Economic security: At the national level, mixture of pension schemes and social security schemes can help to the elderly.  Review BPL categorisation  Improve present allocations in Social Pensions (NOAPS)  Age Limit for Annapurna to be made 60 years and not 65 years.  Strict implementation of “Maintenance and Welfare of Parents and Senior Citizens Act, 2007”
  44. 44. Strategies & Recommendations • Role of Media : Make the people aware about the problems and services available. and create of positive perception of the senior citizens in the society. • Research in Geriatrics and Gerontology: common chronic and neuro-degenerative disorders like Alzheimer's disease, the process of ageing, pharmacokinetics and pharmacodynamics of drugs, health system research and research in alternative medicine.
  45. 45. Conclusion • The steady increase in life expectancy- as witnessed – actually a triumph brought about by advances in medical knowledge. • This current trend in demographics coupled with rapid urbanization and lifestyle changes have led to an emergence of a host of problems faced by the elderly in India. • Old age can’t be cured but we can prevent the health problems in the elderly by increasing the awareness and timely interventions. • Improving the quality-of-life of the elderly calls for a holistic approach and concerted efforts by the health and health-related sectors - the policy makers and health planners must be well prepared to face this challenge.
  46. 46. References • Bhalwar R. Textbook of Community Medicine.1st edition. Dept of Community Medicine, AFMC in collaboration with WHO; 2009 • Situation Analysis Of The Elderly in India. Central Statistics Office Ministry of Statistics & Programme Implementation. Government of India. 2011. • World population aging: 1950-2050. United Nations, New York: Population Division, Department of Economic and Social Affairs, United Nations 2002 • National Programme for the Health Care of Elderly. An Approach towards Active and Healthy Aging Directorate General Health Services, Ministry of Health and Family Welfare, Government of India; 2009. • National Sample Survey Organization (NSSO) 60 th Round. Report no. 507: Morbidity: Health Care and Condition of Aged; 2004. • GK Ingle, A Nath. Geriatric Health in India: Concerns and Solutions. Indian J Community Med. 2008 October; 33(4): 214–218.
  47. 47. • Prakash IJ . Ageing in India. World health organization. Geneva,1999. • Bhattacharya P. Implications of an Aging Population in India: Challenges and Opportunities. Society of Actuaries.2005. • Vibha, AR Laskar. Women’s Health- beyond reproductive years. Ind J of Public Health. Oct 2011;55(4):247-51 • Singh Z. Ageing: The triumph of humanity- are we prepared to face the challenge? Ind J of Public Health. July 2012; 56(3):189-95 • Reddy PH. The health of the aged in India. Health Transit Rev. 2006;6:233– 44.] • SI Rajan. Population ageing and health in India. The Centre for Enquiry into Health and Allied Themes (CEHAT), Mumbai. 2006 • K. Park. Textbook of Preventive and Social Medicine. 22nd edition. M/s Banarasidas Bhanot publishers.2013;10:549-51
  48. 48. “You do not heal old age. You protect it; promote it; extend it” Thank you