National Program for Healthcare of the Eldery (NPHCE)

1. Dr.V.Monisha

2. Elderly Day – 1st October

3. Elderly Population in India
• Is it Large ?
– Yes !
– 8% of 1.2 billion – more than 100 million (btw,
total population of Australia+NZ+UK = 89
million)
• Is it Growing ?
– Yes !
– Proportion of elderly in the Indian population is
rising, from 5.6% in 1961 to 12.71% in 2026
• Is it Healthy ?
– The Physical, mental and social wellbeing of the
elderly is interrupted with problems

4. Health Risks of Elderly
PRONE
FOR
INFECTIO
NS
PRONE
FOR
INJURIES
PRONE
FOR
PSYCHOL
OGICAL
PROBLEM
S
PRONE
FOR
DEGENE
RATIVE
DISORDE
RS
INCREASED
RISK FOR
DISEASE
INCREASED
RISK OF
DISABILITY
INCRASED
RISK OF
DEATH

5. Common Morbidities in Elderly
Cataract &Visual
impairment- 88%
Arthritis & locomotion
disorder-40%
CVD &HT – 18%
Neurological
problems- 18%
Respiratory
problems including
Chronic bronchitis-
16%
GIT pro
blems 9%
Psychiat
ric
problem
s- 9%

6. Skin Changes
• Skin becomes less elastic & dry
• Itching is common
 Dark yellow or brown colored spots (Senile
lentigines (Liver spots))
• Lines and wrinkles appear
• Nails become thick, tough, and brittle
• Increased sensitivity to temperature

7. Circulatory System Care
• High Blood Pressure
– Diet low in salt
– Decrease fat intake
– Exercise as recommended by physician

8. Respiratory Changes
• Respiratory muscles become weaker
• Changes may cause the elderly to
experience:
– Dyspnea
• Breathing increases in rate
• Increases susceptibility to infections such as
a cold or pneumonia

9. Respiratory Care
• Alternate activity with periods of rest
• Avoid polluted air
• May need continuous oxygen therapy
• Sleep

10. Nervous System Changes
• Blood flow to brain decreases & there is a
progressive loss of brain cells -- Interferes with
– Thinking - Reacting
– Interpreting - Remembering
• Senses of taste, smell, vision, & hearing are
diminished
• Nerve endings less sensitive
– Decreased ability to respond to pain and other stimuli
• Decrease in taste& smell frequently affects
appetite

11. Changes in Vision
– Problems reading small print
– Seeing objects at a distance
– Decrease in peripheral vision
– Decrease in night vision
– Increased sensitivity to glare
–Cataracts
–Glaucoma

12. Changes in Hearing
Hearing loss
Person may speak louder than usual
Ask for words to be repeated
Not hear high frequency sounds
May not hear well in crowded places

13. Digestive System
Changes
• Muscle action becomes slower &
peristalsis decreases
• Teeth are lost
• Liver function decreases
• Dysphagia is frequent complaint
• Slower digestion of food
• Indigestion
– Increase flatulence
– Constipation
• Decrease sensation of taste
– Poor appetite, Poor diet
Care
• Good oral hygiene
• Repair or replace
damaged teeth
• High-fiber high-
protein foods
• Increased fluid
intake

14. Urinary
Changes
• Kidneys decrease in size &
become less efficient
• Bladder becomes less efficient
– May not empty completely
Care
• Increase fluid intake

15. Endocrine System
Changes
• Increased production of some
hormones and decreased of
others
• Immune system less effective
• BMR decreases
• Intolerance to glucose
• Lose bone density
Care
• Proper exercise
• Adequate rest
• Medical care for illness
• Balanced diet
• Healthy lifestyle

16. Reproductive System
• Decrease of estrogen / progesterone in female
– Thinning of vaginal wall
– Decrease vaginal secretions
– Inflammation of vagina common
– Weakness in supporting tissue:
Uterine prolapse
Breasts sag when fat redistributed
• Decrease in Testosterone
– Slow production of sperm
– Response to sexual stimuli slower
– Testes smaller less firm

17. Psychosocial Changes
• Some individual cope with psychosocial changes, and
others experience extreme frustration and mental distress
• Fears of a sick person:
– Death
– Chronic illness
– Loss of function
– Pain
• Dealing with fears created by an illness:
– Listening
– Patience
– Understanding
– Provide support

18. Confusion & Disorientation
Signs:
– Talking incoherently
– Not knowing their name
– Not recognizing others
– Wandering aimlessly
– Lacking awareness of time or place
– Hallucinating
– Regressing in behavior
– Paying less attention to personal hygiene
– Inability to respond to simple commands or instructions

19. – Stress and/or depression
– Use of alcohol or chemicals
– Kidney disease
– Respiratory disease
– Liver disease
– Medication
• Diseases:
– CVA
– Arteriosclerosis
– Atherosclerosis
• Cause TIA’s ministrokes which result in temporary periods of
diminished blood flow to the brain.

20. Dementia
• Loss of mental ability characterized by a
decrease in intellectual ability, loss of memory,
impaired judgement, personality change, and
disorientation
• Acute dementia
– When the symptoms are caused by temporary reason:
• High fever, dehydration, hypoxia
• Chronic dementia
– When symptoms are caused by permanent,
irreversible damage to brain cells

21. Alzheimer’s Disease
Form of dementia that causes progressive changes in brain cells
Early Stages
• Memory loss
• Mood & personality changes
• Depression
• Poor judgment
• Confusion regarding time &
place
Middle Stages
• Night time restlessness
• Mood swings increase
• Personal hygiene ignored
• Weight fluctuates
• Paranoia & hallucinations
• Full time supervision
needed

22. Late Changes
• Total disorientation
• Incoherent
• Unable to communicate with words
• Loses control of bladder & bowel functions
• Develops seizures
• Loses weight despite eating a balanced diet
• Becomes totally dependent
• Lapses into a coma
• Dies

23. Care
• Provide a/an safe and secure environment, follow the
same routine, keep activities simple and last for short
periods of time.
• Avoid loud noises, crowded rooms, and excessive
commotion.
• Promote awareness of person, time, and place by
providing reality orientation (RO)
– Address person by name preferred
– Avoid: sweetie, baby, honey
– State your name, correct elderly if calls you by the wrong name
– Make reference to day, time, place
– Use clocks, calendars etc.

24. NPHCE
NPHCE 2010

25. Vision
• To provide accessible, affordable, and high-quality long-
term, comprehensive care to the ageing population.
• To build a framework to create an enabling environment for
"a society for old ages“.
• To promote the concept of Active and Healthy Ageing.
• Convergence with National Rural Health Mission, AYUSH
and other line departments like Ministry of Social Justice and
Empowerment

26. Objectives
• To provide an easy access to promotive, preventive,
curative and rehabilitative services to the elderly through
community based primary health care approach.
• To 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 institutions.

29. Organizational Structure

30. Packages of Services @ Subcentre
Level
• Health Education related to healthy ageing
• Domiciliary visits for attention and care to home bound / bedridden
elderly
• Arrange for suitable callipers and supportive devices from the PHC
• Linkage with other support groups and day care centres etc.
operational in the area

31. Packages of Services @ Primary
Health Centre Level
• Weekly geriatric clinic
• Maintain record using standard format
• Routine health assessment of the elderly
• Provision of medicines and advice on chronic ailments
• Public awareness on promotional, preventive and rehabilitative
aspects of geriatrics during health and village sanitation day/camps
• Referral for those needing further investigation and treatment to
Community Health Centre or the District Hospital

32. Packages of Services @
Community Health Centre Level
• First Referral Unit (FRU) for the Elderly from PHCs and below
• Geriatric Clinic for the elderly persons twice a week
• Rehabilitation Unit for physiotherapy and counselling
• Domiciliary visits by the rehabilitation worker for bed ridden elderly
and counselling of the family members on their home-based care
• Health promotion and Prevention
• Referral of difficult cases to District Hospital/higher health care
facility

33. Packages of Services @ District Level
• Geriatric Clinic for regular dedicated OPD services
• Facilities for laboratory investigations and provision of medicines for geriatric
health problems.
• Ten-bedded Geriatric Ward for in-patient care of the Elderly
• Existing specialities like General Medicine; Orthopaedics, Ophthalmology; ENT
services etc. will provide services needed by elderly patients.
• Provide services for elderly patients referred by the CHCs/PHCs
• Conducting camps for Geriatric Services in PHCs/CHCs and other sites
• Referral services for needy/ severe cases to tertiary level hospitals

34. Responsibilities of CHOs
• Undertake comprehensive geriatric assessment twice a year
• Providing immediate/primary management of common ailments of
elderly and referring to MO at PHC or conducting teleconsultaion
services and manage as per MO-PHC instructions.
• Develop and administer a personalised care plan for each elderly
identified in the community in consultation with MO-PHC.
• Facilitate identification and provide guidance to care givers
regarding care given to bed bound elderly.

35. Things to note
• Develop elderly support groups named “sanjeevini”
• Conduct periodic home visit to bedbound elderly, sick elderly and
restricted mobile elderly.
• Undertake preliminary assessment for the need of assistive devices-
support, rehabilitative service for elderly.