Class presentation at Pokhara University, MPH course

1. Presenters: Sampada
Dhakal
Pratikshya Kisiju
MPH 1st Semester, 2021
Pokhara University
PUBLIC HEALTH
CONCERNS
OF THE ELDERLY
PC: NepaliTimes

2. Introduction & Related terminologies
 Ageing: ‘Age-dependent & age-progressive decline in intrinsic
physiological function leading to increase in age specific mortality
& decrease in age specific reproductive rate.’
 Active-ageing: ‘Process of optimizing opportunities for health,
participation and security to enhance quality of life as people age.’
 Gerontology: ‘Study of the physical and psychological changes
incident to old age.’
 Geriatrics or Clinical Gerontology: ‘Care of the aged’
 Preventive Geriatrics: ‘Art and science of preventing disease in
the geriatric population and promoting their health and efficiency.’

3. Classification
WHO Classification of the Elderly individuals (on basis of
chronological age)
Elderly: 60 - 75 years
Old: 76 - 90 years
Very Old: > 91 years

4. Gender
Perspectiv
e
Global &
Ecological
Perspective
Public Health
Perspective
Genetic
Perspective
Socio-
economic &
Cultural
Determinant
s
AGEING
Life
Course
Environment
al Influences
Disease
Experience
Health and
Well-Being
of Olds

6. Global/Regional Scenario of Ageing
 Globally, over 962 million people aged 60 years or over in 2017;
projected to more than double by 2050 to reach nearly 2.1 billion.
 East & South-East Asia, largest number of the world’s older
population (260 million), followed by Europe and North America
(over 200 million)
The largest increase (+312 million persons) projected to occur in
East & South-East Asia, growing from 261 million in 2019 to 573
million persons aged 65 years or over in 2050.
World Population Ageing 2017 &19

7. Risks to Elderly
Prone to
- Infections
- Injuries
- Psychological Problems
- Degenerative Disorders
Risk of
- Disease
- Disability
- Death

8. Health Problems Of Aged Population
Classified on the basis of :
(1) Problems due to Ageing process
(2) Problems associated with Long term illness
(3) Psychological and Social problems

9. Problems due to Ageing process
 Hypertension
 Atherosclerosis
 Congestive heart failure
 Cardiomyopathy
 Strokes
 Senile cataract
 Glaucoma
 Nerve deafness
 Osteoporosis
 Emphysema
 Failure of special senses

10. Long Term Illness
 Degenerative diseases
 Cancer
 Accidents
 Diabetes
 Diseases of loco-motor system (Osteoarthritis,
Rheumatoid Arthritis, Gout, Fibrositis, Myositis)
 Respiratory illness (COPD, Asthma)
 Genitourinary diseases

11. Psychological & Social Problems
 Cognitive Changes
 Emotional Disorder
 Sexual Adjustment
 Mental Problems
 Depression
 Maniac Depressive Psychosis
 Alzheimer’s Disease
 Parkinsonism
 Retirement
 Elder Mistreatment and Abuse
(Financial, Physical & Verbal
Abuse, Neglect)
 Loss of Social Status
 Widowhood
 Generation Gap
 Loneliness
 Homelessness

12. COVID-19 Pandemic & Elderly Population
 Elderly more vulnerable and at greater risk of requiring
hospitalization or dying if diagnosed with COVID-19.
Highest covid fatality among elderly in European countries followed
by the Americas (US, Canada, Brazil) and then Germany and Austria.
In Nepal, though infection remains high among 21-50 age, infection
& fatality rate is in increasing trend among elderly, evident with surge
since Sept-Oct 2020 (on Oct 31, 2020 single day fatality was 23, of
which 13 were above 70 & older, and 20 deaths were aged 60-70)
Further the pandemic has added other complexities: collapse of
joint families, isolation, children and grandchildren abroad for
studies or work, economic hardships & expensive health care.

13. Elderly in Nepal
 In Nepal, 60 and above considered as elderly.
 Despite that, different practices in Nepal are
operational :
- Civil servant retirement – 58 years
- University service retirement- 63 years
- Constitutional organs of government retirement age- 65
years

14. National Picture
In Nepal, proportion of 60 years and above: 8.1%,
majority are in their sixties (69%).
 Female elderly are more than the males (97.7 sex ratio)
 Among 77 districts, Gorkha (12.75%) reported the
highest, & Jajarkot (5.12%), reported the lowest
proportion of elderly.
CBS, National Census 2011

15. Province-wise elderly population in Nepal
18.2
18.8
21.2
13.1
15.6
4.1
8.9
0
5
10
15
20
25
Elderly Popn
1
2
Bagmati
Gandaki
Lumbini
Karnali
Sudurpaschim
CBS, National Census, 2011

16. Indicators of Ageing

17. 35.583
40.881
46.776
54.404
62.288
67.611
70.478
0
10
20
30
40
50
60
70
80
1960 1970 1980 1990 2000 2010
Trends of Life Expectancy in Nepal
World Bank Report, 2018

18. Elderly Growth Rate Vs. Annual Population Growth Rate
2.25
3.19
3.77
2.08
2.25
1.35
0
0.5
1
1.5
2
2.5
3
3.5
4
1991 2001 2011
Elderly Population Total Population
CBS, National Census 2011

19. Policy Milestones
 Civil Code, 1963
 Constitution of Nepal, 1990; 2007 & 2015
 Five Year Periodic Plans
 Three year Interim Plan, 2007-2010
 Local Self Governance Act, 1999
 Senior Citizen Policy, 2001
 National Plan of Action for Senior Citizens, 2005
 Senior Citizen Act, 2006
 Senior Citizen Regulation, 2008
 Public Health Service Act, 2018

20. Programs/Schemes for Elderly in Nepal
 Non-contributory universal social pension program in 1994/95 AD.
Allowance increased from Rs 100 to Rs. 3000 at present to elderly
above 70 years. Increased to Rs. 4000 in 2078/79 BS.
 Pension scheme for retired public servants and their widows and
children.
 Old Age Home & day care centers: Established Pasupathi Vridhha-
Ashram for old people, Charity based– Nishahya Sewa sadan,
Aamako ghar.
 Establishment of Senior Citizen Welfare Fund at the Central level
and District Senior Citizen Welfare Committee in the leadership of
DDC at the Municipal level.

21.  Free Health Care Service Program for target groups since 2064 in
hospitals and primary health centers for inpatients and emergency
services and was made free for all citizens in all health posts and
sub-health posts from FY 2064/65.
 Adoption of Jeshtha Nagarik Swasthya Upachar Sewa Nirdeshika
2061 with provision of Jeshtha Nagarik Swashthopachar Kosh in
each district.
 Efforts for provision of concession in the fees for treatment in
private nursing homes and clinics.
 Initiation of Social Service unit in 8 hospitals and geriatric ward in
24 referral hospitals

22.  Mobilization of NGO or Civil Society and coordinating with other
agencies such as GOs, UN, INGOs National NGOs a for welfare of
senior citizen in Nepal.
 Legal discount of 50% in public transportations for >60 above
 Strong Commitment to Madrid International Plan on aging and
other International Plan of Action on Elderly.

23. Public Health Issues of Elderly in Nepal
 Nepal, experiencing a rapid increase in the elderly population.
 Breakdown of the traditional family as family members are migrating
out of country for the good opportunity, elderly people left at alone
without support, facing health and social problems like homelessness,
abuse etc.
 Increasing elderly population posing financial pressure on national
economy.
 Irregular & untimely distribution of allowance due to administrative
issues mostly in rural areas
 Out of pocket health expenditure remains high for specialized elderly
care.
 Scarce specialized health care providers for geriatric care. Only few
consultant doctors for geriatric medicine.

24.  Even the established geriatric units face insufficiency as per the
standard, due to huge demand for geriatric services.
 Interdisciplinary approach is major challenge (difficult to manage
surgical, medical, gynaecology, orthopaedic, ENT & psychiatric
patients under the same unit.
 Major focus on maternal & child health and other sector; health care
for elderly people is neglected.
 A 2015 study showed that there are about 1,500 elderly living in
about 70 organizations registered all over Nepal at present. Of which
many are deprived of proper care, support & basic need for
comfortable survival. Thus there is lack of quality elderly home with
respect to the facilities they provide.
 Lack of proper monitoring system of geriatric care homes

25. Way Forward
Develop policies and enforce laws
Formulation of evidence based policies to strengthen abilities of
elderly and healthy ageing
Adequate investment on social security and pension plan &
increment in the retirement age of civil servants
 Revision of age criteria for geriatric services to be considered
Assure competent workforce
 Ensuring adequate production of specialized human resource
through trainings and specialized courses by NHTC and
Universities
Formulating policies and facilities to retain the specialized human
resources within country

26. Assure health services
 Aligning health system with the needs of elderly people
Prioritizing easy access and availability of geriatric health care and
home care centers.
 Since maximum % of elderly reside in rural Nepal, geriatric care
should be made a integral part of primary health care services.
 Organizing routine, quality and sustainable health campaigns at local
levels across the country
 Increasing demand requires geriatric service expansion; so including
mandatory geriatric services in private and teaching hospitals. Holistic
care – Preventive, Promotive and Palliative services required.
 Encouraging private sector involvement in geriatric health care and
home care
 Timely Monitoring of elderly homes & care centers across the
country

27. Capacity Building at all three tiers of government
 Capacity building and coordination for effective design and
implementation of programs
 Channeling the support from national and international
institutions including the donors such as WHO, ILO, UN
Agencies.
Upgrading Self reliance of elderly people
 Continuous participation of elderly at all levels, within their
capacity, respecting their experiences and skills.
 Creating age-friendly environment for dignified ageing
Assuring psychological health during old age
 Creating enabling environment for the mental wellbeing of
people living in old age home, abandoned and disrupted families.

28. Awareness and Education
 Extensive dissemination about geriatric nutritional need and
healthy behavior.
 Re-orienting community regarding elderly care at local level
 Revision and strengthening the existing curriculum of formal
health education system of the country to incorporate subjects of
Gerontology and Geriatrics with higher emphasis.
Enhancing Research and studies
 Further research on different dimensions of elderly health
issues and related policy research
 Comprehensive baseline morbidity survey and functional
assessment of their different health aspects

29. References
• Bhandari K. (2015).Trends in Age Structure and Ageing Population in
Nepal. Nepal’s Journal Online
• Bhandari K.(2017) Social Security System of Elderly Population in Nepal by
Kamala Bhandari. NUTA JOURNAL, 6
• United Nation (2017) (2019). World Population Ageing. United Nation.
• Dhungel S. (2018). Provincial Comparison of Development Status in Nepal:
An Analysis of Human Development Trend for 1996 to 2026. Journal of
Management and Development Studies Vol. 28
• Shrestha L.(2012). Geriatric Health in Nepal: Concerns and Experience.
Nepal Medical College Journal
• WHO Factsheet on Ageing and Health (2018)

30. References
• Dhital, S., H.N. Chalise and D. Rupakheti (2015). Migration, ageing and
spousal separation: A review of current population trend in Nepal. Jacobs
J. Gerontol., Vol. 1, No. 1
• Sahara Mishra and Hom Nath Chalise, 2018. Health Status of Elderly living
in Government and Private Old Age Home in Nepal. Asian Journal of
Biological Sciences, 11: 173-178
• Yanez, N.D., Weiss, N.S., Romand, JA. et al. COVID-19 mortality risk for older
men and women. BMC Public Health 20, 1742 (2020).
• Pant S. and Subedi P.(2020).Impact of COVID-19 on the elderly. Journal of
Patan Academy of Health Science

31. THANK
YOU!