concept and trends ,problems and issue for elderly persons

1. D R . A N J A L A T C H I M U T H U K U M A R A N
V I C E P R I N C I P A L
E R A C O L L E G E O F N U R S I N G
Unit-VI
Geriatric Management
Senior Citizens - status in India

2. INTRODUCTION TO GERIATRIC NURSING
 Ageing is a natural process, characterized by
continued development and maturation. It is estimated
that by 2013 the number of people aged 65 and over will
exceed 15 million people and comprise 23% of the whole
population.
 This population shift will have dramatic effects on
healthcare provision and it is essential not only that the
services are in place to meet this demand but also that
the nurses have the skills to care for this age group.
 They are unique people because they have lived the
longest and have participated in and adapted to complex
social changes. Rapidly growing older adult population
and continuing shortage of advanced practice nurses
educated to care for older adults.

3. Who is called a Senior citizen?
 According to the law, a "senior citizen" means any
person being a citizen of India, who has attained the
age of sixty years or above.

4. Definitions
 DEFINITIONS
 "Old age is an incurable disease." (Seneca)
 "You do not heal old age; you protect it; you
extend it." (Sir James Sterling Ross)
 "Ageing is the progressive and generalized
impairment of functions resulting in the loss
of adaptive response to stress and in
increasing the risk of age related diseases."
(Dr. A.B. Dey)
 ."

5. Continued
 Geriatrics – Geriatrics is the branch of medicine
dealing with the physiological and psychological
aspects of ageing and with diagnosis and treatment
of diseases affecting older adults.
 Gerontology – Gerontology is the study of all
aspects of the ageing process and its consequences.

6.  Gerontological Nursing – It is concerned with
assessment of the health and functional status of
older adults; diagnosis, planning and implementing
health care and services to meet the identified needs
and evaluating the effectiveness of such care.

7. Continued
 Gerontic Nursing – Gerontic Nursing is a seldom-
used term considers the nursing care of older adults
to be the art and practice of nurturing, caring and
comforting rather than merely the treatment of
disease.
 Geriatric Nursing- "The adaptation of
professional nursing knowledge, skills and attitude
in recognizing and meeting the nursing, health &
emotional needs of an aging population

8. Categories of older population:
 Young old age 60-70 years
 Old old age 70-80 years
 Oldest old age >80 years
CATEGORIES OF AGED POPULATION
A modern classification is categorized the old age
into the following categories -
Young old : 60-70 yrs.
Middle-aged old : 70-80 yrs.
Oldest old : 80-100 yrs.
Elite old : Over 100 yrs.

9. DEVELOPMENT OF GERIATRIC
NURSING
 Gerontological nursing involves advocating for the health
of older persons at all levels of prevention.
 In the 1960's gerontological nursing became a
subspecialty of nursing.
 In the 1980's gerontological leaders stated that most
practicing nurses did not have sufficient knowledge
about gerontological nursing.
 As a result since 1990's schools of nursing provide classes
or courses about nursing care of the elderly. Practicing
gerontological nursing can obtain gerontological nursing
certification through the American Nurses Association.
 Advanced practice in gerontological nursing requires a
master's degree in nursing, of which here are two
options: the gerontological clinical nurse specialist and
the gerontological nurse practitioner.

10. Concept of Population Ageing
 The ageing of a population has been defined as an
increase in the proportion of the aged vis-à-vis a decrease
in the proportion of the young.
It is important to remember the following concepts of
geriatric medicine.
 Older patients get symptomatic early but seek health care
much later due to socioeconomic reasons.
 Some s/s, such as anemia confusion, and recent onset of
incontinence warrant immediate attention, as they may
be associated with several life-threatening conditions.
 Older people often require rapid access to health care
and may need specialized care.

11. Continued
 Apart from medicines and surgeries, physiotherapy
and counselling play a major role in the care of older
patients.

12. Status in India
 According to Population Census 2011 there are nearly 104 million
elderly persons (aged 60 years or above) in India; 53 million
females and 51 million males.
 A report released by the United Nations Population Fund and Help
Age India suggests that the number of elderly persons is expected to
grow to 173 million by 2026.
 According to the Report of the Technical Group on Population
Projections for India and States 2011-2036, there are nearly 138
million elderly persons in India in 2021 (67 million males and 71
million females) and is further expected to increase by around 56
million elderly persons in 2031.
 Both the share and size of elderly population is increasing over time.
From 5.6% in 1961 the proportion has increased to 8.6% in 2011.
 The proportion has increased to 10.1% in 2021 and further likely to
increase to 13.1% in 2031. For males it was marginally lower at
8.2%, while for females it was 9.0%.

13. up-to Population Census 1991
 It is interesting to note that up-to Population Census 1991, the number of elderly
females exceeded the number of elderly males. However, in the last two decades, the
trend has been reversed and the elderly males outnumbered the elderly females.
Further, it is projected that the number of elderly females will exceed the number of
males in 2031.
 As regards rural and urban areas, as per 2011 census, 71% of elderly population
resides in rural areas while 29 % is in urban areas.
 As per the Report of the Technical Group on Population Projections for India and
States 2011-2036, State-wise data on elderly population of 21 major states divulge
that Kerala has the maximum proportion of elderly people in its population (16.5%)
 followed by
 Tamil Nadu (13.6%),
 Himachal Pradesh
(13.1%), Punjab (12.6%) and
 Andhra Pradesh (12.4%) in 2021.
 On the contrary, proportion is the least in the States of Bihar (7.7%) followed
by Uttar Pradesh (8.1%) and Assam (8.2%).

14. The life expectancy at birth during 2014-18
 The life expectancy at birth during 2014-18 was 70.7 for
females as against 68.2 years for males. At the age of 60 years
average remaining length of life was found to be about 18.2
years (17.4 for males and 18.9 for females) and that at age 70
was 11.6 years (11.1 for males and 12.1 for females). Kerala has
got the highest life expectancy at birth, followed by Punjab
and Maharashtra. The life expectancy at birth in Kerala is 72.5
years and 77.9 years for males and females respectively as per
the SRS Report 2014-18.
 For 2018, the age specific death rate per 1000 population for
the age group 60 - 64 years was 20.4 for rural areas and 17.7
for urban areas. Altogether it was 19.5 for the age group 60 -
64 years. As regards, sex - wise, it was 22.2 for males and 16.7
for females.

15. The old - age dependency ratio
 The old - age dependency ratio climbed from 10.9% in
1961 to 14.2% in 2011 and further projected to increase to
15.7% and 20.1% in 2021 and 2031 respectively for India
as a whole. For females and males , the value of the ratio
was 14.9 % and 13.6% in 2011 and the projected
dependency ratio for
female and male is 14.8% and 16.7% respectively in 2021.
 Among economically dependent elderly men in 2017-18,
it has been observed that in both rural and urban areas
they were financially supported mainly by their own
children followed by their spouses, grand-children and
by others. In case of elderly women, more or less similar
pattern has been observed

16. Periodic labour Force Survey (PLFS), 2018-19
 Periodic labour Force Survey (PLFS), 2018-19, about 65% of
elderly men and 18% of elderly women in the age-group 60-64
years had participated in economic activity. However, there is
wider difference in rural and urban areas. In rural areas, 72%
of elderly men and 21% of elderly women participated in
economic activities whereas in urban areas, it was only 51%
among elderly men and 10% among elderly women. Similarly,
in the age group 65 years and above, participation in
economic activity by the elderly male and female is seen to be
at a much reduced level.
 The percent of literates among elderly persons increased from
27% in 1991 to 44% in 2011.The literacy rates among elderly
females (28%) is less than half of the literacy rate among
elderly males (59%).

17.  The most prevalent disability among elderly persons is
loco motor disability followed by hearing disability and
visual disability
 In the age - group of 60 - 64 years, 76% persons were
married while 22% were widowed. Remaining 2% were
either never married or divorced.
 The percentage of female elderly persons (60 years and
above) staying in the other’s houses is more than double
vis-à-vis male elderly persons. Also, the
percentage of female elderly persons living alone not as
an inmate of old age home is also much higher as
compared to male elderly persons.

18.  The highest crime rate per lakh population against the
senior citizens (60 years and above) has been found in
the Delhi (93.8) followed by Gujarat (85.4),
Chandigarh (74.5), Madhya Pradesh (73.2) and
Chhattisgarh (67.3) whereas UTs of Lakshadweep, Dadra
& Nagar Haveli and Puducherry have reported no crime
against the senior citizens. Similarly, the States of Assam,
Jammu & Kashmir, Jharkhand, Meghalaya and
Uttarakhand have reported less than one crime against
the senior citizens.


19. Administrative set-up
 The Ministry of Social Justice and Empowerment, as the
name suggests, is to ensure equitable treatment to such
sections of society which has suffered social inequalities,
exploitation, discrimination and injustice. The Social Defence
Division of the Ministry mainly caters to the requirements of
Senior Citizens, besides victims of alcoholism and substance
abuse, Transgender Persons and Beggars / Destitute.
 The Ministry develops and implements Acts, Policies and
Program for welfare of Senior Citizens in collaboration with
State Governments/ Union Territory Administrations to
ensure that Senior Citizens may lead a secured, dignified and
productive life.


20. Problem faced by elderly

21. Elderly person problems
 A study conducted in the rural area of Pondicherry
reported decreased visual acuity due to cataract and
refractive errors in 57% of the elderly followed by pain in
the joints and joint stiffness in 43.4%, dental and
chewing complaints in 42%, and hearing impairment in
15.4%.
 Other morbidities were hypertension (14%), diarrhea
(12%), chronic cough (12%), skin diseases (12%), heart
disease (9%), diabetes (8.1%), asthma (6%), and urinary
complaints (5.6%).(9)
 A similar study that had been conducted among 200
elderly people in rural and urban areas of Chandigarh in
Haryana observed that as many as 87.5% had minimal to
severe disabilities.

22. prevalent morbidity
 The most prevalent morbidity was anemia, followed by
dental problems, hypertension, chronic obstructive
airway disease (COAD), cataract, and osteoarthritis.(10)
 A study on ocular morbidities among the elderly
population in the district of Wardha found that refractive
errors accounted for the highest number (40.8%) of
ocular morbidities, closely followed by cataract (40.4%)
while other morbidities included aphakia (11.1%),
pterygium (5.2%), and glaucoma (3.1%).(11)
 In a community based study conducted in Delhi among
10,000 elderly people, it was found that problems related
to vision and hearing topped the list, closely followed by
backache and arthritis

23. Continued
 Elderly people who belong to middle and higher
income groups are prone to develop obesity and its
related complications due to a sedentary lifestyle and
decreased physical activity.(13)
 In a study conducted among 206 elderly persons
attending the Geriatric Clinic at a tertiary care
hospital in Delhi, about 34% of the men and 40.3%
of the women were obese respectively

24. Elderly people are highly prone to
 mental morbidities due to ageing of the brain,
 problems associated with physical health, cerebral
pathology,
 socio-economic factors such as breakdown of the family
support systems, and decrease in economic
independence.
 The mental disorders that are frequently encountered
include dementia and mood disorders.
 Other disorders include neurotic and personality
disorders, drug and alcohol abuse, delirium, and mental
psychosis.(

25.  The rapid urbanization and societal modernization
has brought in its wake a breakdown in family values
and the framework of family support, economic
insecurity, social isolation, and elderly abuse leading
to a host of psychological illnesses.
 In addition, widows are prone to face social stigma
and ostracism.(

26. Continued
 The socio-economic problems of the elderly are
aggravated by factors such as the lack of social
security and inadequate facilities for health care,
rehabilitation, and recreation.
 , in most of the developing countries, pension and
social security is restricted to those who have worked
in the public sector or the organized sector of
industry.(17)
 Many surveys have shown that retired elderly people
are confronted with the problems of financial
insecurity and loneliness.

27. Continued
 The elderly are also prone to abuse in their families
or in institutional settings. This includes physical
abuse (infliction of pain or injury), psychological or
emotional abuse (infliction of mental anguish and
illegal exploitation), and sexual abuse.

28. Trends in geriatric care

29. Healthcare Trends
 Geriatric Care Geriatric care facilities
 –Adult Day Care
 –Independent living facilities
 –Nursing Homes
 –Retirement incomes

30. Healthcare Trends Wellness
 Common wellness practices –
 –Weight management –
 –Health foods –
 –Nutrition –
 –Stress reduction –
 –Healthy behaviors

31. Healthcare Trends
 Healthcare Trends
 Cost
 Containment Measures
 Outpatient Care
 –Patient receives ambulatory care.
 –Does not stay overnight in the facility.

32. References
 Source : Elderly in India 2021
 Source : Ministry of Social
Justice and Empowerment
 Related resources
Long-term Care of Older Persons in
India

33. Thank you