A growing number of elderly with chronic diseases or disabilities require a family caregiver, or several, for physical, emotional, and financial support; for daily activities and medical.
Medical advances, new drugs, improved technology, and possible preventive strategies might be decreasing mortality and extending life. Since the 1970’s, medical care has resulted in a progressive shift from “care in the community to care by the community.”
This oral presentation was given at the International Congress on Gerontology and Geriatric Medicine, AIIMS 2009.
CBR and USE OF ASSISSTIVE
TECHNOLOGY FOR THE
DISABLED ELDERLY IN THE
Dr Alakananda Banerjee
Dharma Foundation of India
•To review existing scenario of the work in the indian community by
• Identify solutions in utilization of assistive technology in the
community based rehabilitation (CBR) services for the elderly in India
A growing number of elderly with chronic diseases or disabilities require a family
caregiver, or several, for physical, emotional, and financial support; for daily
activities and medical.
Medical advances, new drugs, improved technology, and possible preventive
strategies might be decreasing mortality and extending life. Since the 1970’s,
medical care has resulted in a progressive shift from “care in the community to care
by the community.”
WHY CBR FOR ELDERLY?
Assistive technology (AT) is a generic term that includes
assistive, adaptive, and rehabilitative devices for people with
disabilities and includes the process used in selecting,
locating, and using them.
DEFINING THE DISABLED ELDERLY
Although by no means clear cut, long-term care researchers have developed some
common definitions to describe the disabled elderly.
Activities of Daily Living, commonly referred to as ADLs
Instrumental Activities of Daily Living, or IADLs
The Rapid Disability Rating Scale can be used to assess the level of patient disability especially
in the elderly. It is useful for monitoring over time to see if the patient is improving stable or
The scale is completed by a caregiver familiar with the patient.
Based on the response points ranging from 1 to 3 are assigned indicating no or slight moderate
and severe impairment
CBR is a quick, cheap episodic distribution of some appliances for physically disabled
people living in urban slum or rural area.
Many government as well as non government agencies, with all good intentions to
rehabilitate the disabled elderly, resort to quick fix solutions, with no long lasting
impact in the community.
India’s population of just over one billion in the year 2000 continues to grow at about1.5%
per annum and is expected to exceed one and a half billion by mid century.
The increase in life expectancy with better health care, nutritious food and socio-economic
While the existing support system of joint families, preponderance of physical activity,
vegetarianism, and social and spiritual enrichment, all known to promote healthy ageing, are
widely prevalent in India.
With changing lifestyles the younger generation are migrating from not only rural to urban
areas but from country to another as well; leading to increase in old age dependency ratio.
The old age dependency ratio (number of old persons 60+ years) to the working age group
(15-59 years) has increased from 9.8 per cent in 1981 to about 12.6 per cent in 2001
(Census 2001) AND EMERGING
ISSUES OF ELDERLY IN INDIA
Traditional bonds between the elders and younger members of the family are
gradually becoming weak.
(Perceived status of the elderly in family.(A.L.Srivastava,Dinesh Kumar Singh and Sanjay Kumar) Indian Journal of
Gerontology,2003,Vol 17,No 1& 2.pp 127-135)
Social support plays a vital role in the life satisfaction of elderly.
(A note on social support as a function of life satisfaction (Ira Das, Archana Satsangi) Indian Journal of Gerontology,
2008, Vol 22, No 2.pp2333-234)
It is a commonly held belief that older people need to be "looked after", and their views are
rarely taken into account in the formulation of health policy.
(She too counts: Critical need for gender responsive healthcare for the elderly ;Indu Kapoor, Director,CHETNA)
NEED FOR ADDRESSING THESE
• Geriatrics is still relatively less known and geriatric wards exist merely in two hospitals in
the whole of India. This shows the gross apathy towards this age group. To meet the
preventive, curative, restorative and rehabilitative needs of older population in a country
with a population of over one billion are a Herculean task.
(She too counts: Critical need for gender responsive healthcare for the elderly (Indu Kapoor,
• There is marked absence of any public policy on either home base health care or training
of cadres of professional care providers for the disabled elderly.
• Skyrocketing costs of private sector healthcare institutions resorts to avoidance of
diagnostic and curative health opportunities.
(The socio-demographic contact of the elderly in India.-Sugan Bhatia-President-Indian Association for
• A CBR aims at promoting interventions in the general systems of society, as well as
adaptations of the physical and psychological environment that will facilitate the social
integration and the self-actualizations of disabled people.
• Its goal is to bring about a change; to develop a system capable of reaching out to people
in need and to educate and involve governments and the public. A CBR should be
sustained by using a level of resources that is realistic and maintainable.
(Einar Helander: Prejudice and Dignity. An introduction to Community-based rehabilitation.; published
by United nations Development Programme,1993,2nd edition 1999.)
AIMS OF A CBR
SOME EXISTING NGOs WORKING IN
THE COMMUNITY FOR ELDERLY IN
•Nightingales Home Health Services
Nightingales Home Health Services (NHHS) was started in Bangalore in 1996 to serve elders
and those who, for medical or other practical reasons, need access at their doorstep to routine or
emergency medical care and services.
HelpAge India is secular, not-for-profit organization registered under the Societies'
Registration Act of 1860. We were set up in 1978, and since then have been raising resources to
protect the rights of India’s elderly and provide relief to them through various interventions.
•Silver Care Module (‘Home-based Healthcare’ for elderly) Medybiz’s network
“Silver Care” is a unique home based health care program for senior citizens and elderly
people with or without morbid conditions or active disease status. It aims to provide them regular
care and personalized services like ‘Wellness & Health Management’ and ‘Chronic Care
Management’ in the comfort & security of their homes.
• Vellore CBR for PWD.
This project was established to demonstrate that people with disabilities in Vellore
town can be helped to discover and improve their potential through suitable
assessment, treatment and training in a Community Based Rehabilitation Program.
• A free taxi service for the elderly
An NGO, ‘The Path’, has brought good news for the elderly in Delhi. It has come
up with a brilliant idea of a free-taxi service, Bujurgo Ke Hamsafar, to provide
transport services free to senior citizens for hospitals, railway stations
World Health Organization introduced the concept Community Based
Rehabilitation (CBR) in the early 1980s. CBR was designed to enhance the quality
of life for people with disabilities through community initiatives. To facilitate this,
WHO published a CBR Manual 'Training in the community for people with
disabilities' in 1989.
The conventional technology that was followed explains the origins of the CBR
technology, building on a long series of field observations of "indigenous,
spontaneous rehabilitation." In all societies, examples can be found of successful
rehabilitation carried out by the family by people who had never access to
THE CBR TECHNOLOGY
A SYSTEM MODEL
Elder in Community
Community Club Family member/local
Community Rehabilitation Center
•The government's role in development program is to encourage and to give local support to a
•The steps of the system model is described for how to develop a management system through
which the government functions can be carried out effectively.
•Long-term sustainability cannot be achieved unless there is both a clear community involvement
and full government responsibility.
•Given the multi-sectoral character of the program, it is necessary to establish a well-functioning
national co-ordination mechanism.
•Governments must establish a network of public services aimed at organizational and technical
supervision, providing the backbone of a countrywide organization.
•A public effort is needed to plan for and administer the program.
•It is no longer politically acceptable to provide services to a large underprivileged group by
relying wholly on charity and un-coordinated voluntary efforts.
AN EDUCATIONAL MODEL FOR CBR TRAINING FOR
LOCAL SUPERVISORS BY THE PMR AT VELLORE
•The approach used in the CBR project in Vellore is an educational model which has been found
to work in other developing countries. The project uses the WHO training manuals and
emphasizes the development of skills, knowledge and attitudes.
•The Local Supervisors (volunteers chosen from among the community or can be a caregiver to
the disabled elderly) receive an education.
•Training involves teaching the local supervisors problem solving skills by using the resources
available. These resources will include people such as their fellow local supervisors and teachers,
plus books such as the paper based version of the WHO manual "Training in the community for
people with disabilities".
•They find a PWD in their local area and help them identify their felt needs.The LS act as local
rehabilitation resource persons through this educational model. The CBR team builds up local
resources and establishes referral services as needed.
• Attitudes are relevant only to the extent that they are believed to determine human
behavior, and most researchers agree that attitudes are one of the key factors that
predispose a person to act or behave in a particular manner towards another.
Awareness on community wellness should be incorporated in primary school
• CBR is not a blueprint or ready-made solution. It calls for flexibility, taking into
consideration the social, cultural and economic situation, the daily realities as
experienced by persons with disabilities, the country's existing services and
personnel, and its phase of development, priorities and policies.
Einar Helander: Prejudice and Dignity. An introduction to Community-based rehabilitation.(published by United nations
Development Programme,1993,2nd edition 1999).