HEALTHCARE IN INDIA – GERIATRIC CARE

In the west, it is a specialized field and they have doctors who specialize in tending to older people. In our country, however, the physicians cater to the older people along with all the other age groups.

One in five elderly persons in India has mental health issues. Around 75 per cent of them suffer from a chronic disease. And 40 per cent have some or other disability. These are the findings of the Longitudinal Ageing Study of India (LASI) released by the health ministry of India. The survey found that more than one in 10 people aged 60 and above have “probable major depression”.

Figure 31: Burden of illness type among Indians. Source : https://www.nap.edu/read/13361/chapter/20#373

“We find that senior citizens are the most vulnerable group after their transition from being confident to self-doubting. They need special attention and emotional care,’ said Kartik Rajagopal, regional director, south, Fortis Healthcare. In addition, Indian elderly face several social issues such as loneliness, elder abuse, neglect, lack of income security, and poor access to health care. Health Care for elderly people cannot be fully achieved unless we consider complete health of the individual, i.e., physical, social, economic, psychological, and spiritual aspects. Unless we address all these issues, geriatric health cannot be ensured. The biggest aspiration of the elderly in India is to live independently with dignity.

Geriatrics differs from standard adult medicine because it focuses on the unique needs of the elderly person. The aged body is different physiologically from the younger adult body, and during old age, the decline of various organ systems becomes manifest. Previous health issues

and lifestyle choices produce a different constellation of diseases and symptoms in different people. The appearance of symptoms depends on the remaining healthy reserves in the organs. Smokers, for example, consume their respiratory system reserve early and rapidly India is undergoing an epidemiologic and demographic health transition, the average life expectancy of Indians has increased over the years on account of advancement in medical technologies, penetration of better healthcare facilities, better education & living conditions, increased per capita income and better affordability for services. Consequently, the percentage of elderly people (above 60 years) has increased from 5.3% of the total population during 1971 to 6.9% in 2001. As per the 2010 census projection the old aged population was 7.5% of India's population. India has thus acquired the label of "an ageing nation" as per the classification of United Nations.

The increasing number of elderly persons has a direct impact on the demand for health services due to the consequent rise in degenerative diseases of aging and changing life style. Elderly people suffer from both communicable as well as non-communicable diseases; further, this is compounded by impairment of sensory functions like vision, hearing, and stability management. Poor life style, decline in immunity as well as age-related physiologic changes lead to an increased burden of communicable diseases in the elderly. In the population over 70 years of age, more than 50% suffer from one or more chronic conditions. The rapid urbanization and Societal modernization has also brought in its wake a breakdown in family values and the Frame work of family support, resulting in economic insecurity, social isolation, and elderly abuse leading to a host of psychological illnesses. This demands a timely initiative in this direction by the policy makers to arrange and mobilize additional resources for the geriatric population. At the same time, it emerges as a challenge and major responsibility of health care providers in India. However, there is an acute dearth of specialized geriatric care units in hospitals or as standalone centers in the state.

Age consideration There is no set age at which patients may be under the care of a geriatrician or geriatric Physician but in general people over 60 years of age are considered under geriatric care. (Agarwal G. , n.d.)

Figure 32: Percentage distribution of population by age group to the total population by sex and residence, India 2012 Source: https://www.academia.edu/28726381/GERIATRIC_HOSPITAL

A) Need for specialized care for elderly geriatric illness

The old age people are more susceptible to chronic diseases, physical inability and mental inabilities which depend on the social values as well. Due to deteriorating physical conditions their body is more prone to illness which is multiple and chronic in nature. People have wrong perception that ailments are part of old age and they accept the sufferings and the physical trouble even though they are curable, so this results in neglecting the health conditions.

Most of

Figure 33: Number of disabled per 100,000 elderly persons for different types of disability the elderly Source: https://www.academia.edu/28726381/GERIATRIC_HOSPITAL patients, among the population over 60 years age, 10% suffer from impaired physical mobility and 10% are hospitalized at any given time, both proportions rising with increasing age. In the population over 70 years of age, more than 50% suffer from one or more chronic conditions. The chronic illnesses usually include hypertension, coronary heart disease, and cancer.

3.7 million suffer dementia 40 million suffer from poor vision 1.6 million annual stroke cases 1 in 3 suffer from arthritis 1 in 3 has hypertension 1 in 5 has diabetes 1 in 5 has auditory problems 1 in 4 suffer from depression 1 in 10 falls and sustains a fracture I in 3 bowel disorder Cancer is 10 times more common.

According to Government of India statistics, cardiovascular disorders account for one-third of elderly mortality, respiratory disorders account for 10% mortality while infections including tuberculosis account for another 10%. Neoplasm accounts for 6% and accidents, poisoning, and violence constitutes less than 4% of elderly mortality with more or less similar rates for nutritional, metabolic, gastrointestinal and genito-urinary infections.

An Indian Council of Medical Research (ICMR) report on the chronic morbidity profile in the elderly, states that hearing impairment is the most common morbidity followed by visual impairment. However, different studies show varied results in the morbidity pattern. A study 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%,

Limited supply of medical and para medical personnel trained in Geriatric medicine-

Madras Medical College in Chennai is the only college in India offering an M.D course in Geriatrics and the number of MD Geriatrics seats is limited to three per year. There are no other formal training centers for geriatric care and hence there is a dearth of availability of medical and paramedical geriatric specialists. The Government hence under the NPHCE, had issued orders to extend the reach of medical care for the elderly in all the levels of the healthcare - tertiary, secondary and also primary. Government also has planned the Inclusion of geriatric course in the syllabus of medical courses and also courses for nurse. (Agarwal G. , n.d.)

B) Mental, social, cultural and other impacts on health Another important area is the mental condition of the old aged people. People of all ages feel sad or depressed but it is observed that the degree of depression increases with increase in age. In India, the suffering of elderly by metal disorders is under-reported because the elderly don't go for a regular check-up to a hospital and the common mental disorder observed is dementia. Dementia is defined as the global deterioration of individual's intellectual, emotional and cognitive faculties in a state of impaired consciousness.

Social and cultural impacts on healthThe elder people after retirement restrict their activities resulting in limited usage of their mental ability, and slowly confine themselves to the house and even reduce their physical activity. It is deeply rooted in the Indian mind that old age is the age of ailments and the elderly consider many of the health issues that can be cured as natural and inevitable. There is a perception in the society that aged people should their living habits especially their diet by eating less, sleeping more and developing religious interest. However, due the lack of physical activity, absence of work and irregular sleeping habits health issues arise.

In the past traditional families were the key institutions that provided psychological, social, and economic help to the family members. The elders in the family were respected and approached for advice and were taken care of. However, with urbanization and modernization nuclear families are not able to support the aged family members; this has put a great social strain on the healthcare of the elderly. The rapid urbanization and societal modernization has brought in its wake a breakdown in family values and the framework of family support resulting in, economic insecurity, social isolation, and