Professional Documents
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Issues in Geriatic Care
Issues in Geriatic Care
*
Assistant Professor, Department of Hospital Management, H.N.G. University, Patan-
(Gujarat) India.
**
Dean, California School of Management and Leadership, Alliant International
University, Pomerado Road, San Diego
A paper published for the WHO titled „Ageing in India‟, states that “The UN defines a country
as „ageing‟ where the proportion of people over 60 reaches 7 per cent. By 2000 India will have
exceeded that proportion (7.7%) and is expected to reach 12.6% in 2025.” By that definition
alone, India qualifies as an „Ageing‟ country. An aging population puts an increased burden on
the resources of a country. With more mouths to feed and less hands to earn, the productivity of a
country goes down. “Nearly 60-75% of all elderly are economically dependent on others, usually
their children. Even those with pensions find their economic status lowered after retirement”.
With such a large old aged dependent population, India faces a unique problem.
Near about 830 million people currently live in rural areas against 31.99% in urban areas (census
2011). Although the percentage population staying in rural areas has gone down from 2001
(72.19%) to 2011 (68.84%), the significant majority still resides in rural India. The prominent
majority of them are elders. This rural-urban disparity is a significant socio-demographic factor.
This factor becomes more important in the scenario where majority of geriatric care is offered in
tertiary hospitals in urban India, and the rural elders face a sort of negligence. Not only hospital
care, but elder nursing homes, recreation facilities and old age centres are mostly present in
urban areas. With this sort of disparity in the rural-urban population and health care delivery
system in India, geriatrics and elderly care continues being a challenging task.
oversee such conditions. Except a modest bunch of foundations, gerontology and geriatric
fellowships are barely advertised. Geriatric medication is not empowered as a practice. As a
consequence of this, aside from a couple of private healing facilities, geriatric patients are taken
care of in the inward solution branch of most government possessed open clinics. Interns,
without being exceptionally qualified to survey and treat geriatric conditions go to such patients.
Thus, the normal geriatric restorative condition goes under/untreated and the aggregate weight in
the number of inhabitants in such conditions is constantly disparaged. With expanding life
compasses, elderly folks in India are usually confronting conditions which were viewed as
uncommon two eras back.
Just sporadic information has been gathered on different wellbeing conditions on the elderly in
India. The most well-known geriatric condition connected with maturity in India is disability
related to listening and vision disability. In any case, the profundity and scope of information
with respect to predominance of such issue in the shifted Indian populace are a long way from
acceptable. Also, information on other normal conditions, for example, Dementia and
Alzheimer's ailment are rare. There is an impending need to set up a database of such conditions
to start intercession techniques and to alter needs for arranging health awareness administrations
in regard to the elderly.
Healthcare programmes in the country in the last few decades have focused intensively on
obvious issues, as family planning (and population stabilization), reproductive and child health
(RCH) or maternal and child health (MCH), and disease control. But, equally important sector,
i.e. Geriatric care has skipped the attention of policy makers. There is an urgent need to highlight
this sector alongside different policies, as the elder population has shown continuous increase in
effect of clinical, social, economic and behavioral problems.
Apart from geriatric conditions seen specifically in these populations, the average elder in India
suffers from dual set of conditions: communicable/ infectious and non-communicable conditions.
Physiological changes with age as well as a decrease in immunity lead to an increase in
communicable diseases. A large number of infectious cases seen in the public hospitals in India
are in the geriatric age group. Risk for cardiovascular disease is also known to increase with age.
Diabetes, hypertension and heart disease are fairly common conditions seen in India. With
increasing life spans, more and more elders find themselves to be suffering from these chronic
debilitating disorders. An aging Indian population ailing from chronic illness puts an incredible
amount of burden on the already stretched health care system. In 2005, India lost an estimated 9
billion dollars to heart disease, stroke and diabetes. It is also expected to lose between 23 billion
dollars to 53 billion dollars annually, in foregone national income over 10 years between 2005
and 2015 due to deaths from these conditions.
Elderly are also prone to mental disorders, primarily, as senile changes are more prominent. It
may lead to conditions like dementia, delirium or may take more severe form as Alzheimer‟s.
Rapid urbanization and migration to urban areas has led to increased preference for nuclear
families. Somehow this trend also leads to psychological issues in elderly population, arising
because of a sense of social insecurity, economic dependence and vulnerability. As the life
expectancy and average life span for Indian women is more than males, it also leads to a
different set of social issues, as widows are socially stigmatized and economically dependent on
their care-givers. There are incidents of elder abuse and domestic violence reported frequently,
which highlight the plight of elderly females, more specifically in rural and semi-urban arena.
The condition is aggravated by lack of access and availability of adequate healthcare facilities
and social security. Most of the social security incentives are available for those elderly who
have worked in public or organized sectors, and a huge proportion of employees in unorganized
sector, are devoid of retirement benefits/social security in later years of life.
Government Initiatives:
Governments at various level have initiated their share of efforts to take care of these issues. Few
of these steps are:
NSAP:Objectives: The National Social Assistance Programme(NSAP) which came into effect
from 15th August,1995 represents a significant step towards the fulfillment of the Directive
Principles in Article 41 of the Constitution. The programme introduced a National Policy for
Social Assistance for the poor and aims at ensuring minimum national standard for social
assistance in addition to the benefits that states are currently providing or might provide in
future. NSAP at present, comprises of Indira Gandhi National Old Age Pension Scheme
(IGNOAPS), Indira Gandhi National Widow Pension Scheme (IGNWPS), Indira Gandhi
National Disability Pension Scheme (IGNDPS), National Family Benefit Scheme (NFBS) and
Annapurna. (http://nsap.nic.in/)
NOAPS: Indira Gandhi National Old Age Pension Scheme (IGNOAPS) or National Old Age
Pension Scheme (NOAPS) is a social sector scheme and forms part of the National Social
Assistance Programme (NSAP) which came into effect from 15th August, 1995. This scheme
provides social assistance for the old age persons. (Government of India)
But there have been accusations of irregular payment, long procedures,beneficiary identification
problem and insufficient allocation of budget in these schemes and implementation is also not
uniform. All theseleads to loss of reputation and trust for Government sponsored programmes.
From the available literature, it can be visualized that geriatrics or elderly care is an area,
preferable neglected in most healthcare settings. Though, it is significantly mentioned in the
healthcare policies, but implementation phase witness great deal of ignorance or neglect.
Conclusion:
This is a period of paradigm shift in terms of demographic changes and modified lifestyle, which
has led to anambiguous situation. Now the older adults find it very difficult to keep pace with the
changing times. This, coupled with perceived indifferent attitude of medical professionals
towards the healthcare issues of elderly, has made the matter worse. The focus of this article has
remained on the healthcare issues of elderly in India and few recommendations to improve the
situation. But, to achieve the goal of Quality of life to all citizens, especially for those in the later
stage of life, a combined effort is the need of the hour.
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