International Journal of Research in Social Sciences

Vol. 7 Issue 9, September 2017,

ISSN: 2249-2496 Impact Factor: 7.081
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Issues in Geriatric care in India

Dr. Bhupinder Chaudhary *

Dr. Rachna Kumar **
Abstract
As the second most populous country in the world (next only to China), population of India is
1.21 billion (2011). In the age group of 60 years and above, the population has increased by
about 55% in the last 15 years. Contrary to this, the working population (15-59 years) has grown
by 42.34% in the last 15 years. The old age dependency ratio, which measures the number of
elderly people as a portion of those of working age, stands at 0.132 (01 March 2012), which is
expected to be over 0.20 (by 2050). With the increase in life expectancy and decline in death
rate, there is an increased demand for care-givers to provide care to the elderly.According to
prediction by demographers, globally, inabout another 25 years, the population aged 65 years
and above will be double the population under age of 5 years. So, we would need more
geriatricians than pediatricians in the next few years. In the Indian context, the situation is
acquiring a critical status, as the healthcare system is still not geared for geriatric care as a
separate specialization. Eventually, the number of geriatricians in public and private sector is
minimal and grossly inadequate to ensure a reasonable level of healthcare to the ageing nation.
This article is an attempt to enlist and analyse the salient features of Geriatric care system in the
Indian context, the problem associated with it and probable solutions to these issues.

*
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

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Geriatric care in India

The total fertility rate in India declined to 2.6 (2011) from 3.5 (1994). The life expectancy at
birth in India as per the 2011 census is 65 years of age. In 1991, it was 58.6 years for males and
59 years for females. There was a major demographic change because of declining fertility rates
and increasing life expectancy. With both the under 15 and the 60+ population increasing more
rapidly than the 15-60 population, the population pyramid has assumed a „pear shape‟. The
adverse effect of such a transition is on the working population of the country.

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.

Gerontology in India is still in an early stage. Gerontology incorporates an arrangement of

conditions particularly connected with age maturity. The rate of such conditions, for example,
falls, subjective weakness, vision disability, listening to debilitation, wooziness and fragility is
expanding. The normal Indian specialist does not get presented to the obliged instruction to

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 ISSN: 2249-2496 Impact Factor: 7.081

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.

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 ISSN: 2249-2496 Impact Factor: 7.081

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:

NPOP:The National Policy on Older Persons established in 1999 visualizes Government

support to elderly to ensure financial and food security, health care, shelter, equitable share in
development, protection against abuse and exploitation, and availability of services to improve
the quality of their lives. It also covers issues like social security, intergenerational bonding,
family as the primary caretaker, role of Non-Governmental Organizations, training of

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 ISSN: 2249-2496 Impact Factor: 7.081

manpower, research and training. (Ministry of Social Justice & Empowerment,Government of

India)

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.

Improving quality of life of older adults

Indian public healthcare delivery system needs to devise strategies, keeping in consideration, the
following:
 Training of medical and para-medical professionals in geriatrics. This should be the
primary goal, as most of the geriatric care centres are available in tertiary care hospitals. So,
having trained care providers at primary and secondary level may be more accessible to the
population.
 Training of health workers and volunteers in geriatric care to enable them to identify the
cases to be referred to healthcare institute.

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 ISSN: 2249-2496 Impact Factor: 7.081

 Availability of adequate transport facility at primary or secondary level of healthcare

centres to refer the elderly patient to a higher centre as and when needed. It will also reduce their
dependency on someone to avail healthcare.
 Government and non-government organizations should be encouraged to organize
frequent screening camps for common ailments like cataract, dental problems and awareness
camps for lifestyle conditions like cardiovascular disease, diabetes, can be significant.
 Provision for rehabilitation of elderly, which includes counselling, physiotherapy,
psychological rehabilitation and most significantly, employment opportunities, as financial
dependency is also one main reason for exploitation of elders.
 Promotion of professional trainings in Geriatrics, specifically at tertiary level. This would
include medicos from different specialties, who are also formally trained in geriatrics and
gerontology. The trainings should also include focus on sensitization to thepsychological issues
of elderly. It should also address the incidents of „ageism‟ in healthcare.
 Research in this field needs more attention and encouragement. Indian Council of
Medical Research is also keen to get research done in the area of eldercare.

Significance of Accreditation/standards in promoting geriatric care:

The Joint Commission (the agency regulating JCI Hospital accreditation standards at the United
States) and Quality Council of India (the Indian agency regulating NABH Hospital accreditation
standards) in their respective standards, have given special consideration to the patients with
special needs, which also includes elderly patients. It includes restructuring infrastructure and
procedures in such a way, so as to minimize discomfort to all type of patients. But the main
cause of concern is that, these standards are not mandatory for all healthcare organizations, so,
only the hospitals applying for these accreditation standards can be regulated under these
parameters.

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.

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 ISSN: 2249-2496 Impact Factor: 7.081

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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