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Healthcare for elderly inaccessible, unaffordable

Healthcare for elderly inaccessible, unaffordable

Dr R Kumar
President, Society for Promotion of Ethical and Affordable Healthcare

THE ever-growing elderly population poses social and financial challenges and puts immense strain on the healthcare system, even as specialised medical services for them are scarce. It is estimated that 8-10 per cent of India’s population is above 60 years of age; this figure will reach 20 per cent in the years to come, matching that of developed countries, but bereft of corresponding medical services. Growing old is a progressive process associated with decline in functioning, impaired maintenance and repair systems, and increased susceptibility to disease and death. Old age warrants attention to health problems and diseases in order to sustain healthy ageing.

About 90 per cent of the elderly are from the unorganised sector or abandoned by rich children, without adequate food, clothing or shelter, let alone healthcare or medical treatment. The absence of government-supported social security and geriatric medical services compounds the problem. 

Earlier, it was perceived that chronic ailments like diabetes, hypertension, coronary heart disease and cancer afflict the affluent class of older people, but now it has been found that the poor, too, have no immunity against such diseases. Rather, poverty is responsible for accentuation of ailments. Heart diseases account for one-third of elderly mortality; respiratory disorders, 10 per cent; infections, including TB, 10 per cent; tumours, 6 per cent; and accidents, poisoning and violence constitute less than 4 per cent. Many of them also suffer from nutritional, metabolic, gastrointestinal and genitourinary infections. A report published by the Indian Council of Medical Research found that hearing and vision impairment were the most common morbidities. A study from Tamil Nadu found that pain in the joints and joint stiffness was the most common morbidity, found in 43.4 per cent of the cases, followed by dental complaints (42 per cent), visual loss (57 per cent) and hearing impairment (15.4 per cent). 

Geriatrics as a medical speciality is ignored in the same manner as the elderly are subjected to neglect and abuse. Geriatric teaching is missing from the MBBS curriculum. The Central Government formulated the National Programme for the Health Care of Elderly (2011) to provide easy access to preventive, curative and rehabilitative services to the elderly along with specialised long-term and short-term training of health professionals to address their growing health needs. Earlier, the government had enacted the Maintenance and Welfare of Parents and Senior Citizens Act (2007). Despite these provisions, healthcare for the elderly is virtually non-existent.

Barring some centres in the corporate sector, specialised services for the aged or postgraduate medical teaching in geriatrics do not exist. The announcement that a geriatric centre will be set up at the PGI in Chandigarh is heartening. Hopefully, it will not become a dumping ground for the ‘unwanted at home’ senior citizens or a club for the uncared oldies. It is expected to provide the following services: (a) MD in geriatrics to create faculty for geriatric centres in the field; (b) Comprehensive physical, cognitive and psycho-social assessment; (c) Development of a personal care plan; (d) Super-specialist-recommended surgical programmes; (e) Rehabilitation in post-operative or post-illness recovery phases; (f) Recommendations to improve health and functional ability; (g) Domiciliary and extension services to reduce pressure on hospitals; (h) Training to the caregivers for healthcare at home; (i) Research in aspects of ageing.

The areas of research would include etio-pathological mechanisms of ageing, socio-economic support mechanisms for ageing, mechanisms to promote healthy and active ageing, efficient models of geriatric healthcare delivery, alternative medicine and the study of age-related disorders.

The traditional norms and values of Indian society used to lay stress on showing respect and providing care to the elderly. However, old and sick parents are at times discarded by their family members. There is a tendency to trivialise their health problems, citing ‘paucity of time’ and ‘unaffordable costs’. A study identified lack of family support, family nuclearisation, immobility, inaccessibility and poverty as the underlying factors for the denial of healthcare to old persons. One out of two elderly people in India suffers from one or more chronic diseases, which require life-long medication. It has been reported that a geriatric individual takes an average of six prescription drugs concurrently and often suffers from adverse drug reactions. This is due to forgetfulness and a poor mental state, besides lack of assistance. 

Village elders, especially women, are subjected to greater neglect. Strained relationships and bad nourishment are responsible for poor health and denial of medical care. The elderly themselves may deny themselves nutrition and other care due to eccentricity, depression, lack of awareness or ego problems.  Even insurance policies tend to exclude medical care for the elderly, who need it the most. 

Medical insurance protection for the elderly should be provided to all, irrespective of the age, and it should include a comprehensive health package as well, including knowledge and awareness regarding common geriatric problems and their prevention, healthy nutrition, physical exercise, yoga and meditation, and promotion of mental well-being. It should have the provision of caregiver support services and domiciliary visits for the home-bound elderly. Structured health education is essential to raise awareness about health problems in old age. A social security phone call service should get them instant attention in case of emergency. Services of a wellness and well-being coach to tackle health issues are at no time more valuable than in old age.

 

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