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Geriatric healthcare in India; Scarce, inaccessible, unaffordable!

Dr. R.Kumar

President, Society for Promotion of Ethical and Affordable health Care

Ever growing elderly population poses social and financial challenges and puts immense strain on the healthcare system, whereas specialized medical services for the elderly are scarce. It is estimated that 8- 10% of the population is above 6o years of age and this will reach 20% in the years to come, to match that of developed countries, but bereft of corresponding medical services . Growing old is a progressive process associated with declines in structure and function, impaired maintenance and repair systems, increased susceptibility to disease and death. Old age warrants attention to health problems and diseases in order to sustain comfortable and healthy aging and smooth sunset of life.

Regrettably, 90% of the elderly are from the unorganized sector or rural background or abandoned by the rich children, without adequate food, clothing, or shelter, let alone healthcare or medical treatment. Absence of any government supported social security and geriatric medical services compounds the problem. The oldies are left with no other option but to decay and stench in the garage of the house, which they once built. Can they be the beneficiaries of Geriatric services?

Ailments abound in old age

Earlier it was opined that chronic ailments like diabetes, hypertension, coronary heart disease, and cancers belong to the rich class of older people, but now it has been discovered that poverty does not confer any immunity against any disease.  Rather poverty is responsible for accentuation of ailments. Heart diseases account for one third of elderly mortality. Respiratory disorders account for 10%, while infections including TB account for another 10%. Tumors account for 6% and accidents, poisoning and violence constitute less than 4% of elderly mortality. 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. Another study from Tamil Nadu found that pain in the joints and joint stiffness was the most common morbidity, which was found in 43.4% cases, followed by dental complaints in 42%, visual loss in 57% and hearing impairment in 15.4%.

Geriatric healthcare is neglected

Geriatrics as a medical specialty is neglected in the same manner, as the elderly are subjects of neglect and abuse. Geriatric teaching is absent from the MBBS curriculum. GOI formulated ‘National Program for the Health Care of Elderly 2011’ to provide easy access to preventive, promotive, curative and rehabilitative services to the elderly along with specialized long-term and short-term training of health professionals to address their  growing health needs. Earlier GOI enacted ‘Maintenance and Welfare of Parents and Senior Citizens Act, 2007’. Despite these provisions healthcare of the elderly is sham.

Barring some centers in corporate sector like Apollo hospitals and AIIMS New Delhi, specialized services for the aged or postgraduate medical teaching in geriatrics do not exist. Announcement of setting up of a geriatrics centre at PGI is heartening. A word of caution is that it will not become a dumping ground for the ‘unwanted at home’ senior citizens or a club for the uncared oldies. This is expected to provide the following services for the benefit of deserving patients.

  • MD program in Geriatrics to create faculty for geriatric centres in the field.
  • Comprehensive physical, cognitive & psycho-social assessment
  • Development of a personal care plan
  • Super-specialists recommended surgical programs
  • Rehabilitation  in post-operative or post illness recovery phase
  • Recommendations to improve health & functional ability
  • Domiciliary and extension services to reduce pressure on the hospital beds.
  • Training to the caregivers for healthcare at home
  • Research in aspects of ageing

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

Denial of Medical care

The traditional norms and values of Indian society used to lay stress on showing respect and providing care to the elderly, but not any longer. Old and sick parents are considered not only of no use, but also a burden to get rid of, by the modern family members. There is a tendency to trivialize their health problems, alleging ‘lack of time’ and ‘unaffordable costs’.  A study found that lack of family support, family nuclearisation, immobility, inaccessibility; misconception and poverty as the underlying factors in denial of healthcare to the older persons. One out of two elderly in India suffers from one or more chronic disease, which requires 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 (ADR). This is due to the forgetfulness and poor mental state, besides lack of assistance.

Village elders, especially women are subject to greater neglect. Poor relationships and bad nourishment is 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 the elderly medical care, who need it the most. This needs to change.

Way forward

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 provision of caregiver support services and domiciliary visits for homebound elderly. Structured health education is essential to raise awareness about health problems in old age and to impart concept of healthy living. A social security phone call should get them instant attention in case of emergency. Services of a wellness and well-being coach to prevent health issues are nowhere more valuable than in old age.

 The Tribune 16th March 2019

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