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Geriatric Care in India |
| Email your comments Despite its comparatively young population, India is poised to become home to the second largest number of elderly in the world. Projection studies indicate that the number of 60+ seniors in India will increase to 100 million in 2013 and to 198 million in 2030. Characteristic of older people in India: (a) since most (80%) live in rural areas, providing services to them will be challenging, (b) the majority of the elderly (51%) will be female by 2016, (c) many seniors are over 80 years of age, and (d) 30% of the elderly live below the poverty line. This increase in India’s older population will affect their health and impact their families, communities and the nation. Fifty-five million - slightly less than the population of UK - go to sleep hungry every night. Thirty million elderly - the population of Australia - are lonely. Six and half million - the population of Singapore - feel no one knows they exist. Ninety per cent must work to live, and twelve million are blind. The seniors’ major health problems include chronic diseases (e.g. heart disease, stroke, cancer, COPD, and diabetes). Communicable disease and nutrition deficiencies continue to affect the elderly. Economically, the ninety percent of the elderly in the unorganised sector receive no pension to support them. These people depend on their children and many must work to live. Increasing numbers of rural elderly live alone because their children have moved to urban areas or other countries. Their loneliness produces conditions like depression and dementia. The migration of adult children has also increased the number of old age homes in India; but, no regulatory body oversees these facilities. India, once a country with the age-old tradition of “vanaprastha” or life stages approach, where an individual typically followed the four stages of life, childhood, education, family and spiritual quest, is losing that tradition. With the elderly alone and many having to work, the spiritual quest stage has become something of the past. Yet, all is not lost: The government and the non-government sectors offer services for the elderly. In 1999, through the National Institute of Social Defense, the Government established a National Policy for Older Persons. This policy’s purpose was to advise the Government and co-ordinate services for the elderly. The policy set up a National Council, consisting of members from Non Government Organisations ( NGOs), citizens’ groups, and retired professionals from law, social welfare, research, and medicine. In 2004 the Government established the National Initiative on Care for the Elderly (NICE) to increase awareness of the problems of the elderly, identify their needs, and target interventions (e.g., rebates, concessions and other incentives) and to improve the quality of life of the elderly. The government initiatives have increased awareness of the needs of the elderly. Many elder abuse hotlines’ have been established, and the elderly have come together to fight for and protect their rights. The government has also trained community health workers in a 6-month geriatric care course. Unfortunately, many of the course’s graduates work in urban areas and in hospitals or other health settings, but more are needed to work in non-clinical and rural settings. Sadly, the government initiatives offer no health care to the elderly. Various non government organisations in India are working to care for the elderly. Examples of these groups include Helpage India, the Alzheimer’s and Related Diseases Society of India, the International Longevity Center, medical colleges , universities, and private practitioners – mainly psychiatrists and neurologists. Very few Indian physicians are trained to care for the elderly. Of India’s 206 medical colleges, only one has an MD Program in Geriatrics. This program has trained 20 Geriatricians, but only four currently practice in India. Four other colleges are working to offer services for the elderly. Two physician organisations in India work with the elderly: the Indian Academy of Geriatrics (IAG) and the Geriatric Society of India (GSI). Most of these organisations’ members are internists, GP’s, Psychiatrists and Neurologists. Unfortunately, most of their members lack formal training in Geriatrics. Memory clinics are staffed mainly by internists, psychiatrists, or neurologists who lack training in dementia care. Recognising the need for training GP’s in geriatric care, the Indira Gandhi Open University conducts long distance training in Geriatric Medicine with 4 weeks of practical training to encourage participation. This program has reduced the number of referrals of geriatric patients to neurologists and other consultants. The training has also increased the confidence of GP’s in elder care (unpublished reports, evaluation by Kuba, et al IGNOU). Unfortunately this meaningful effort is not recognised by the Medical Council of India. Major health care services, advocacy, and training for elder care is offered by non government organisations, but there is little coordination of efforts. Although there are many NGO’s serving the elderly, the services they offer are poorly organised and lack the resources necessary to meet the needs of the elderly. The increasing number of elderly, old age homes without regulation, decreasing quality of life, lack of trained health care providers, and a paucity of economic resources for the elderly appear to be a crisis in the future of elder care in India. However, coordination of services between government and the NGO and improved ways of collecting data on elderly care can change this bleak future. India’s government plans to fund Geriatrics Departments in 25 state hospitals and establish two National Institutes of Aging: one in Delhi and the other in Chennai. Questions remain about the needs of the elderly and how the planned measures will meet those needs. The resources invested on the measures could spent to increase programs like the Nightingales Medical Trust in Bangalore that offers comprehensive services for the elderly. This program is one example of how government and NGO can collaborate. The problems of India’s elderly are many, and the answers to solve these problems are also many. One of the ways Indian professionals from abroad can be a part of the solution is to join one of the two societies mentioned above, and participate in decisions and training that improve care for India’s elderly. BGS Newsletter, July 2009 |