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Scenario of Geriatric Care in India
Dr. Tapas Das
Professor, Department of Medicine, In-charge, Geriatric Clinic
I.P.G.M.E.R & SSKM Hospital, Kolkata
Joint Secretary, Indian Academy of Geriatrics.
Introduction
The geriatric age group is taken as 60 years and above in India. It is also the recommendation of the W.H.O. In developed countries, the cut-off age is 65 years and above. Recently, the elderly have become have become the focus of attention in developing countries, particularly China and India, because of their increasing number and deteriorating conditions.
Demography of Ageing in India
India has a population of 1000 million which constitutes about 16% of the world's population. The elderly population in India has grown from 12.06 million in 1901 to 75.93 million in 2001 as shown in Figure 1. It is the second largest in the whole world. The aged population in our country is likely to touch the 300 million mark within the next half century. Among the states, Uttar Pradesh has the highest number of elderly and the smallest number is in Lakshadweep. The percentage of population aged 60 and over to general population in India was 5.06 in 1901 and in 2001 it was 7.70, The projected figure in 2050 is 23 – 30%. The highest population of older people is found in Kerala (8.77%) and the lowest is Andaman and Nicobar Islands (3.55%).
In general, the elderly males slightly predominate over the elderly females except in the 70+ age group where there is slight female preponderance. In India the expectation of life in males at age 60 years has gone up from 11.8 years to 15.2 years between 1961 and 2001 respectively. In females over the same period the life expectancy has increased from 13.4 years to 16.4 years. In India, 78% of elderly live in rural area comprising 7.22% of population whereas 22% of elderly live in urban area comprising 5.37% of population. In our country 70% of elderly are dependent, more so the females; 70-90% elderly are dependent on children. Regarding living arrangement, 55-57% of elderly live with their spouses, 33-35% with their children, 5% with relatives and friends and 4-5% live alone.
Patients belonging to the ‘geriatric' age group have multiple problems. Various workers have studied the morbidity of elderly in India as shown in Figure 2. The common chronic problems in old age are hypertension, cataract, osteoarthritis, chronic obstructive pulmonary disease, ischaemic heart disease and Type – 2 diabetes mellitus. The incidence of the latter is increasing day by day in geriatric clinics. Besides, enlarged prostate (in males), dyspepsia, irritable bowel syndrome and depression are also frequently seen. Stroke, cancer, infections like tuberculosis as well as malnutrition is also common.
The National Scenario of Geriatric care
In 1999, the Ministry of Social Justice and Empowerment, Government of India, promulgated the “National Policy on Older Persons”. The national policy stressed on setting up of geriatric wards in all hospitals, training of medical and paramedical personnel in Geriatrics at all levels of health care and promotion of research on ageing. Till now, the national policy has been partly implemented and will also be incorporated in the forthcoming eleventh five-year plan. Some centres in our country are doing outstanding work in geriatrics. At Chennai Medical College there is a full-fledged Geriatric Medicine Department with 35 beds as well as a Geriatric Surgery Department. At A.I.I.M.S New Delhi, Geriatric services are available and it has got a geriatric clinic for a long period. Ram Manohar Lohia Hospital and Safdarjung Hospital at New Delhi are also developing geriatric wards. Besides Dr. S.N. Medical College and Hospital at Jodhpur, Institute of Medical Sciences, B.H.U. at Varanasi, G.S. Medical College and KEM Hospital at Mumbai and Government Hospital, Trivandrum have facilities for geriatric care. In this context, it must be mentioned that the Amrithanandamayee Institute of Medical Science at Kochi, Kerala has got comprehensive geriatric services. At Kolkata, the first geriatric clinic in this part of the country started functioning at Calcutta Medical College from 04.08.2001. There are geriatric clinics at S.S.K.M Hospital, Kolkata and national Medical College, Kolkata also. Non Government Organizations (NGO) play a big role in taking care of geriatric patients. The Helpage India is an institutional organization which runs mobile medicare units for elderly patients in slums and rural areas adjoining big cities. This mobile medicare unit is a large van with doctor, pharmacist and drugs. Other NGO's are the Dignity Foundation, Indian Association of Retired Persons, The Alzheimer and Related diseases Society of India (A.R. D.S.I.) etc. In South Kolkata, the Bethune Institute of Geriatrics Research and Rehabilitation Centre is also doing commendable work at the community level. Apart from these there are numerous old age homes and day-care centres throughout our country.
The Academic Scenario of Geriatrics in India
The pioneering role in the academic scenario of geriatrics in our country has been played by both New Delhi and Chennai. Prof. A. B. Dey, Chief of Geriatric Services at A.I.I.M.S, New Delhi, has conducted several training programs on “Health Care of the Elderly” at A.I.I.M.S, New Delhi for teachers of Medical Colleges. Prof. B. Krishnaswamy, Head of Geriatric Medicine, conducts M.D. Course in Geriatric Medicine at Chennai Medical College. The Indira Gandhi National Open University (IGNOU) conducts Post Graduate Diploma course in Geriatric Medicine (PGDGM). A national organization the Indian Academy of Geriatrics was born in 2004 with the idea of promoting academics in geriatrics. It also publishes a quarterly journal from Jodhpur.
Consultative Workshop on National Strategy for Health Care of the Elderly
A workshop sponsored by the Ministry of Health and Family Welfare Government of India, was held at A.I.I.M.S. New Delhi on 14*15 April 2006. It was decided that the Geriatric Service at the tertiary care setting should ideally have daily O.P.D.S. special clinics like memory clinic, day-care centres and facilities for in-patient care, long term care and community services. It was also agreed that the Natioanl Rural Health Mission (NRIIM) could be used as a platform to disseminate old age care at the primary level. For this purpose the Accredited Social Health Activist (ASHA) and the Anganwadi Worker (AWW) could be trained to look after the problems of the elderly in addition to their maternal and child health duties.
Expert Group Meeting on Science and Technology in old age care
This meeting was held at AIIMS, New Delhi on 22 nd September 2006 to discuss how newer developments in Science and Technology could be applied in improving geriatric care. Suggestions were made for the development of multidisciplinary collaboration among various experts; utilizing web based educational programs including distance education.
Conclusion
The increasing number of elderly persons will have a direct impact on the demand for health services. In view of the changing social system, social security measures for the prospective elderly may also become imperative. Mobilization of additional resources for geriatric care will emerge as a major responsibility of health care providers in future for countries like India.
Growth of Elderly Population aged 60 and over by sex in India 1901-2001
Morbidity of Elderly in India chronic Diseases higher in Urban (55%) than in rural (52%)
References
- Rajan S. I. Demography of ageing. In ageing in India. Ikl A.B. Dey Ministry of Health and Family Welfare, Government of India and World Health Organization. 2003 3-11
- Jai Prakash I. Ageing in India. World Health Organization. Geneva. 1999 1-15
- Government of India National Policy for older Persons 1999 Ministry of Social Justice and Empowerment, Government of India, New Delhi
- Moharana D.N. Moharana S. Geriatric Medicine in the Indian context Quartmed rev. Jan-March 2007 58:1:2-6.
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