geriatric health

1. Geriatric health with special emphasis
on functional disability in elderly
Dr. Devendra kumar

2. Definition of elderly
• Elderly or old age consists of ages nearing or
surpassing the average life span of human beings.
• WHO -65 years and above
• India ,"senior citizen“ - 60 years or above*
*National Policy for Older Persons Year 1999 .Ministry of Social Justice and
Empowerment.GOI.

3. Contd..
1. Age group 60-69 years* -Young old or 'not so old'
2. Age group 70-79years* -Old old
3. Age group 80 years* and over -'older old' or 'very
old' category
• Gerontology - medical study of the ageing process
• Geriatrics- study of diseases that afflict the elderly
*National Policy for Older Persons Year 1999 .Ministry of Social Justice and
Empowerment.GOI.

4. Demography: Geriatric population
• Globally- persons over 60 yrs constitute ~11% of
total population (United Nations Population Division report, 2010)
• In India : persons over 60 years constitute ~ 8 % of
total.(census 2011)
• By the year 2050*:
- overall population in India will grow by 55%,
- elderly people above 60 years - 326%
- the age group of 80+ by 700%
[*World population aging: 1950-2050.United Nations: Population Division,
Department of Economic and Social Affairs, United Nations 2002]

5. World Population trend of 60+ Years
1980-2020 (in millions)
1980 1990 2000 2010 2020
World 381.2 484.7 608.7 754.2 1011.6
Developed 173.3 203.6 234.6 232.4 308.2
Developing 207.9 281.8 374.1 491.8 703.4
Asia (excl. Japan) 160 218.2 290 377.7 539.9
China 78.6 101.2 131.7 167.9 238.9
India 44.6 60.2 81.4 107 149.7
United Nations,World Demographic Estimate and Projections

6. Elderly population (aged 60 years & above)
Source: Population Census Data
As regards rural and urban areas, 71 % of elderly population
reside in rural areas while 29 % of elderly population are in
urban areas.
(8.6%)
(7.4%)
(6.7%)
(6.5%)
(6.0%)
(5.6%)

7. Percentage of the elderly in the total population of
States/UTs
Source: Population Census 2011
Comparison of 2001 and 2011 Population Census data - average
increase of elderly population among states is 1%.
Maximum increase - 3% in Goa.

8. Percent of literates among elderly persons over years
Source: Office of the Registrar General,India

9. Percentage of persons aged 60 yrs and above working
in India
population census 2001,NSSO 2007-08

10. Percent distribution of elderly population by state of
economic independence
National Sample Survey, 2004

11. Old-age dependency ratio in India, 1961-2011
Source: Office of the Registrar General,India
The Old age dependency ratio shows an increasing trend and the
ratio has risen from 10.9% in 1961 to 14.2% in 2011.

12. COMMON MORBIDITIES IN ELDERLY IN INDIA
Cataract &Visual
impairment- 88%
Arthritis & locomotion
disorder-40%
CVD – 18%
Neurological
problems- 18%
Respiratory problems
including Chronic
bronchitis- 16%
GIT problems
9%
Psychiat
ric
problem
s- 9%
12
Situational analysis of the elderly , 2011

13. • International classification of functioning, disability
and health
• Disability- umbrella term for impairment, activity
limitation and participation restriction.(1) (WHO ICF-2001)
• Functional disability defined as having disability in
activities of daily living (ADL) or blindness or bilateral
hearing impairment or a combination of these (2), (3)

14. • Visual disability:
– (a) No light perception - both eyes taken together and
– (b) light perception+ but cannot correctly count fingers
(with spectacles/contact lenses if he/she uses
spectacles/contact lenses) from a distance of 3 metres
(or 10 feet) in good day light with both eyes open.
• Hearing disability:
- cannot hear at all (deaf), or could hear only loud sounds,
or can hear only shouted words, or can hear only when
the speaker is sitting in the front, or usually asking to
repeat the words spoken or would like to see the face of
the speaker.

15. • Locomotor (Orthopaedic) Disability:
(a) loss or lack of normal ability to execute distinctive
activities associated with the movement of self and
objects from place to place and
(b) physical deformities, other than those involving the
hand or leg or both, regardless of whether the same
caused loss or lack of normal movement of body

16. Number of Functionally disabled Persons per 100,000
elderly population
1733 1551
2796
6401
1087
1385
2850
5511
0
1000
2000
3000
4000
5000
6000
7000
Visual Hearing Locomotor At least one
Disability
Rural
Urban
situational analysis of the elderly in India,2011

17. Work in the field of welfare of the elderly
• Constitutional provision- Article 41
• Welfare Approach in Five Year Plans
• Integrated Programme for Older Persons (IPOP),1992
• National Policy on Older Persons (NPOP),1999
• National Council for Older Persons (NCOP),1999
contd..

18. Objectives of NCOP
• Advice the Government on policies and programmes for
older persons
• Provide feedback to the Government on the
implementation of the National Policy on Older Persons
as well as on specific programme initiatives for older
persons
• Advocate the best interests of older persons
• Provide a nodal point at the national level for redressing
the grievances of older persons which are of an
individual nature
contd...

19. • Provide lobby for concessions, rebates and discounts for
older persons both with the Government as well as with
the corporate sector
• Represent the collective opinion of older persons to the
Government
• Suggest steps to make old age productive and interesting
• Suggest measures to enhance the quality of inter-
generational relationships.
• Undertake any other work or activity in the best interest
of older persons.

20. Maintenance and welfare of parents and senior citizen
Act, 2007
• Enacted in December 2007, to ensure need based
maintenance for parents and senior citizens and their welfare.
The Act provides for:
i. Maintenance of Parents/ senior citizens by children/ relatives
made obligatory and justiciable through Tribunals
ii. Revocation of transfer of property by senior citizens in case of
negligence by relatives
iii. Penal provision for abandonment of senior citizens
iv. Establishment of Old Age Homes for Indigent Senior Citizens
v. Protection of life and property of senior citizens
vi. Adequate medical facilities for Senior Citizens

21. NATIONAL PROGRAMME FOR HEALTH CARE OF ELDERLY
(NPHCE-2010)
NPHCE 2010
21

22. National Programme for the Health Care of Elderly
(NPHCE)-2010
Objectives
• Easy access
• provide appropriate health interventions
• Capacity building
• Referral services

23. Core
Strategies
Community level
- domiciliary
visits by trained
health care
workers.
PHC/CHC level -
equipment,
training, additional
human resources
(CHC), IEC,
District Hospital -
10 bedded
wards, additional
human
resources,
8 RMC - PG
courses in
Geriatric
Medicine, and
training
IEC using mass
media, folk
media and other
communication
Strategies for NPHCE 2010
23

24. Supplementary Strategies for NPHCE
Promotion of
public private
partnerships in
Geriatric Health
Care.
Mainstreaming
AYUSH and
convergence with
programmes of
Ministry of Social
Justice and
Empowerment in
the field of
geriatrics.
Reorienting
medical education
to support
geriatric issues.
24

25. Services at Sub-centre
• Health Education related to healthy ageing
– Domiciliary visits to home bound / bedridden
elderly persons .
– Arrange for suitable calipers and supportive
devices.
– Linkage with other support groups and day care
centers.
25

26. Services at PHC
• Weekly geriatric clinic by a trained Medical Officer
• Conducting a routine health assessment (eye, BP,
blood sugar & record keeping).
• Provision of medicines and proper advice on chronic
ailments
• Public awareness on promotional, preventive and
rehabilitative aspects of geriatrics during health and
village sanitation day/camps.
• Referral services.
26

27. Services at Community health centre
• First Referral Unit (FRU)
• Geriatric Clinic - twice a week.
• Rehabilitation Unit for physiotherapy and counselling
• Domiciliary visits by the rehabilitation worker for bed
ridden elderly and counselling of the family members
on their home-based care.
• Referral of difficult cases to District Hospital/higher
health
27

28. Services at District Hospital
• Geriatric Clinic for regular dedicated OPD services with
Lab facility & adequate medicine.
• Ten-bedded Geriatric Ward with existing specialties
• Provide services to referred by the CHCs/PHCs etc.
• Referral services to tertiary level hospitals
28

29. Services at Regional Geriatric Centre
• 30-bedded Geriatric Ward for in-patient care and
dedicated beds for the elderly patients in the various
specialties.
• Laboratory investigation required for elderly with a
special sample collection centre in the OPD block.
• Tertiary health care to the cases referred from
medical colleges, district hospitals and below.
29

30. • NGO’S addressing the elderly :
- Help age India
- Age well foundation
- Rajasthan Voluntary Health Association, Jaipur
- Missionary of Charity, Kolkata
- Ramakrishna Math & Mission, West Bengal
- West Bengal Voluntary Health Association, Kolkata

31. Regional Geriatrics Centers
31
Sr
No
Regional Institutes States Linked
1 All India Institute of Medical Sciences, New
Delhi
Delhi, Haryana, Uttarakhand, Punjab
Himachal Pradesh, M.P.
2 Institute of Medical Sciences, Banaras Hindu
University, Uttar Pradesh
Uttar Pradesh, Bihar, Jharkhand, West
Bengal
3 Grant Medical College & JJ Hospital, Mumbai,
Maharashtra,
Maharashtra, Goa, Northern Districts
of Karnataka,Chattisgarh
4 Sher-e-Kashmir Institute of Medical Sciences,
Srinagar, Jammu & Kashmir
Jammu & Kashmir
5 Govt. Medical College, Tiruvananthapuram,
Kerala,
Kerala, Southern Districts of
Karnataka & Tamil Nadu
6 Guwahati Medical College, Guwahati, Assam Assam & NE States
7 Madras Medical College, Chennai, TN. Tamil Nadu, Andhra Pradesh, Orissa
8 SN Medical College, Jodhpur, Rajasthan Rajasthan & Gujarat

32. Developing Geriatric Department in Medical college
of each States/UTs
It is proposed to develop 12 additional Regional Geriatric
Centers in selected Medical Colleges of the country
7 Aug 2012 32
Sr No State Medical College
1 Punjab PGIMER, Chandigarh
2 Uttar Pradesh KGIMS, Lucknow
3 Jharkhand Ranchi Medical College, Ranchi
4 West Bengal Kolkatta Medical College, Kolkata
5 Andhra Pradesh Nizam Institute of Medical Sciences, Hyd.
6 Karnataka Bangalore Medical College, Bangluru
7 Gujarat B.J.Medical College, Ahmadabad
8 Maharashtra Government Medical College, Nagpur
9 Orissa S.C.B.Medical College, Cuttack
10 Tripura Agartala Medical College, Agartala
11 Madhya Pradesh Gandhi Medical College, Bhopal
12 Bihar Patna Medical College, Patna

33. Benefits Extended By Other Central Ministries For The
Welfare Of Senior Citizens
1) Ministry Of Rural Development
• Indira Gandhi National Old Age Pension Scheme
(IGNOAPS)
2) Ministry of Health and Family Welfare
• Separate queues for older persons
• Geriatric clinic
• National Programme for the Health Care for the
Elderly (NPHCE) from the year 2010-11.

34. 3) Ministry of Finance
• Tax Benefits
- 60-79 yrs- upto 3 lack/yr
- 80 and above upto 5 lack/yr
• Under Section 80D - Deduction of Rs 30,000
• For medical treatment:
- Deduction of upto 60,000 ( 60- 79 yrs)
- Upto 80,000 (> 80 yrs)

35. 4) Ministry of Home Affairs
• Protection of Life and Property
• Ensure safety and security and for elimination of all
forms of neglect, abuse and violence against old
persons through initiatives such as
-identification of senior citizens;
-sensitization of police personnel regarding
safety, security of older persons;
-regular visit of the beat staff;
-setting up of toll free senior citizens helplines(1298);
- setting up of senior citizen security cell;

36. 5) The Ministry of Railways
-Separate ticket counters
- Provision of lower berth
- 40% and 50% concession in basic rail fare for male
(60 years) and female (58 years) above.
- Wheel chairs
6) Ministry of Civil Aviation
• Air fare concession- upto 50% of basic fare

37. Major constraints for geriatric health care
Lack of
specialized and
trained
manpower
Geriatrics
not yet a
popular
specialty
No dedicated
health care
infrastructure
37

38. Contd...
• The current health care system lacks adequate number of trained
medical, paramedical personnel in geriatric medicine - adversely
affect the health care of the elderly.
• Mobile health services for the elderly and ambulance services are
limited in the rural & peripheral areas making the health care
facilities difficult to reach.
• Not a very effective health insurance system in our country.
• At present, most of the geriatric OPD services are available at
tertiary care hospitals and are urban based. At the primary care
level, the infrastructure is grossly deficient.
• Low awareness regarding the services available.