ELDERLY CARE IN INDIA-CHANGING PERSPECTIVES

DR. K.L.SHARMA INDIAN GERONTOLOGICAL ASSOCIATION, INDIA

TRADITION SPEAK

One who always serves and respects elderly is blessed with four things : Long Life, Wisdom, Fame and Power Manusmriti Chapter 2:121

Worldwide Trend of Population of 60 Years and Above : 1980-2020

1980 1990
484.7 203.6

2000
608.7 234.6

2010
754.2 232.4

2020
1011.6 308.2

World Developed

381.2 173.3

Developing
Africa Latin America Asia (excl. Japan) China India

207.9
23.4 23.4 160 78.6 44.6

281.8
30.9 31.7 218.2 101.2 60.2

374.1
41.8 41.9 290 131.7 81.4

491.8
57 56.4 377.7 167.9 107

703.4
82 80.7 539.9 238.9 149.7

United Nations,World Demographic Estimate and Projections

Proportion of Aged 60 and Over Population (in Per cent)

1980 World Developed Developing Africa Latin America Asia (excl. Japan) China India 8.6 15.2 6.3 4.9 6.5 6.5 7.4 6.5 1990 9.2 16.8 7 4.8 7 7.4 9 7.3 2000 9.9 18.4 7.7 4.8 7.7 8.5 10.5 8.4 2010 10.8 19.7 8.7 4.9 8.8 9.8 12.4 9.9 2020 12.9 22.4 10.9 5.6 11 12.8 16.6 12.6

United Nations,World Demographic Estimate and Projections

Elderly Population-Facts!
Aging of population is an end product of demographic transition. The number of elderly people in developing countries is almost 3-4 times of that of developed countries. The developed countries have already experienced the consequences of this transition.

Elderly Population-Facts!
World population of 6.1 billion at the dawn of 21st century is likely to become 9.3 billion in 2050 (UN 2004). Global aged population from 595 million to 2 billion a four fold riseby 2050! In terms of proportion -10% in 2000, 15% by 2025, rising to 21.6% by 2050.

Elderly Population-Facts!
73 % of deaths in the elderly are related to heart diseases, smoking and cancers. 20% of doctors visits, 30 % of hospital days and 50% of bedridden days are ascribed to elderly patients. Expansion of morbidity even though increased life expectancy due to chronic non-communicable diseases.

Elderly in India -Facts!

24 million in 1961 increased to 77 million in 2001 Projected to rise to 179 million in 2031 and 301 million in 2051. 70 and above projected to increase from 29 million in 2001 to 132 million in 2051. 80+ would be fastest to grow 8 million in 2001 to 32 million in 2051.

Elderly in India -Facts!

2nd largest elderly (60+) population in the world (2001) 80% are in rural areas 40% are below poverty line over 73 per cent are illiterate. about 90 % of the old people have no official social security (i.e., without PF, Gratuity and Pension etc).

Elderly in India -Facts!

Life expectancy 31.7 years in 1941 increased to 60.5 years in 2000. 55% of the women of 60 years and above are widows. Older women most vulnerable. Elderly poverty is a major risk of ageing in developing countries.

Not just the numbers

Family structure is changing to nuclear/small unit families. Without the safe, secure and dignified status in the family, the elderly are finding themselves vulnerable. Welfare of the elderly has been a low priority with the state

Distribution of Aged Persons by State of Economic Dependence (n=1000)

Not Dependant Rural Male Female Urban Male Female 515 115 169 110 297 757 19 18 485 121 180 146 313 706 22 27 Partially Dependant Fully Dependant No Response

National Sample Survey 52nd Round Survey, 1995-96

Distribution of Care Provider of Economically Dependent Aged

Spouse Own Children Grand Children Others

Rural
Male Female Urban 113 159 766 717 50 52 71 72

Male
Female

105
182

792
695

54
56

49
67

National Sample Survey 52nd Round Survey, 1995-96

The Support
The major thrust has been on improving the health status of children and women Geriatric services are largely unorganized. There are 186 old age homes, 233 day care centers and 28 medical vans These are managed by NGO/network of PHC and subentries in the rural areas.

Geriatrics in India
Most hospitals do not have a special geriatric facility. At present most elderly patients are still being treated in general medical wards. There is only one hospital in Chennai that gives post-graduate (M.D.) education in geriatric medicine! Similarly the nursing and other paramedical staff are not formally trained in providing care for elderly patients.

Distribution of Chronic Diseases in Aged (n=1000)

Rural Urban F 1958 16 404 105 27 23 28 M 179 32 285 200 68 49 85 F 142 18 393 251 53 24 66

India
Chronic Disease
Cough Piles Joint Problems High/low BP Heart Disease Urinary Problem Diabetes

M 250 33 363 108 34 38 36

Cancer
Any of the above

2
527

3
514

2
528

4
560

National Sample Survey 52nd Round Survey, 1995-96

Distribution of Physical Disability in Aged (n=1000)

Rural India Disability
Visual M 249 F 291 M 225 F 260

Urban

Hearing
Speech Locomotor

139
32 107

156
38 115

111
29 80

132
3 94

Amnesia/Senility
Any Disability

96
380

113
425

61
333

80
367

National Sample Survey 52nd Round Survey, 1995-96

The policy Initiative in India

1999 Indian Government announced a National Policy on Older Persons policy implementation is to be monitored by National council for Older Persons (NCOP). joint responsibility of the state and Central governments in December 2007 Indian parliament has passed a bill known as Maintenance of parents and Senior citizens Act

Policy aims to.

to encourage geriatric units in hospitals and clinics infirmary care units emphasis on family care of the aged through incentives and schemes for the needy families promotion of values through formal education and media subsidizing old age homes and day care centers

Geriatric Nursing Care Workshop (November 07)

In collaboration with NICE/ICCE 5 day workshop Attended by nursing staff of different hospitals in the state of Rajasthan, India.

Aims of the Workshop

Provide improved ideas and practices in the Care of elderly Refine existing practitioners skill in the care of elderly Draw attention of general practitioners to the needs of care of elderly Positively influence Government policy initiatives on geriatric care

Indian Gerontological Association www.gerontologyindia.com

Established in 1968 Devoted to well being of Senior citizens & research on ageing Indian Journal of Gerontology -1969 Affiliated to IAGG in 1971

Indian Gerontological Association

Runs a Day Care Centre Runs a counselling centre for elderly Organises training for family care givers Organises lectures on diseases common in old age Consultancy for NGOs working for elderly

In Summary
Elderly population in India is increasing. Status of elderly changing in family. Geriatrics is in incipient stage. NGOs have important role to play in creating awareness, imparting information and training of support services. We need to learn from the model of geriatric care in the developed countries.

THANKS

By: Dr. K.L. SHARMA