Care in the twilight years

Geriatric care is a multidisciplinary branch of medical science. A relatively new discipline in India, it requires a keen focus from healthcare experts, sociologists, psychologists and policy makers

All people who are 60 and above qualify as senior citizens in our country. However there are several sub-classifications of this group. Infact some scientific journals on geriatric science say that people between 60 and 65 years of age are just considered to be elderly. The old tag really sets in at 65. People between 65 and 74 years are considered to be the young old, the people between 75 and 84 are considered as the middle old and people who are 85 and older are considered to be the old-old.
This however is not a watertight demarcation in terms of discussions and analysis on the various aspects that constitute geriatric care. Generally speaking, in our society people within the age bracket of 60 to 69 years are perceived as a group of elderly individuals who are capable of leading independent lives both in a physical and economic sense. This independence is ofcourse subject to sound health conditions and it cannot be denied that this group is also vulnerable to a slew of diseases that signal the human ageing process like arthritis, osteoporosis, diabetes, hypertension, cardiovascular ailments etc. The people within the age bracket of 70 and 79 who are more vulnerable to ailments are considered to be old in a biological sense. It is a recognized fact that owing to diminishing physical vitality and mobility most people in this group need some degree of external support to manage their lives. On the other hand people who are in their eighties and nineties are considered to be really old.
Geriatric care in India is unfortunately a partial reality only in the elite and urban strata of society. A country which ranks second in the world in terms of absolute numbers of elderly citizens India has some chilling facts. 90% of our elderly have no official social security by way of gratuity, provident fund and pension. About 52% of the elderly population is living in extreme poverty and abysmal health conditions. Only 12% are aware of government schemes for the elderly and only 5% are covered under health insurance. NGO intervention in elderly care is a miniscule 3%. These very figures reiterate the need for extensive and immediate action in geriatric care. Needless to say the interventions have to be at a medical, social, economic and psychological level.
For starters, though it might seem like a monumental goal at this point of time, the government should ensure health insurance for the entire elderly population. Perhaps it will be a good idea for private public partnerships in this space as mega private corporations can get into health insurance for the elderly by way of their CSR (corporate social responsibility) mandates. But it is not just the money that can make a difference. Hospitals and primary health care centers in both rural and urban India should have dedicated geriatric care departments, specialized doctors and trained caregivers. These doctors need to be nuanced in comprehending multiple (and often conflicting) patient reports and prescriptions as aged patients often visit doctors with previous reports of medical procedures prescribed by other doctors. Needless to say they also need to have a compassionate disposition as older patients require a lot of psychological assurance while undergoing treatment.
Interestingly in geriatric medical care, unlike other branches of medical science, the discussions on what can be done often shifts to what needs to be done. For instance it is not enough to prescribe an effective line of treatment. It is equally important to have the patient's consent in terms of following the treatment. Doctors often share experiences of how aged patients resist certain medical prescriptions and procedures owing to apprehensions, anxiety or just plain overwhelming physical discomfort. Palliative care and hospice care are intrinsically linked to the treatment of terminally ill geriatric patients. Social history taking meaning taking notes on the patient's familial, recreational and occupational history and examining the clinical aspects of the disease in the ambit of this history is crucial.
About 52% of the elderly population is living in extreme poverty and abysmal health conditions
NGO's and individuals who are interested in making a positive difference to geriatric care can facilitate the formation of specialized networks of doctors, nurses and paramedics who can go for home visits as a substantial portion of the older generation are either partially or entirely immobile. Mobile units carrying doctors specialized in treating the elderly should be dispatched to remote rural areas at regular intervals by the state and central governments. The focus should primarily be on annual health checkups and distribution of nutrition supplements. It is also critical to have state of the art government hospitals that can effectively deal with the evolving spectrum of geriatric diseases in rural areas so that they do not have to rush to the nearest city hospital in times of emergencies.
Representative image
Image: Representative image
It is psychologically very important for society to make the older generations feel wanted. Today with the massive disintegration of the joint family structures older people often experience a sense of isolation. This can be addressed in a variety of innovative ways. For instance NGOs can set up hobby clubs for older people where they get to interact with their contemporaries. A substantial number of aged people feel alienated from the world as they are not up-to-date with the latest advancements in technology. Hence they should be secured the provision of employing certified professionals who can help them to upgrade their technical skills. This should ideally be like an in person consultation. The consultation fees should be extremely nominal and this infact is another area that NGOs and concerned individuals can address.
Economic independence is vital for the elderly both in terms of their self esteem and financial freedom. Therefore creating employment ecosystems to engage the aged who are seeking employment opportunities is perhaps a good idea. These jobs should have flexible working hours and employers should secure transportation to and from the workplace. Teaching underprivileged children, making crafts and cuisine and consultancy are some work options that might appeal to the aged. Though jobs that can be done from home are more conducive for the aged it cannot be denied that many do experience a better sense of self worth if they venture out and socialize with people.
The perspectives and discussions in geriatric care are ever evolving and everything can never actually be stated in a single article or forum. However, we hope we have managed to bring your attention to some of the alarming facts and aided introspection in the right directions.
Do watch this space for a feature on geriatric care specific to the north eastern states.



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