WELFARE OF SENIOR CITIZENS - GERIATRIC CARE

WELFARE OF SENIOR CITIZENS- GERIATRIC CARE

Workshop Series : 6 / HSW / 2013

State Planning Commission24th July 2013

11State Planning Commission

Workshop Series: 6 / HSW / 2013


Welfare of Senior Citizens - Geriatric Care

2 State Planning Commission

Tamil Nadu State Planning Commission The State Planning Commission was constituted in Tamil Nadu as an Advisory body on 25th May 1971 under the Chairmanship of the Hon’ble Chief Minister to make recommendations to the Government on various matters pertaining to the development of the State. The Chairman of the Commission is assisted by Vice Chairman, Full Time Member & Part Time Members who are experts in various fields. The Principal Secretary to Government, Planning, Development and Special Initiatives and the Principal Secretary to Government, Finance Department are the ex-officio members. The Member Secretary is responsible for administration in the Commission.

The Commission has the following technical divisions:1. Agricultural Policy and Planning2. Industries, Power and Transport3. Land Use4. Education and Employment5. Health and Social Welfare6. District Planning and Rural Development7. Plan Co-ordination.

Main activities of SPC:1. Preparation of Five Year and Annual Plans based on the policies and priorities of the Government.2. Undertake Mid Term review of the Five Year Plan, other special reviews on the Economy and

advise the Government on appropriate modification and restructuring of the schemes.3. Monitor development indicators that influence the Human Development Index, Gender

Development Index, etc., at a disaggregated level and suggest correctional measures.4. Undertakes special studies as required for formulation and implementation of plan projects

and programmes. The State Planning Commission also organizes seminars/workshops.5. Tamil Nadu State Land Use Research Board (TNSLURB) is functioning under the chairmanship

of Vice Chairman, State Planning Commission as a permanent body in the State Planning Commission. This Board is intended to promote interaction and study in the vital areas of land use. TNSLURB The State Planning Commission organizes seminars/workshops and undertakes studies on Land Use.

6. Human Development Reports (HDRs) were prepared for Dindigul, Sivagangai, Tiruvannamalai, Cuddalore, Nagapattinam, the Nilgiris, Kanyakumari and Dharmapuri districts. The concept of Human Development has been disseminated to all districts through workshops organized in the concerned districts. Preparation of District Human Development Reports (DHDR) for the remaining districts is under process.

7. State Balanced Growth Fund (SBGF) is operated to bridge the regional imbalances among the districts.

Welfare of Senior Citizens - Geriatric Care ...............................................................................................................................


CONTENTS

Page No

Workshop Team 4

Executive Summary 6

Introduction 7

Geriatric Care Management 7

Demographic data of Elders 7

Ageing – Problems and Challenges 10

Health Status of Elders 11

Insight into Geriatric Medicine 13

Comparison of Geriatric Services in India with other Countries 15

Geriatrics Department in the Madras Medical College (MMC) 16

Strategies proposed for strengthening Geriatrics Department 18

Elder Abuse 20

Maintenance and Welfare of Parents and Senior Citizens Act, 2007 21

National Programme for the Health Care of the Elderly (NPHCE) 23

Interventions of the State in Geriatric Care 25

Role of NGOs in Geriatric Care 28

HelpAge India 28

Senior Citizens Bureau 30

Federation of Senior citizens Association of Tamil Nadu 31

Remarks / Suggestions of the Participants 33

Recommendations of the State Planning Commission 37

List of Participants 38

............................................................................................................................... Welfare of Senior Citizens - Geriatric Care


WORKSHOP TEAM

State Planning Commission

Tmt. Santha Sheela Nair, I.A.S. (Retd.)Vice Chairman

Dr. K. SridharMember (Health)

Thiru. M. Balaji, I.A.S.,Member Secretary

Tmt. S.R. NavaneethamHead of Division (Health and Social Welfare - HSW)

Thiru S. Boopathy MohanProgrammer

Tmt. R.B. KoteeswariTechnical Assistant - HSW Division

Tmt. K.S. JayanthiTechnical Assistant - HSW Division Thiru. A. SabarinathanPlanning Junior Assistant - HSW Division

Tmt. S. VijayalakshmiTypist - HSW Division

Welfare of Senior Citizens - Geriatric Care ...............................................................................................................................


WORKSHOP TEAM

Presentations by

Dr. B. KrishnaswamyProf. and Head, Department of Geriatric MedicineMadras Medical College andRajiv Gandhi Government General HospitalChennai

Dr. C. RajendiranAcademic Head & Senior Consultant PhysicianBillroth Hospitals Chennai

Thiru. Edwin BabuJoint Director – ProgramsHelpAge IndiaChennai

Dr. Capt. M. SingarajaChairman, Senior Citizens Bureau and Editor “LINKAGE”Chennai

Th. D. Rajasekaran, I.R.S. (Retd.)President, Federation of Senior citizens Association of Tamil NaduChennai

............................................................................................................................... Welfare of Senior Citizens - Geriatric Care


Executive Summary ......................................................................................................

is a need for elder care in all aspects, viz. socio-economic, financel, health, shelter etc.

As the elderly population is more likely to increase in future, there is also a definite need to emphasise the fact that disease and disability are part of old age and it is high time that the health care system gears itself to the growing health needs of the elderly in an optimal and comprehensive manner. The Senior Citizens are a treasure to the society since they possess vast experience in different walks of life, through which younger generations can gain more in all perspectives. After having served all through their life, they need to be taken care of and made to feel privileged.

In this context, a workshop was organised in the State Planning Commission under the Chairmanship of the Vice Chairman, State Planning Commission. Resource persons working for the welfare of the Senior Citizens and in the domain of Geriatrics shared their experiences and contributed vital inputs to improve the services provided to Senior Citizens substantially.

Ageing is an irreversible biological phenomenon and is a universal process affecting every human being in the world. The demographic ageing of population has implications at the macro and also at household level. This phenomenon is more evident in developed countries, but recently it is increasing more rapidly in developing countries like India, which has the second largest aged population in the world. Increase in life span also results in chronic functional disabilities creating a need for assistance to manage simple chores and consequent loss of autonomy.

Industrialisation, Urbanisation, Educa-tion are bringing changes in values and life styles in our society. Disintegration of the joint family structures, rapid expansion of the nuclear family system and migration to urban areas & out of the country have created challenges in the care of the elderly. Poverty and loneliness further add to the problem of elder care by rendering them even more vulnerable. As a result of the current ageing scenario, there


Geriatric care generally means elderly care or care of the elders. Care of elders encompasses the care at the individual level and also at the community level. Elderly being the expanding population are in need of all levels of health care. The Elderly face deprivations under three broad heads viz. Health, Economical and Emotional. The health of the aged has become a major concern, since the infrastructure and trained manpower in the current health care system is grossly deficient for provision of comprehensive health care to the elderly at all levels. Physically active adults are more likely to survive to age 80 years or beyond and have approximately half the risk of dying with disability when compared with their sedentary peers. Positive personal health behaviour as well as preventive practices can ameliorate the health problems among all segments of the population and particularly among the elderly.

Geriatric Care Management

Geriatric Care Management is the process of caring for and coordinating the needs of older adults. Geriatric Care Management is also known as “Elder Care Management”, “Senior Health Care Management” and “Professional Care Management”. It is the process of planning and coordinating the care of the elderly with physical and/or mental impairments to meet their long term care

needs, to promote good health, improve their overall quality of life, reduce the need for hospitalisation and all the while working to enable independent living for as long as possible. It entails working with persons of old age and their families in managing, rendering and referring various types of health and social care services. Geriatric care managers accomplish this by combining a working knowledge of health and psychology, human development, family dynamics, public and private resources and funding sources, while advocating for their clients throughout the continuum of care.

Geriatric care management integrates health care and psychological care with other needed services such as housing, home care services, nutritional services, assistance for the activities of daily living, socialisation programmes as well as financial and legal planning (e.g. banking, trusts). A care plan tailored for specific circumstances is prepared after a comprehensive assessment and is continuously monitored and modified as needed. The Care Managers are knowledgeable, warm and compassionate people, who coordinate, observe and adjust the levels of services the clients receive.

Demographic data of Elders

Ageing is a byproduct of demographic transition i.e. the shift from high fertility and

Introduction .....................................................................................................................


mortality rates to low fertility and mortality rates and one of the major features of demographic transition in the world has been the considerable increase in the absolute and relative number of elderly people. Demographic transition has been accompanied by changes in society and economy. These are of a positive nature in some areas and a cause of concern in others.

According to estimates released by the United Nations Population Fund, by 2050, there will be 64 countries where older people make up more than 30 percent of the population. In simple terms, within a decade there will be one billion older persons worldwide. Also by 2050, nearly 80 percent of the world’s older persons will be living in developing countries — with China and India contributing to over one-third of it.

The population of the elderly is one of the fastest growing segments in India. Countries with huge population such as India have large number of people aged 60 years or more. The population over the age of 60 years has tripled in the last 50 years in India and will relentlessly increase in the near future.

In 2001, the proportion of older people was 7.7% which increased to 8% in 2011 and the same is expected to increase to around 9% by 2016. Within the next five years, the number of adults aged 65 & above will outnumber children under the age of 5. According to 2001 census,

there were 75.93 million Indians above the age of sixty years; of them 38.22 million were males and 37.71 million females. In 2011, there were 90 million elderly persons in India and currently there are an estimated 100 million elderly in India. It has been projected to grow to 173 million by 2026 and cross 300 million by 2050.

Another emerging scenario is the increase in life expectancy. The expectancy of life at birth is also consistently increasing indicating that a large number of people are likely to live longer than before. The expectancy of life at birth during 1996-2001 was 62.3 years for males and 63.39 years for females. The projected data for the periods 2011-2016 are 67.04 for men and 68.8 years for women.

Feminisation of elderly population has also become a major concern. Nearly three out of five single older women are very poor and two out of three rural elderly women are fully dependents. Further, the older population itself is ageing, with the Oldest Old being more than 10 percent of the world’s elderly.


The demography of the last 15 years shows that more than 8% of Population in India are elders who have multiple problems and are dependent.

• In2012,96millionwereOlderPeople.Thecurrent estimate is approximately 100 million and their population is expected to rise to 177 million by 2025 and 324 million by 2040.

• 75%oftheolderpeopleliveinruralareas.

• 33%arebelowthepovertyline.

• More than two third of the Oldest Old(80+) are financially dependent on others.

• Mostof themare fromtheunorganizedsector with no financial and social security.

• TheirIlliteracyrateis70.3%

• 58% of them are widows/unmarried/divorced

• 8% of older Indians are confined totheir home or bed. The proportion of such immobile or home bound people rose with age to 27% after the age of 80 years.

• Life Expectancy is 16.2 at 60 years and10.6 at 70 years.

Further, by the year 2016,

• Agegroup<15yrswilldeclinefrom353to 350 million

• Agegroup15-59will increase from519to 800 million

• Agegroup>60yrswillincreasefrom62.3to 112.9 million


Ageing is the process that converts healthy adults into frail ones with diminished reserve and vulnerability to diseases. This decline causes no symptoms and imposes few restrictions on Activities of Daily Living (ADL). Ageing can be classified into three types viz. Active, Assisted and Dependent. The factors of Ageing are:

• Intrinsic-Genetic

• Extrinsic–Diet,LifeStyle,PersonalHabits,Psychosocial

Oldest Old (80+ years)

Elders generally mean those above 60, but they can be classified as those in the age group of 60-70, 70-80 and the third group above 80. Each group has its own problems and requires different approach for solutions, especially the 80+ group, whose problems are predominant. Health care providers strongly recommend that, people aged 80+ years need respect in family, security, emotional, mental and family support which is desirable for providing them a healthy life. Outreach services should also be provided to the oldest of the old. Houses with oldest of the old population should be identified and registered with their health status, issues/ concerns. This can be done by the local health functionaries. Since financial dependence on family members and others is a primary issue at this age, the

oldest of the old should be provided with free treatment and medicines or universal health insurance coverage that covers all types of health problems of the oldest of the old.

Mobilisation and community based support towards the Oldest of the Old also needs to be emphasised and worked upon. Efforts need to be made to sensitise the people especially the young generation towards the needs and concerns of the Oldest of the Old. Government should initiate some elder friendly health schemes exclusively for 80+ people and all the new and existing schemes should be made available at each and every door step.

Ageing – Problems and Challenges ..............................................................


Problems of Older Persons (10+1)

• Abuse

• Boredom

• FailingHealth

• Fear

• Isolation

• Neglect

• InabilitytoMainstream

• EconomicInsecurity

• LossofControl

• LoweredSelfEsteem+Equity

Population Ageing - Challenges

• How do we help people remainindependent and active as they age

• How can Health promotion andprevention policies be strengthened

• Howcanqualityoflifebeimproved

• What effect does ageing has on SocialSecurity System and Health Care

• How to balance the role of Family andState

Active Ageing

Active Ageing is the process of optimi-sing opportunities for Health, Participation and Security in order to enhance quality of life as people age. The interconnecting principles are Sustainability, Participation and Environment. The concept of Active and Healthy Ageing needs to be promoted not only among the

elderly but the younger age groups as well, which include promotional, preventive and rehabilitative aspects of health. The key factor of Active Ageing are:

• PeriodicHealthCheckup

• PromotingNutritionandExercise

• Avoiding Substance Abuse and SelfMedication

• HealthEducation-ElderlyandCaregiver.

Determinants of Active Ageing

• HealthandSocialservices

• Behaviouraldeterminants

• Personaldeterminants

• Socialdeterminants

• Economicdeterminants

• Physicalenvironments

Health Status of Elders

Health is the single most important determinant of the quality of life among elderly and their health status is determined by a host of economic, social, psychological and physiological factors. With advancing age, ill-health becomes a major hindrance for the well–being of the elderly. The unprecedented increase in human longevity in the 20th century has resulted in the phenomenon of ageing population all over the world. The prevalence and incidence of diseases are much higher in older people than the other population. The burden of morbidity is enormous in old age.


There is also a shift in the disease pattern i.e. from communicable to non-communicable. Non-communicable diseases (life style related and degenerative) requiring large quantum of health and social care are extremely common in older people, irrespective of socio-economic status. Disabilities resulting from these non-communicable diseases are very frequent which affects the functionality in old age compromising the ability to pursue the activities of daily living. The treatment/management of these chronic diseases are also costly, especially for cancer, joint replacements, heart surgery, neuro-surgical procedures etc., thereby making it out of bound for the elderly whose income decreases post-retirement and more so for the elderly in the unorganised sector and dependent elderly women.

The public health significance of these demographic transformations includes the increased burden of chronic disease and disability on health care and socio-economic impacts on care giving. Women are more frequently affected than men in both villages and cities.

The Physical Health Status of the Elderly is as follows:

• More than 45% suffer from ChronicDiseases (Rural- 45%; Urban-55%).

• It is estimated thatbyyear2015,nearly7 lakh elderly in India within the age bracket of 60–69 will die of Coronary Heart Diseases.

• Multiple Medical & PsychosocialProblems

> SensoryImpairment

> MobilityDisorders

> CVS (Cardiovascular System) and CNS (Central Nervous System) disorders

> Falls / Fractures / Incontinence /Dementia

• Declining Functional Status /Dependency

• Thedatarelatingtotheirailments:

> Arthritis–86%

> Sensoryimpairment–74%

> Hypertension–45%

> IHD–42%

> Diabetes–32%

> Nutritional–24%

> Depression–14%

> COPD (Chronic Obstructive Pulmonary disease) – 14%

> CVA (Cerebrovascular Accident) – 12%


The Clinical decision making including diagnosis, treatment and outcomes differ between younger and elderly patients. If the disease is acute, curative treatment is possible and if the disease is chronic, only control or symptom modifications should be aimed. The conventional disease-specific approach is not optimal in elderly patients.

The disease patterns in the elderly are of multiple Pathology/ Etiology in nature and non-specific. If left untreated, there will be rapid deterioration and high incidence of secondary complications. As such, early aggressive and appropriate treatment results in good response.

Multiple-pathology is multiple co-existing chronic diseases, less consistent relationship between pathology and disease or between disease and clinical manifestations. One disease may obscure or change the pathology, manifestations or accuracy of laboratory evaluation of co-existing diseases and treatment of one disease may increase the severity of another.

The aim of any investigation should be based on identification of the impairments, diseases and other factors. The goal of treatment should be to offer more cure than relief. In every step of clinical decision, the role of family, especially the care-giver is very crucial, who may provide additional

sources of information, facilitate adherence to treatment recommendations and offer both emotional and instrumental support. Striking a balance between patient confidentiality & family involvement, between independence & support and between patient & family is a constant challenge.

The age related diseases include Sensory impairment, Arthritis, Hypertension, Diabetes, Nutritional Problems, Stroke, Depression Dementia, Osteoporosis, Fall, Fracture, Malignancy, Asthma etc. Further, the Communicable (infectious) diseases account for one third of all deaths in people of 65 years and older. Early detection is more difficult in the elderly because the typical signs and symptoms such as fever and leucocytosis are frequently absent. Prevalence of both bacterial and viral infections is more in elders and the diseases preventable by vaccine can be avoided by proper vaccination.

Non-communicable diseases (NCD) may be chronic diseases of longer duration and slow progression or they may result in more

Insight into Geriatric Medicine ......................................................................


rapid deaths such as some types of sudden strokes. The Health Interventions to address the problems of the Elderly include:

• ImprovingHealthAccess

• HealthPromotion

• EarlyDiagnosis&Management

• Rehabilitation

• MaintenanceofIndependence

Preventive Geriatrics

• Care at the Primary Level plays animportant role in our Health system.

• Periodichealthcheckupsofelderlywithspecific goals.

• Investigations to be relevant for theparticular patient.

• Reducing risk factors by increasingfactors that protect health.

• Counselling and Communication on Injury prevention, Life style, Immuni-sation, Early screening of disorders etc. should be given periodically.

• Adoptinghealthylifestylesisapreventivemeasure. It’s a misconception that,

healthy lifestyles cannot be adopted in later years.

The following are the types of Geriatric Services prevalent now:

• AcuteCareHospitals

• DayCareHospitals

• LongTermCare

• MobileGeriatricUnit

• CommunityBasedRehabilitation

Acute Care

The elderly are the major occupants of Critical Care Unit as they are susceptible to a variety of geriatric syndromes and diseases. The goals of Critical care are restoring physiological stability, preventing complications, maintaining comfort and safety, preserving or preventing decline in pre–illness functional ability and Quality of Life (QOL). In USA, over 50% of all ICU bed days are for patients older than 65. According SAPS 3 database (35 countries worldwide) about 47% patients were older than 65. Serial databases show increase in proportion of elderly patients with time. The expanding elderly population and increasing expectation on Health care/Quality of Life demands use of invasive devices and life sustaining technologies.

The Clinical evaluation of patients admitted in Intensive Care Unit show that advanced age was not directly related to increased mortality in ICUs. The elderly and very elderly patients show a sharp improvement during hospitalisation in an ICU. With the


advance of age, people tend to significantly benefit from intensive care.

Day Care

• Closertocommunity

• Minorailments

• ReferralCentre

• Costeffective

Long term Care

• Under long term care, the patients areclassified as Short Stayers (1-6 months) and Long Stayers (6m-years) depending upon their ailment. The Patients are usually referred to as residents.

• Older people with chronic illness,disability, paralysis, dementia, terminal

illness, fractures are provided safe and supportive environment.

• The term nursing facility is inclusiveof other commonly used terms, e.g., nursing home, long-term care facility, sub-acute care unit or nursing home care unit. Nursing facilities are primarily free-standing in the community or separate units in hospitals.

Geriatric Services U.K. U.S.A. IndiaAcute Care In all hospitals In all hospitals Very few

Long Term Care 12,000 hospitals with 1,80,000 beds

15,000 hospitals with 16,00,000 beds

Nil

Community Based Rehabilitation

Well established Well established Poorly developed

Health Security NHS (National Health Service)

Medicare , Medicaid Few organised sectors such as CGHS (Central Government Health

Scheme)

Comparison of Geriatric Services in India with other Countries The developed world has evolved many models for elderly care e.g. Nursing, Home Care, Health Insurance etc. As no such model for older people exists in India as well as most other societies with similar socio-economic situations, it may be an opportunity for innovation in health system development, though it is a major challenge. The requirements for health care of the elderly are also different in our country. India still has family as the primary care giver to the elderly. At present, the elderly are provided health care by the general health care delivery system in the country. At the primary care level, the infrastructure is grossly deficient which needs to be strengthened.


With the aim of providing comprehensive health care to Senior Citizens and to improve the quality of life of the sick and destitute elders, the Geriatrics department was first established in India at the Madras Medical College in the year 1978. It is the first of its kind in India and the only Geriatric Medicine Department in Medical College till date. It is also the only Department in the country with Post-Graduate Training Programme in Geriatric Medicine (MD- Geriatrics).

Geriatric Out-patient service was started at the Government General Hospital and Madras Medical College on 26th April, 1978 to cater to the Physical, Mental and Social problems of the elders. All the basic investigations are done as OPD for screening common ailments. A separate Geriatric surgery Outpatient service was commenced in the year 1983. Subsequently, Government of Tamil Nadu started a Geriatric Surgery Department, the first of its kind in the year 1990. The goal of the Geriatric surgical department is to provide

comprehensive surgical care like promotional, preventive and curative care to the elderly with humane approach.

The following services are provided in the Out-patient Department (OPD) :

• Referral Service (65+ with multipleproblems)

• ComprehensiveEvaluation

• LaboratoryServices

• MedicalandRehabilitativeTherapy

• OtherSpecialisedServices

Geriatrics Department in the Madras Medical College (MMC) ................


In the year 1986, a Separate ward for Geriatric Medicine was started for acute care and Rehabilitation. The main objective of the Geriatric Unit at Government General Hospital, Chennai is to admit, assess and manage the acutely ill elderly patients with multiple problems. In addition to that, physical and social rehabilitation is also being carried out.

The inpatient services include :

• AcuteCareServices

• IntermediateCare

• Rehabilitation

• LongTermCare

Further, a Community based Geriatric Out-patient service is conducted at the Government Peripheral Hospital, Periyar Nagar once in a week as an outreach (community based rehabilitation) programme. Special clinics like osteoporosis clinic are functioning every Friday to screen Osteoporosis at an early stage and to treat and prevent fractures in the elderly.


Patients who need acute care, rehabilitation and continuing care can be admitted directly into the above hospitals. Patients who are initially admitted and treated for acute problems in the Geriatric Unit, Government General Hospital are later transferred to the Peripheral Hospital for treatment of their chronic problems and for rehabilitation.

Strategies proposed for strengthening Geriatrics department

The following are the objectives and strategies proposed for strengthening the Geriatrics department:

Objectives

• ProvidingVisitingHomehealthservice.

• Improvingtheexistingoutpatientserviceand Acute Care.

• ProvidingLongTermCarefacility.

• Developing a research database on thehealth status.

Strategies

• Level One : Home Health Service

• Level Two : Community Based Health Centres

• Level Three : Hospital Based Service


Postgraduate Geriatric courses are grossly deficient in the country. Over and above, there are no posts to absorb the miniscule trained manpower, which is produced by only one Medical college in the country i.e. Madras Medical College, Chennai. Also nearly half of the trained personnel have migrated to the countries where regular jobs are available for them.

The requirement of geriatricians in Tamil Nadu will be around 5,000 as per the present elderly population. But, there are hardly 20 trained geriatricians in Tamil Nadu now and may increase to around 35 in another five years, which is grossly inadequate and so there is a greater need for developing more centres to develop human resources. It is proposed to develop human resources by introducing PG Programmes in Geriatrics, Short term courses in Geriatrics for Doctors/Nurses, Courses for self-help for the elderly and for care-givers.

Training Programmes such as UG/PG training, Primary/Secondary Care physician training, Training in Geriatric Nursing Care, Caregiver training etc. will be imparted. Research activities in biological gerontology, clinical geriatrics, social gerontology and psycho-geriatrics will also be taken up.

Geriatric Departments will be established in all the teaching hospitals in a phased manner. District Geriatric Units

with dedicated Geriatric OPD and Geriatric ward will be developed in District Hospitals. Geriatric Clinics/ Rehabilitation units will be set up for domiciliary visits in Community/ Primary Health Centres and Sub-centres will be provided with equipment for community outreach services.

The Geriatric department would be equipped with Geriatric physician, Surgeon, Physiotherapist, Occupational Therapist, Clinical Psychologist, Social worker, Health visitor, Speech Therapist, Dietician, Nursing personnel and Specialists in Ophthalmology, ENT, Ortho, Psychiatry, Urology etc. Special Clinics such as Incontinence clinic, Psycho-geriatric services, Osteoporosis clinic, Fall prevention clinic, Memory clinic, Care giver services etc. would also be set up.

A full-fledged Institute of Ageing would be developed in the MMC with central assistance with the Geriatrics department as a base. The National Institute of Ageing will have 200 beds to provide comprehensive health care.


Longevity which used to be a matter of joy has now become a matter of concern, since the institution of Joint Family has faced a big onslaught and is on the verge of disappearing. Such separation exposes the elders to isolation, neglect, financial distress and a host of other problems. The support received by the aged segment of the population hitherto from its own family members has diminished substantially and the emerging problem in the recent times is the elder abuse.

Elder abuse is intentional or unintentional neglect at home, civil society, institution and state which cause harm or distress affecting health or safety. The other forms of elder abuse are:

• Physical• Emotional• Psychological• Sexual• Financial• Maltreatment• Mistreatment

The incidence of Elder Abuse is one of the largest in India. “Elder Abuse” exists in homes, communities and institutions. With 75% of 100 million elderly population living in rural India and 30% of them below poverty line, it goes un-reported, un-intervened and un-corrected.

Abuse at family level is also an issue and the family members need to be educated about the harms of the elder abuse. As regards the support system, if both husband and wife are alive, they give support to each other. But, if the Oldest Old is alone then he/she faces a lot of problem at family level in terms of emotional and physical support.

Elder Abuse .........................................................................................................


Causes of Elder Abuse

• Disconnect between main stream andold age

• Discriminationinallstrataoflife

• Degradationoffamilyvalue

• Scornfullife

• Materialisticlifestyle

• SeniorsDeprivedandvulnerable

• AgeingIndia

• Lackofawarenessamongyouth

• DiminishingInterGenerationbond

Significance of Elder Abuse Awareness Day

After a considerable study by WHO and IFA (the International Federation on Ageing) from 2012, the International Network for Prevention of Elder Abuse (INPEA), has called for observance of the World Elder Abuse Awareness Day on June 15 every year since 2006, with the message “My World…, Your World…, Our world… free of Elder Abuse” towards a society for all ages. The theme for the year 2013 is “Stopping Elder Abuse – A Global Priority”.

Maintenance and Welfare of Parents and Senior Citizens Act, 2007

Family is the most cherished social institution in India and the most vital non-formal social security for the old. Traditionally, in India, the most common form of family

structure was the joint family. The extended family consisted of at least two generations living together and this arrangement was usually to the advantage of the elderly as they enjoyed a special status and power. In the recent times, the institution of Joint Family has disintegrated into nuclear families because of the sweeping socio economic changes that are taking place throughout the country. The position of single persons, particularly females, is more vulnerable in old age as few persons are willing to take care of non-lineal relatives. So also is the situation of widows an overwhelming majority of whom have no independent source of income, do not own assets and are totally dependent.


The Maintenance and Welfare of Parents and Senior Citizens Bill, 2007 seeks to make it a legal obligation for children and heirs to provide maintenance to senior citizens. This MWPSC Act was implemented in the State w.e.f. 29.09.2008 and the TN State Maintenance and Welfare of Parents and Senior Citizens Rules have been framed and notified on 31.12.2009.

Under this Act, Senior citizens who are unable to maintain themselves shall have the right to apply to a maintenance tribunal seeking a monthly allowance from their children or heirs. A Tribunal, presided over by the Revenue Divisional Officer has been constituted in each Revenue Division for speedy disposal of petitions under the Act. If the children or relatives fail to obey the orders of the Tribunal, the Tribunal may levy fines and may sentence such person. The maximum maintenance allowance shall not exceed Rs.10,000/- per month. The offenders shall be punished with imprisonment for 3 months or fined upto Rs.5000/- or both. To advise and supervise the effective and coordinated implementation of the Act, a High level Advisory Committee at the State level and District level Committees with the Chief Secretary and District Collectors as the Chairpersons respectively have been constituted.

Objectives of the Act • Thegoal is to protect thewell-beingof

the senior citizens. • TheOlderPersonstolivetheirlastphase

with purpose, peace and dignity.• Extend support towards financial

security, healthcare, shelter and general welfare.• Ensurethattherightsoftheolderpersons

are not violated.• Providemorecaretoolderfemales.• Utilisetheirexperienceandcapacity.• Provide more attention to the older

persons living in rural areas.

Implementation of the Act

• Greater awareness to be given to theyounger generation on caring elders and MWPSC Act.

• Valueeducationonagecaretobeaddedin the curriculum of schools and colleges.

• Free legal aid to be given to the elderssuffering on elder abuse.

• Government and NGOs to createawareness on World Elder Abuse Awareness Day – 15th June (WEAAD).

• Trainingtobegiventothestakeholdersof the Act.


The directive principles of the Constitution cast a duty on the Government to come up with measures to ensure that the elders are enabled to live in reasonable comfort and dignity. As the Elderly suffer from multiple and chronic diseases and they need long term specialised and constant care, a model of care providing comprehensive health services to elderly at all levels of health care delivery is imperative to meet the growing health needs of the elderly, especially the immobile and disabled elderly who need care close to their homes. India was among the first countries to ratify UN Convention on the Rights of Persons with Disabilities (UNCRPD) which came into effect from 3rd May, 2008.

As per the provisions under Article 25 of UNCRPD, the health services needed by persons with disabilities should be provided as close to people’s own communities including rural areas. In addition, at present there is huge shortage of manpower in geriatrics in the country. As the elderly suffer from multiple chronic and disabling diseases, it becomes difficult for them to run from pillar to post to get appropriate health care. Though Elderly health care is part of the general health care system, the general health care system is not adequately sensitised to the health needs of elderly.

The National Programme for the Health Care for the Elderly (NPHCE) is an articulation of the International and National commitments of the Government as envisaged under the UN Convention on the Rights of Persons with Disabilities (UNCRPD), National Policy on Older

Persons (NPOP) adopted by the Government of India in 1999 (which is a comprehensive document for the welfare of older persons) and Section 20 of The Maintenance and Welfare of Parents and Senior Citizens Act, 2007 dealing with provisions for medical care of Senior Citizens.

The Vision of the NPHCE is to provide accessible, affordable and high-quality long-term, comprehensive and dedicated care services to the Ageing population through community based primary health care approach; to identify health problems in the elderly and provide appropriate health interventions in the community with a strong referral backup support; to build capacity of the medical and paramedical professionals as well as the care-takers within the family for providing health care to the elderly; to provide referral services to the elderly patients through district hospitals and regional medical institutions.

In the programme, it is envisaged for providing promotional, preventive, curative and rehabilitative services in an integrated manner for the Elderly in various Government health facilities. The package of services would depend on the level of health facility and may vary from facility to facility. The range of services will include health promotion, preventive services, diagnosis and management of geriatric medical problems (out and in-patient), day care services, rehabilitative services and home based care as needed. Keeping in view the scarcity of specialists in geriatric field, the existing specialists in various fields who are

National Programme for the Health Care of the Elderly – NPHCE .........................


either trained in geriatrics or interested in the field will be utilised for managing geriatric OPD and geriatric wards.

The services under the programme would be integrated below district level and will be integral part of existing primary health care delivery system and vertical at district and above as more specialised health care are needed for the elderly. The programme will support establishment of Geriatrics Centres in the Department of Medicine in 8 selected Medical Institutions of the country. These will be termed as Regional Geriatric Centres. Following will be the key functions of the Regional Geriatric Centres:

• Provide tertiary level services forcomplicated/serious Geriatric Cases referred from Medical Colleges, District Hospitals and below.

• Conducting post-graduate courses inGeriatric Medicine.

• Providing training to the trainers ofidentified District hospitals and Medical Colleges

• Developing evidence based treatmentprotocols for Geriatric diseases prevalent in the country.

• Developing and updating Trainingmodules, guidelines and IEC materials.

• Researchonspecificelderlydiseases.

To carry out various functions at the District level, Districts will be linked to Regional

Geriatric Centres for providing tertiary level care and District Geriatric Unit will be set up in 80-100 District Hospitals. Further, Geriatric Clinics/Rehabilitation units would be set up for domiciliary visits in Community/Primary Health Centres in the selected districts and Sub-centres would be provided with equipment for community outreach services.

The basic activities and role of the Community Health Centre (CHC) under NPHCE are as under:

• First Referral Unit: CHC will be the first medical referral unit for patients from PHCs and below. Referral for further investigations and treatment to District Hospitals/Medical Colleges would be made as per need.

• Geriatric Clinic: CHC will arrange dedicated and specialised Geriatric Clinics for the elderly persons twice a week.

• Rehabilitation Services: Physio-therapist / Rehabilitation worker will be provided at CHC for physiotherapy and medical rehabilitation. Domiciliary visits by the rehabilitation worker will be undertaken for bed-ridden elderly and counselling to family members for caring such patients.

• Data Compilation: Data received from all the PHCs in jurisdiction of CHCs on elderly would be compiled and forwarded to the District Programme Officer.


The following Social and Cultural table released by the Registrar General & Census Commissioner, India reveals that Tamil Nadu stands in the third position (next to Kerala and Goa) in the Percentage of elderly (60 years or more) to total population as per Census 2011.

S.No. Name of the State (Top 5)

% of Elderly

1. KERALA 12.62. GOA 11.23. TAMIL NADU 10.44. PUNJAB 10.35. HIMACHAL PRADESH 10.2

With such a high elderly growing population, the Government is under obligation to set up a social security net to take care of the elders, particularly those belonging to the lower economic strata. The actual benefits of Governmental schemes should directly reach them and hence there is a need for greater efforts to ensure that everyone can be benefited.

Interventions of the State in Geriatric Care ...............................................

The State is implementing/ proposed the following:

• OldAgePensionof 1,000/- per month is given to all eligible BPL elders.

• The ongoing programme AnnapoornaScheme ensures food security for the vulnerable aged and each beneficiary is given 10 kg of rice per month free of cost.


• 64IntegratedComplexofSpecialHomesfor senior citizens and destitute children at block level and night shelters for homeless senior citizens in the city at district level have been established. Separate Home of shelter for BPL Pensioners would be established.

• There would be provision for GeriatricUnits at every Sub-Centre, PHC, District Hospital and Teaching Institutions. Day Care for the elders at the PHC level, District level and Medical College Hospitals would be provided with comprehensive geriatric units which will have Out-Patients, In-Patients facility and all infrastructures under one roof.

• Health Card will be given to all seniorcitizens and Health Bank would be introduced, where they can avail drugs free for BPL elders and at concessional rates for paying patients. Cost-effective health insurance to be created for coverage of the elderly, especially women.

• Regularhealthcamps/eyecampswouldbe organised by Government/ NGOs both at rural/urban areas.

• PalliativeCaretrainingandserviceswouldbe given to the community volunteers/community health workers to take care of the senior citizens till their life time.

• Mobile Medicare, Special AmbulanceUnits with toll free number for

transporting elders would be introduced in remote areas to reach unreached areas.

• Yoga and simple exercise, nutrient foodwould be made available for senior citizens.

• Geriatric in-service training for doctorsand para medical staff would be given to ensure availability of trained persons.

• Therewouldbe‘InHouseCallProgramme’for elders who cannot move and want to avail home care services. The Chief Minister’s Health Insurance Scheme would be propagated and compulsory enrolment of all senior citizens under this scheme to avail services will ensure health security of elders.

• The Old Age Homes would providemedical facilities, palliative care, nutritional food, recreational facilities and encourage spiritual values. Day Care Centre for community elders can be attached to Old Age Homes to encourage mutual bonding among the senior citizens. The Homes would have eco-friendly-ramps (handrails) for elders to move around.

• Senior Citizen Associations in villagesand panchayat level would be formed and the existing associations would be strengthened. Second Career Programme for senior citizens who are experienced will be taken up through Government and NGOs.


• Free transport facilities forelderswouldbe given. Gero-sensitive public spaces with necessary provisions would be created.

• TheNGOs,Government,PrivateSectors,Schools and Hospitals would be encouraged to celebrate 1st October as International Day of Older Persons.

• TheTwelfthPlanobjectivesaretoensuregood physical, mental health for the elderly; to provide them financial and social security; to protect elders from abuse and exploitation and to lead a safe and secured life and to improve the quality of life of senior citizens. The strategies include conducting awareness Campaigns through seminars, workshops, media etc.; involving community, stakeholders in elder’s programmes; ensuring Elders participation in community activities; Government, NGOs, Schools etc. would coordinate in age care activities; involving PRIs in local community activities for elders and organising Training Programmes for Personnel involved in age care.


The society through non-profit organisations is providing help, support and services to the senior citizens. In Tamil Nadu, 28 Voluntary Organisations are receiving the State Government grants to run Old Age Homes in 26 districts accommodating a maximum of 40 inmates in each home. A sum of 2 lakh per annum is given per home as grant. The Government of India also provides grants to 50 Old Age Homes in our State. However, NGO involvement in work related to Oldest Old seems to be low (3%).

The Government would involve the local NGOs in the development and implementation of programmes for elders and they would be given special training in running welfare programmes. NGOs serving other age groups would be sensitised about welfare programmes for the elderly. Guidelines would be set up for NGOs in the planning, development and implementation of programmes for elder persons. The NGOs would be guided to work with PRI and Community locally. NGOs network would be set up and used as resources on

aged care. Periodical meetings of NGOs with Government would be conducted to review activities.

HelpAge India

HelpAge India set up in 1978 is a secular, not-for-profit organisation whose mission is to work for the cause and care of disadvantaged Older Persons in order to improve the quality of their lives. It serves to protect the rights of 100 million grey population (India’s elderly) and provide relief to them through various interventions and help them live with dignity, independence & self-fulfilment. It now lays stress on income-generation and micro-credit projects that enable the participation of Older Persons in the mainstream of society. It strives to Create learning opportunities for the elders; Active participation of Older Persons in Economic Activities – Informal Work and Voluntary activities and also in Family & Community life; Ensure Safety and dignity of Older Persons (Physical, Social and Financial needs and promote equity.

Role of NGOs in Geriatric Care ...............................................................................


Furthermore, HelpAge India acts as the voice of the elderly and promotes their cause with the Central and State governments. HelpAge India focuses on improved access to health and eye care facilities, community-based services and livelihood support for the elderly. In addition, it also supports programmes like old age homes and day care centres and the Support-A-Grandparent scheme. HelpAge also offers integrated age care services for the elderly in urban & rural areas and one such example is the Mobile Medicare Unit (MMU) programme. The MMU service in some areas not only provides basic health care, but is also delving into new initiatives such as providing disability aids, shelter assistance, yoga, specialised home visits, and provision of psychological therapy among others. In order to create a secure financial net for elders HelpAge is also pushing forth Reverse Mortgage for seniors.

MIPAA

HelpAge India is also a full member of the International Federation on Ageing. The

Madrid International Plan of Action on Ageing (MIPAA) has three priorities :

• OlderPersonsandDevelopment

• AdvancingHealthandWellbeingintoOldAge

• EnablingandSupportiveEnvironments

Older persons & development

• Activeparticipationinsocietyanddevelopment

• Work&ageinglabourforce• Ruraldevelopment,migrationand

urbanization• Accesstoknowledge,educationand

Training• Intergenerationalsolidarity• Eradicationofpoverty• Income security, social protection/social

security & poverty prevention• Emergencysituations

Advancing health and wellbeing into old age

• Healthpromotion&wellbeing• Universalaccesstohealthcareservices• OlderpersonsandHIV/AIDS• Training of care providers & health

professionals• Mentalhealthneedsofolderpersons• Olderpeopleanddisabilities

Enabling and Supportive Environments• Housing&livingenvironment• Careandsupportforcaregivers• Neglect,abuseandviolence


Senior Citizens Bureau

Senior Citizens Bureau (SCB) is one among the first in India to commemorate the observance of Elder Abuse Awareness Day every year from 2006, in collaboration with schools and colleges at Chennai. They regularly conduct a signature campaign (2000 to 3000 youth) and organise competitions and cultural programmes at their campus to sensitise them against Elder Abuse. They bring out case studies and special publications on this occasion. SCB, from its inception in1996 has been attending more than 1000 Elder requests in order to relieve their distress from various abuses and restore their dignity and safety.

The SCB states that the Government has stupendous responsibility to eradicate elder abuse through:

• Advocacy

• Legalaid

• Counselling

• Healthtreatmentand

• Homecaremultiservice

The various disciplines to be involved in the above process are Gerontology, Sociology, Criminology, Social Work, Medicine/Nursing and Psychology. The State has to ensure the Human Rights of Older Persons (OP) as observed by UNO Human Rights Commission such as Independence, Participations, Care,

Self-Fulfillment, Dignity and to guarantee, Availability, Accessibility and Affordability in all endeavors of the State. The 4 important securities viz. Social security, Financial security, Health Security, Family Security (Food Security) should be ensured for the elderly.

The Senior Citizens Bureau listed out the following measures which the State can implement:

• WelcomingtheOlderPersonswithsmileand treating with dignity.

• Makethemapartyinthedecisionmakingprocess.

• Involvethemineverystageofgovernessright from Panchayat.

• Provide them with all concessionsextended to disabled persons.

• Provide a separate enclosure with freeentry for all State ceremonies.

• Providehandrail,Elevator,Escalatoretc.wherever necessary.

• Observe World Elder Abuse AwarenessDay and World Elders Day.

• Creation of a separate department forSenior Citizens.

• EstablishingNationalCommission/StateCommission for Seniors and come out with National /State Policy for Elders.

• Implementing the MWPSC Act, 2007properly.

• Establishing a separate Employment


Exchange for elders and employing them on Honorary basis.

• Encourage elders Self Help Groupsand Self Employment to make them financially independent.

• Providing elder friendlywalk paths andcomfortable seating / journey in public transport.

• Priority inpublicandprivateutilities forelders to be made mandatory.

• Facilitatemercykillingforbraindead.

• Extendmonetaryandpromotionbenefitsto the employees of joint family.

Federation of Senior citizens Association of Tamil Nadu

The Federation of Senior Citizens Association of Tamil Nadu (FOSCATAN) was formed in the year 2009 to represent the Senior Citizens issues to Government in unison. Now, 16 Senior Citizens Associations in Tamil Nadu are affiliated to the Federation.

Problems such as isolation, loneliness and lack of family care could be managed by Senior Citizens by forming groups with goals of realising good social objectives. The following are the demands of the Federation:

Funds: As elders too contribute to the coffers of the State through direct and indirect taxes, a good part of the Government’s revenues should be earmarked for the welfare of senior citizens.

Old Age Home: There are many elders who do not have proper accommodation including the affluent class who are on the lookout for decent old age homes of the right kind where they can receive the services of a good order. Hence, the Government to set up model old age homes and give encouragement and financial assistance to the private sector to come up with homes that conform to prescribed standards and norms.

Day care Centres : To be set up mostly by NGOs with assistance from Govt., so that the families can leave their elder parents during the day time in safe and secure environment.

Meals on Wheels : As the elders cannot manage cooking for themselves, this service has to be set up mostly by NGOs with assis-tance from Government in the form of grants with some regulatory control.

Care givers : The care givers have to be professionally trained to do their jobs and certified. The services can be varied and wide ranging from simple things like paying bills, going to banks, shops, taking to doctors, hospitals and also preparing their bed, helping them with toilet, bathing, dressing, taking medicines etc.

Elder Abuse : The abuse can be physical, mental, social, financial, in public or private. They need to be offered protection and family members need counseling. Government may provide courses to train people in providing counseling services in elder abuse cases.


Formation of SHGs for Senior Citizens : They can be engaged in some income generation activity through SHG and can be encouraged with micro finance to run their ventures. This will keep them occupied and make better health.

Old Age Pension : The OAP now provided is inadequate with the higher cost of living, which may be enhanced.

Part time Jobs : Many of them have the skill, expertise and willingness to engage themselves in some part time employment to augment their incomes. The Employment Exchanges may be directed to maintain a separate register of senior citizens seeking a second career and find suitable placements on short time basis.

MMU for elders : Geriatric medical care can be provided through Mobile Medical Units particularly in rural areas.

Senior citizens card : Every senior citizen should be provided a card and arrangements should be made through tie-ups to enable them to get concessions at diagnostic centres, private hospitals, pharmacies etc.

Health Insurance : Affordable, without any conditions on exigencies and restricting about existing diseases.

Tourism : Tourism department could arrange for tour packages exclusively programmed for the elders at concessional rates


The Vice - Chairperson, State Planning Commission remarked that the Senior Citizens are resources of a nation and we should properly use the resources for the betterment of the society rather than considering them as burden. She stressed the need for counselling the Senior Citizens, aware of their legal rights and elder abusement. She stated that the demands of the President, Federation of Senior Citizens Association of Tamil Nadu are very succinct.

She stated that mere allocation of funds for the welfare of the aged is not enough, since the funds allocated get surrendered because of implementation failures, for which suitable methodologies should be adopted. She recommended for increased participation of people involved in Geriatrics (both medical and social) for the proper implementation of

schemes. She suggested to form a core group to work on the plan schemes for Geriatric Care and Welfare. She assured that the SPC will take response on the issues highlighted with the departments concerned.

Dr. K. Sridhar, Member (Health), SPC strongly recommended for establishment of Health Care Clinics close to communities. Dr. B. Krishnaswamy, Prof. and Head, Dept. of Geriatric Medicine, Madras Medical College and Rajiv Gandhi Government General Hospital explained about the establishment of Geriatric Department in the MMC, its functions and services offered. He stressed the need for Geriatric care and suggested that on par in the European countries, exclusive specialities for Geriatrics

Remarks / Suggestions of the Participants ......................................................


should be established for addressing multiple problems (like Incontinence, Dementia etc.) of the elders in one place. He detailed on the strategies proposed for strengthening Geriatric services in hospitals across Tamil Nadu and mentioned that 4 districts have been identified for developing Geriatric Clinics in PHCs. He suggested that basic training programmes on Geriatric care can be conducted for all the doctors in PHCs, District and Medical College Hospitals.

He also displayed the photographs of centenarians (including a freedom fighter) who are recuperating in the Geriatric ward of MMC. He concluded that the elderly should not be neglected and should be given proper care as they have a right to avail it.

Dr. Rajendran, Billroth Hospitals, Chennai stressed the importance of the Role of the family as care-giver to the elderly. He highlighted that since the elderly are different from adults in expression of diseases and they are more vulnerable to develop complications, Specialised Geriatric Services is the need of the hour.

Thiru. Edwin Babu, Joint Director – Programs, HelpAge India stated that Advocacy is one of the strongest tools for impact & change in the society and stressed that Value Education on Age Care should be included in school curriculums. He informed that an awareness campaign was launched by HelpAge India sensitizing decision makers to take action to deal with the rising crime against elders.


He stated that Reverse Mortgage Loans have positive effect on the Senior Citizens, though the Banks are not very keen as it is not profitable. He suggested that more awareness on Reverse Mortgage Loans should be created among the Senior Citizens and counselling on the same is also given by HelpAge India.

Thiru. Singaraja Chairman, Senior Citizens Bureau and Editor “LINKAGE” highlighted the issue of Elder Abuse and stressed the importance of pre-retirement and post-retirement counselling. He stated that there is lack of awareness among youth about the disabilities of the aged and they should be sensitised properly. He highlighted the diminishing Inter generation bond which is a major cause of Elder Abuse. He stated that

Tamil Nadu is always leading in Social service programmes and hence Tamil Nadu shall also take lead in preventing Elder Abuse. He requested for setting up of a patrolling agency to ensure the human rights of Senior Citizens. He also requested to improve the Doctor vs Nurse ratio, which is very low.

He suggested various measures that the State can implement such as involving the Senior Citizens in the decision making process; extending all concessions on par with disabled persons; providing elder friendly supportive provisions in public spaces; creation of separate department for Senior Citizens; priority in Public utilities; encouraging SHG and Self Employment of Senior Citizens and employing them on honorary basis; observing World Elder Day (1st October) and World Abuse Awareness Day (15th June); proper implementation of the MWPSC Act etc. He concluded that the most


important expectation of the elders is nothing but love and affection.

Thiru. Rajasekaran, I.R.S. (Retd.), President, Federation of Senior Citizens Association of Tamil Nadu listed out various requirements of the elders which are expected from the Government such as Model Old Age Homes, Day Care Centres, Meals on Wheels, Professionally trained care-givers, Counselling service in elder abuse cases, Income generation activities, Augmenting funds for enhancement of Old Age Pension and creation of Senior Citizen Cess, Mobile Medical Units, Senior Citizens Card, Senior Citizens Bond, exclusive Tourism packages for elders, to prevail upon the Insurance companies not to impose pre-conditions on exigencies etc.

He viewed that the present allocation of funds for senior citizens is not adequate and a good part of the Government’s revenues should be earmarked for them. He also stated that the Government needs to formulate a holistic policy for the aged comprising of broad features addressing geriatric care in general (Health security), financial concerns (social security) and institutional support.

The officials from the Social Welfare and Nutritious Meal Programme Department mentioned that under the MPWSC Act, 1266 applications have been received before the mediator and cases have been referred to tribunals. They suggested that Old Age Pension can be enhanced for the betterment of the Senior Citizens.


Recommendations of the State Planning Commission ...........................

• Awareness tobe created amongSeniorCitizens about their legal rights andaboutelder abuse.

• AcoregroupshallbeformedtoworkonplanschemesforGeriatricCareandWelfare.

• PropermethodologiestobeadoptedforutilisingthefundsallocatedforthewelfareofSenior Citizens taking care that funds are not surrendered because of implementation failures.

• IncreasedparticipationisrequiredinGeriatriccare(bothmedicalandsocial)forproperimplementation of the schemes.

• The State Planning Commission will facilitate further co-ordination between thedepartments concerned.

• HealthCareClinicstobeestablishedclosetocommunities.


Tmt. Santha Sheela Nair, IAS. (Retd)Vice Chairperson, State Planning Commission.

Dr. K. SridharMember (Health),State Planning Commission.

Dr. K. RamaswamyMember (Agriculture),State Planning Commission.

Th. M. Balaji, IAS.,Member SecretaryState Planning Commission.

Dr. B. KrishnaswamyProfessor & Head, Department of Geriatric Medicine, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai.

Dr. C. RajendiranAcademic Head & Senior Consultant Physician, Billroth Hospitals, Chennai.

Th. Edwin BabuJoint Director – ProgramsHelpAge India, Chennai.

List of Participants .............................................................................................


Dr. Capt. M.SingarajaChairman, Senior Citizens Bureau and Editor “LINKAGE”, Chennai.

Th. D. Rajasekaran, I.R.S. (Retd.)President, Federation of Senior citizens Association of Tamil Nadu, Chennai.

Tmt. Y. Dorathy Sulochana.Additional Secretary to Government, Social Welfare and Nutritious Meal Programme Department, Secretariat, Chennai.

Dr. K. Amudhadevi,Joint Director (Inspection), Department of Public Health and Preventive Medicine, Chennai.

Dr. R. Geetha,Deputy Director, Directorate of Medical Education, Chennai.

Tmt. R. Santhiya Maheswari,Assistant Director, Department of Social Welfare and Nutritious Welfare Programme, Chintadripet, Chennai.


WELFARE OF SENIOR CITIZENS- GERIATRIC CARE

Workshop Series : 6 / HSW / 2013


Documents

WELFARE OF SENIOR CITIZENS - GERIATRIC CARE