Medico social problems of elderly

Medico-social problems of elderly and National Programmes for elderly

SpeakersCapt Dr Naveen PhuyalDr Amol

Medico social problems of the elderly

• There's one advantage to being 102. There's no peer pressure. Dennis Wolfberg

• I truly believe that age – if you're healthy -- age is just a number. Hugh Hefner

• If I knew I was going to live this long, I'd have taken better care of myself.

Mickey Mantle

And now the end is near And so I face the final curtain, I’ll state my case of which I’m certain. I’ve lived a life that’s full, I traveled each and ev’ry highway, And more, much more than this. I did it my way.

200 kms and 3 weeks long walk at the age of 61 is not impossible for the fight of freedom.

Was Not 92 when he passed away but 10 years old with 82 years of experience

Top of the world ??? No big deal !!!

We were just 73 and 76 years old when we climbed it.

Old People

ROCK

Olga Kotelko , 92

Super Athlete

Who says I can’t play?

Daphne Selfe 83, Worlds Oldest Supermodel

Scheme of Presentation

1. Introduction2. 10 Facts on ageing (WHO)3. The epidemiology of population ageing (WHO) 4. Situation analysis of ageing in India5. Demography of ageing population in India6. Studies on ageing in India7. Fighting stereotypes8. Challenges and opportunities

Introduction

• Ageing is a natural process that begins at birth, or to be more precise, at conception, a process that progresses throughout one’s life and ends at death.

Who are the elderly or aged?

United Nations Organization (UNO)

> 65 years of age as senior citizens.

The Indian Census >60 years and above as old.

Population 2012 Total >65 yrs

Global > 7 billion >56 million

India >1.2 billion 7 million

(United states population bureau)

India population > 60 > 10 million

Population proportion above 60 8%

(WHO)

10 facts on ageing

1. The world population is rapidly ageing.

2. The number of people aged 80 and older will quadruple in the period 2000 to 2050.

3. By 2050, 80% of older people will live in low and middle-income countries.

Ref: WHO Fact File 2012

10 facts on ageing4. The main health burdens for older people are from non-

communicable diseases.

5. Older people in low- and middle-income countries carry a greater disease burden than those in the rich world.

6. The need for long-term care is rising.

7. Effective, community-level primary health care for older people is crucial.


10 facts on ageing8. Supportive, “age-friendly” environments allow

older people to live fuller lives and maximize the contribution they make.

9. Healthy ageing starts with healthy behaviors in earlier stages of life.

10. We need to reinvent our assumptions of old age.


1. Add Life to Years (1982)2. Healthy Living: Everyone a winner (1986)3. Active ageing makes the difference (1999)4. Good Health adds life to years (2012)

WHO and Geriatric Health

The epidemiology of population ageing

• Life expectancy

• Years lost due to premature death

• Years lost due to disability

• Disability adjusted life years

Life expectancy at birthWHO Region Male ( Years) Female ( Years)

World 66 71

Africa 52 56

Americas 73 79

Eastern Mediterranean 64 67

Europe 71 79

South – East Asia 64 67

Western Pacific 72 77

Ref:World health statistics 2011. Geneva, WHO

Life expectancy at age 60

WHO Region Male ( 2009) Female ( 2009)

World 18 21

Africa 14 16

America 21 24

Eastern Mediterranean 16 18

Europe 19 23

South- East Asia 15 18

Western Pacific 19 22

Ref: World health statistics 2011. Geneva, WHO

Premature Death

Fig: Years of life lost due to death per 100000 adults aged 60 yrs and older by country income group


Year

s lo

st d

ue to

pre

mat

ure

deat

h

Diseases

Disability

Fig: Years Lost due to Disability (YLDs) per 100 000 adults over age 60 by country income group

Year

s lo

st d

ue to

dis

abili

ty


Disability causes

Disability

High Income countries Low Income Countries

Visual Impairment 15.0 94.2Hearing Loss 18.5 43.9Osteoarthritis 8.1 19.4Ischemic Heart Disease 2.2 11.9Dementia 6.2 7.0COPD 4.8 8.0Cerebrovascular Disease

2.2 4.9

Depression 0.5 4.8Rheumatoid Arthritis 1.7 3.7


Total burden of Death and DisabilityDA

LY

Fig: Disability Adjusted Life years ( DALYs) per 100000 adults over age 60 by country income group


Diseases

Other health problems

• Approximately 28-35% of people over the age of 65 fall each year.

• Falls may lead to post-fall syndrome, which includes increased dependence, loss of autonomy, confusion, immobilization and depression.

• Within the year following a hip fracture from a fall, 20% of older people will die.

Other health problems

• Around 4-6% of elderly people have experienced some form of maltreatment at home.

• While depression is identified as a significant cause of disability and a likely problem in older age, social isolation and loneliness are not recorded in these databases.


Situation analysis of elderly in India


• Majority population aged less than 30

• The problems and issues of its grey population has not been given serious consideration

• Focus - on the children and the youth

• Rapid changes in the social scenario -nuclear families

• Elderly - emotional, physical and financial insecurity


• Ageing of population - downward trends in fertility and mortality.

• Low birth rates coupled with long life expectancies, push the population to an ageing humanity.

• Mounting pressures on various socio economic fronts including pension outlays, health care expenditures, fiscal discipline, savings levels etc.

Demography of ageing population in India

Ref: Situation analysis of the elderly in India, 2011

Fig: Age distribution of population in India over decades

Fig 3: More Older parents to support

Fig 2: Dependency ratios, India 1961-2026

Fig 1: Population by broad age groups, India, 1961-2026

Ref: Situation analysis of the elderly in India, 2011

Studies on ageing in India

Studies on ageing in India

• Economic aspects of ageing• Social aspects of ageing• Psychological aspects of ageing• Health conditions of elderly• Malnutrition in elderly• Mental Health in elderly• Elder Abuse• Crime in elderly

Economic aspects• Are elderly a burden on the family and the

nation?

• 40 % of the elderly > 60 are working.• While adults (in the age group 15-59) who are

not working and are dependants.• Inadequate income is a major problem of the

elderly in India .

Economic aspects

• Nearly 90 per cent of total workforce employed in the unorganized sector.

• Retire without any financial security like pension and other post-retirement benefits.

• Women depend more on others.

Social aspects

• Individualism in modern life• Materialistic thinking among young generation• Greater alienation and isolation of the elderly• Decline in value system, respect, honor, status

and authority for elderly• Elderly relegated to an insignificant place in

our society

Social aspects

• The loss of the decision-making power by those who have surrendered their property in favor of younger members.

• The loss of status and decision-making power is felt more by ageing women than men.

Social aspects

Provide support

Aid relationship building

Maintenance, facilitate coping

with stress

Issues in relation to death and

dying.

Religiosity seems to have increase with age.

Spirituality was perceived to

Psychological aspectsThe prominent thrust areas

resulting in socio-psychological frustration among the elderly are

•Attitude towards old age•Degradation of status in community•Problems of isolation•Loneliness•Generation gap

Psychological aspects

Shortage of money

Passing time

Widowhood

Feeling of physically weak

Fear of death

Mental tension

Feeling of social neglect

The problems of retirees mainly include:

Health conditions of elderly• More and more susceptible to chronic

diseases, physical disabilities and mental incapacities in their old age.

• Illnesses are multiple and chronic in nature.

• Arthritis, rheumatism, heart problems and high blood pressure are the most prevalent chronic diseases affecting them.

How elderly describe their disease?

Elderly Poor Upper-class elderly

Describe their health problems, on the basis of easily identifiable symptoms, like chest pain, shortness of breath, prolonged cough, breathlessness/ asthma, eye problems etc.

In view of their greater knowledge of illnesses, mention blood pressure, heart attacks, and diabetes which are largely diagnosed through clinical examination.

Malnutrition in elderly

• 50 % are at risk in low income group• Both macro and micronutrient deficiencies are

common in elderly• Malnutrition is due to a. Lack of financial resources b. Reduced ability to go to market c. Reduced ability to cook nutritious meals d. Difficulty in mastication

Mental health in elderly

The worries among the poor are usually about: Inadequate economic support

Poor health

Inadequate living space

Loss of respectUnfinished familial tasks

Lack of recreational

facilities and

The problem of spending

time

Multiplicity of disease

• Multiplicities of diseases are normal among the elderly and that a majority of the old are often ill with Chronic bronchitis Anemia HypertensionDigestive troublesRheumatism

Health, Literacy and Income

• Elderly members are confronted with various nutritional, physiological and other general problems.

• The men are more literate, economically independent and face less physiological and nutritional problems as compared to their female counterparts.

Illness and treatment

• Most of the ailments of the elderly are not medically treated.

• The two most important reasons for not seeking care were

1.Financial problems 2.Perception that the ailment was not serious.

Elder abuse

A female of very advanced

age

Role-less in family

Functionally impaired

Lonely

The most likely victim of elderly abuse is a

Elder abuse• The prevalent patterns of elder abuse include

1. Psychological abuse in terms of verbal assaults 2. Threats and fear of isolation 3. Physical violence 4. Financial exploitation

• More women than men complain of maltreatment in terms of both physical and verbal abuse.

Elder abuse

• Person suffering from physical or mental impairment and dependent on the caretakers for most of his or her daily needs is likely to be the victim of elder abuse.

• Old people with high educational background and sufficient income are also found to be subjected to abuse.

Elder abuse

• Who are the abuser?• Factors for Abuse

Son and daughter in law

Daughter in law and spouse

Spouse

Dependent position of the older

Perceived powerlessness

Social isolation

Drug or alcoholic addiction

Anti-social behavior of the abusers

Crime against elderly

• These crimes range from hurt, robbery, murder and even sexual assault.

• Most remain unreported. • Female victims outnumber male victims • More in urban areas as compared to rural

areas.• 60 per committed indoors during the day.• 25 percent by family members.

Elderly are heterogeneous group

• Rural elderly

• Urban Poor elderly

• Urban Middle Income and well to do elderly

• Female elderly

Rural elderlyUnorganized sector.

Insecure employm

ent

Insufficient

income.

Lack access to any form of social security

and good quality or reasonably priced health care

Have to pay more for even the most

basic healthcar

e services.

Urban poor elderlyPoor

InfrastructurePoor physical

condition Low income

levels

High rates of unemployment

/underemployment

Crime, alcoholism,

mental illness

Lack of public and community

facilities

Lack of access to affordable

healthcare services.

Urban middle income and well-to-do elderly

• The impact of urbanization has touched many a life leading to migration of children to cities or abroad.

• Many elderly are well-off due to their prosperous children but are left alone to take care of themselves.

Female elderly• Feminization of later life.

The female elderly are more likely to be

WidowedHave low economic security

Lower educational attainment

More care giving

responsibilities than their male counterparts.

Female elderly

• The absence of gender-specific health services

• Poor health due to child bearing

• Less nutrition

• Economic deprivation throughout their lives

Female elderly

• The loss of status at the death of their husband only increases the situation of dependency in old age.

• This dependency can become more complex as the woman grows older

• Her relationship with her son and daughter-in-law decides her fate in old age

Fighting stereotypes

Common stereotyping of elderly

1. Older people are "past their sell-by date“2. Older people are helpless .3. Old people are afraid of dying.4. Older people will eventually become senile .5. Older women have less value than younger

women .6. Older people don't deserve health care

1.Older people are "past their sell-by date"

• On 16 October 2011, Fauja Singh became the first 100 year-old to complete a marathon by running the Toronto Waterfront Marathon in Canada.

2.Older people are helpless

• 2007 Cyclone in Bangladesh• Older people’s committees

disseminated early warning messages to people and families most at risk

• Identified who were worst hit• Compiled beneficiary lists and

notified them when and where to receive relief goods

3.Old people are afraid of dying

• 2011 earthquake and Tsunami in Japan• Older people and retirees came forward to

volunteer at the nuclear disaster sites

4.Older people will eventually become senile

• Occasional memory lapses occur at any age

• Some types of our memory stay the same or even continue to improve with age

• Our semantic memory, which is the ability to recall concepts and general facts that are not related to specific experiences

5.Older women have less value than younger women

• People often equate women’s worth with beauty, youth and the ability to have children.

• The role older women play in their families and communities, caring for their partners, parents, children and grandchildren is often overlooked.

• Women tend to be the family caregivers. • Many take care of more than one generation.

6.Older people don't deserve health care

• Treatable conditions -often overlooked or dismissed as being a "normal part of ageing".

• Age does not necessarily cause pain, and only extreme old age is associated with limitation of bodily function.

• The right to the best possible health does not diminish as we age.

• It is not age that limits the health and participation of older people.

• It is individual and societal misconceptions,

discrimination and abuse that prevent active and dignified ageing.

6.Older people don't deserve health care

Challenges and opportunities• Elderly people are a heterogeneous group.

• It is essential to recognize this heterogeneity in defining need, assessing the effects and relevance of intervention, and planning for the future.

• Ageing population will change society at many levels and in complex ways, creating both challenges and opportunities.

Opportunities of ageing

• Older people already make a significant contribution to society, whether it is through the formal workforce, through informal work and volunteering or within the family.

• We can foster this contribution by helping them maintain good health and by breaking down the many barriers that prevent their ongoing participation in society.

Challenges of ageing

• Towards the end of life, many older people will face health problems and challenges to their ability to remain independent.

• We need to address these too, and do it in a way that is affordable and sustainable for families and society.

• Good health must lie at the core of any successful response to ageing.

• If we can ensure that people are living healthier as well as longer lives, the opportunities will be greater and the costs to society less.

Challenges of ageing

• Recognize them as a resource group • Develop suitable policies

National Policies & Programmes for the Welfare of the Elderly

National Policies & Programmes for the Welfare of the Elderly: Introduction

1. Majority (80%) of them are in the rural areas, thus making service delivery a challenge

2. Feminization of the elderly population ( 51% of the elderly population would be women by the year 2016),

3. Increase in the number of the older-old ( persons above 80years) and

4. A large percentage (30%) of the elderly are below poverty line.


1. Administrative set-up

2. Relevant Constitutional Provisions

3. Legislations

4. National Policy on Older Persons (NPOP), 1999

5. National Council for Older Persons

6. Inter-Ministerial Committee on Older Persons


7. Central Sector Scheme of Integrated Programme for Older Persons (IPOP)

8. Schemes of Other Ministries I. Ministry of Health & Family Welfare

– National Programme For Health Care Of The Elderly (NPHCE)

II. Ministry of Rural Development III. Ministry of Railways IV. Ministry of Civil Aviation V. Ministry of Finance VI. Department of Pensions and Pensioner Grievances

Ref: Situation Analysis Of The Elderly in India, June 2011, Ministry of Statistics & Programme Implementation, GOI

1.Administrative set-up

Ministry of Social Justice & Empowerment

Nodal Ministry which focuses on policies & programmes for the Senior Citizens in close collaboration with State governments, NGOs and Civil society.


2.Relevant Constitutional Provisions

Article 41 of the Constitution provides that the State shall, within the limits of its economic capacity and development, make effective provision for securing the right to work, to education and to public assistance in cases of unemployment, old age, sickness & disablement, & in other cases of undeserved want.


3.Legislations

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

To ensure need based maintenance for parents and senior citizens and their welfare.

The Act provides for:- Maintenance of Parents/ senior citizens by children/ relatives

made obligatory and justiciable through Tribunals Revocation of transfer of property by senior citizens in case of

negligence by relatives Penal provision for abandonment of senior citizens Establishment of Old Age Homes for Indigent Senior Citizens Adequate medical facilities and security for Senior CitizensRef: Situation Analysis Of The Elderly in India, June 2011, Ministry of Statistics & Programme Implementation, GOI

3.Legislations

Maintenance and Welfare of Parents and Senior Citizens Act, 2007:– The Act has to be brought into force by individual State

Government.

– As on 3.2.2010, the Act had been notified by 22 States and all UTs.

– The Act is not applicable to the State of Jammu & Kashmir

– The remaining States yet to notify the Act are - Bihar, Meghalaya, Sikkim and Uttar Pradesh.


4.National Policy on Older Persons (NPOP), 1999

Ref: National Policy on Older Persons (NPOP), 1999 Ministry of Social Justice & Empowerment, GOI


Announced in January 1999 to reaffirm the commitment to ensure the well-being of the older persons.

Envisages State support to ensure– financial and food security, – health care, – shelter,– equitable share in development, – protection against abuse and exploitation, – availability of services to improve the quality of their lives



Objectives: To encourage individuals to make provision for their own as well

as their spouse’s old age;

To encourage families to take care of their older family members;

To enable and support voluntary and non-governmental organizations to supplement the care provided by the family;

To provide care and protection to the vulnerable elderly people;



Objectives:

To provide adequate healthcare facility to the elderly;

To promote research and training facilities to train geriatric care givers and organizers of services for the elderly;

To create awareness regarding elderly persons to help them lead productive and independent live.



Implementation Strategy : Preparation of Plan of Action for operationalisation of the

National policy.

Setting up of separate Bureau for Older Persons in Ministry of Social Justice & Empowerment.

Three Yearly Public Review of implementation of policy.



Implementation Strategy: Setting up of a National Council for Older Persons

Establishment of Autonomous National Association of Older Persons

Encouraging the participation of local self-government


5. National Council for Older Persons(NCOP)

Constituted in 1999

Under the Chairpersonship of the Minister for Social Justice & Empowerment to oversee implementation of the Policy

Highest body to advise the Government in the formulation and implementation of policy and programmes for the aged

Last re-constituted in 2005 with members comprising Central and State governments representatives, representatives of NGOs, citizen’s groups, retired person’s associations, and experts in the field of law, social welfare, and medicine

With a view to have a more definite structure, the Council was reconstituted and renamed as National Council for Senior Citizens (NCSrC) vide a Resolution dated 17.02.2012 to this effect which was published in the Gazette of India on 22.02.2012.


6.Inter-Ministerial Committee on Older Persons

Comprises of twenty-two Ministries/Departments,

Headed by the Secretary, Ministry of Social Justice & Empowerment

Another coordination mechanism in implementation of the NPOP.

Considers Action Plan on ageing issues for implementation by various Ministries/ Departments concerned, from time to time


7.Central Sector Scheme of Integrated Programme for Older Persons(IPOP)

Implemented since 1992

Objective of improving the quality of life of senior citizens by providing basic amenities like– shelter, – food, – medical care and – entertainment opportunities



Encouraging productive and active ageing through providing support for capacity building of Government/ Non-Governmental Organizations/Panchayati Raj Institutions/ local bodies and the Community at large.

Under the Scheme, financial assistance up to 90% of the project cost is provided to nongovernmental organizations for establishing and maintaining old age homes, day care centres and mobile medicare units



Other projects for Financial Assistance under revised scheme from 2008:– Maintenance of Respite Care Homes;– Running of Day Care Centres for Alzheimer’s Disease Patients,– Physiotherapy Clinics for older persons;– Sensitizing programmes for children particularly in Schools &

Colleges;– Training Centres of Caregivers to the older persons;– Awareness Generation Programmes for Older Persons & Care

Givers;– Formation of Senior Citizens Associations etc


8.Schemes of Other Ministries

I. Ministry of Health & Family Welfare

– Separate queues for older persons in government hospitals.

– Started Geriatric clinic in several Govt. hospitals

– National Programme For Health Care Of The Elderly (NPHCE)

Ref: Ministry of Health & Family Welfare, GOI


II. Ministry of Rural Development

– Implementing Indira Gandhi National Old-age Pension Scheme.

– For persons above 60 years belonging to a household below poverty line,

– Central assistance @ Rs. 200/- per month, which is meant to be supplemented by at least an equal contribution by the States so that each beneficiary gets at least Rs.400/- per month as pension.

Ref: Ministry of Rural Development, GOI


III. Ministry of Railways– Separate ticket counters for senior citizens of age 60 years

and above at various (Passenger Reservation System) PRS centres

– Provision of lower berth to male passengers of 60 years and above and female passengers of 45 years and above.

– 40% and 50% concession in rail fare for male passengers aged 60years and above and female passengers aged 58 years and above respectively.

– Wheel chairs at stations for old age passengers.Ref: Ministry of Railways, GOI


IV. Ministry of Civil Aviation– Air India provides concession up to 50% for male senior

citizens of 65 years and above, and female senior citizens of 63 years and above in air fares.

Ref: Ministry of Civil Aviation, GOI


V. Ministry of Finance– Income tax exemption for senior citizen of 65 years and above up

to Rs. 2.50 lakh per annum.

– Deduction of Rs 20,000 under Section 80D is allowed to an individual who pays medical insurance premium for his/ her parent or parents, who is a senior citizens of 65 years and above.

– An individual is eligible for a deduction of the amount spent or Rs 60,000, whichever is less for medical treatment (specified diseases in Rule 11DD of the Income Tax Rules) of a dependent senior citizen of 65 years and above

Ref: Union Budget 2012-13, Ministry of Finance, GOI


VI. Department of Pensions and Pensioner Grievances• A Pension Portal has been set up to enable senior citizens to

get information regarding the status of their application, the amount of pension, documents required, if any, etc.

• The Portal also provides for lodging of grievances. As per recommendation of the Sixth Pay Commission, additional pension to be provided to older persons

Age Group % pension to be added

80+ 20

85+ 30

90+ 40

95+ 50

100+ 100

National Programme For Health Care Of The Elderly (NPHCE)

National Programme For Health Care Of The Elderly (NPHCE)

NPHCE 2010

The Maintenance

and Welfare of Parents and

Senior Citizens Act, 2007.

National Policy on

Older Persons (1999)

The Vision

Ref: National Programme For Health Care Of The Elderly (NPHCE),Operational Guidelines, MOHFW, GOI

To provide accessible, affordable, and high-quality long-term, comprehensive and dedicated care services to an Ageing population;

Creating a new “architecture” for Ageing;

To build a framework to create an enabling environment for “a Society for all Ages”;

To promote the concept of Active and Healthy Ageing;

Objectives

•Provision of dedicated health care facilities at various level of State health care delivery system with referral support

• Human resource development in geriatric Health

•Strengthening of preventive, promotive and rehabilitative services.

• Promotion of Research in geriatric health care

• Convergence with NRHM, AYUSH & all other dept.


Strategies

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 trainingIEC using mass

media, folk media and other

communication


Supplementary Strategies

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.


Major Components:

1. Geriatric Department in 8 Regional Medical Institutions/ State Medical Colleges

2. Dedicated Health Care in 100 Districts(21 states)

Geriatric unit at District hospitals

Rehabilitation Units at CHCs

Weekly Geriatric Clinic at PHCs

Provision of supportive devices/equipments at Sub centers


Operational Guidelines

A. Package of Services at

different levels

B. Institutional framework for implementatio

n

C. Management

StructureD. Activities at various levels


A. Package of Services

Health

promotion

Preventiv

e service

Diagnosis

& managemen

t

Day care services

Rehabilitative services

Home

based

care


A. Package of Services

Organizational Structure:


B. Institutional Framework for the Implementation of NPHCE

Funds from Government of India (80%)

State Health Society

District Health Society (NCD Cell)

CHC / PHC /SC

State Level Activity

District Level Activity

Funding for Program:



State Health Society (SHS): Under the NRHM framework different Societies of national

programmes such as RCH, Malaria, TB, Leprosy, NBCP have been merged into a common State Health Society.– Chairperson- Chief Secretary/Development commissioner– Vice chair person -Principal Secretary (H&FW)– Mission director - Member –Secretary of SHS



District Health Society (DHS): All programme societies have been merged into the District

Health Society (DHS).

The Governing Body – Chairperson - Chairman of the Zilla Parishad.– Member -Secretary - DHO

The Executive Body– Chair person - District Collector – Member -Secretary - DHO.


C. Management Structure

National NCD Cell

State NCD Cell

District NCD Cell



National NCD Cell: The NCD Cell constituted at the central level for planning, monitoring

and implementation of the National Programme for Prevention and Control of Cancer, Diabetes, CVD and Stroke (NPCDCS) will also be

responsible for NPHCE.

Main functions: MOU with the States/UTs. Preparation and dissemination of operational guidelines. Plan for capacity building of health functionaries. Monitoring and review of programme activities at each level. Release of funds and monitoring of expenditure under NPHCE



20% of the total

expenditure

Provision of land

Support of lab services

Additional support for medicines

Maintenance of equipments,

wards and OPD


State contribution:


State Programme Officer

Programme Assistant

Finance cum Logistics Officer

Data Entry Operators (2)


State NCD Cell:Composition: State NCD Cell will be supported by following contractual staff:


State NCD Cell:Role and responsibilities of the State NCD Cell:Preparation of State action plan for implementation.

Organize State & district level trainings for capacity building

Liaison with Regional Geriatric Centre for tertiary Care, Training & Research.

Monitoring of the programme



District Programme Officer

Programme Assistant

Finance cum Logistics Officer

Data Entry Operators


District NCD Cell:Composition: District NCD Cell will be supported by following contractual staff:


District NCD Cell:Role and responsibilities of the District NCD Cell: Preparation of District action plan. Engage contractual personnel sanctioned for various facilities

in the district Maintain fund flow Convergence with NRHM activities & Other Depts. Ensure availability of rehabilitative services for the Elderly.


D.Activities under NPHCE at Various levels

At Sub Centre level: Provision of walking sticks, calipers & other supportive

equipments to the needy elderly Information on healthy diet, yoga, and life style diseases

through charts, pamphlets Domiciliary visit to the house of elderly by ANM/ Male worker

and maintenance of record Arrangement of ambulance for disabled bed ridden elderly for

referral to PHC/CHC.



At PHC level:

The weekly geriatric clinic.

Coordination with CHC, district hospital, sub centers, other National Health Programmes/ Departments for medicines, ambulances

Training of manpower & Separate registration counter for elderly.

Public awareness during health and village sanitation day/camps.

Provision of medicine to the elderly for their medical ailments.



At PHC level:

Following items will be made available at the PHC:• Nebulizer• Glucometer• Shoulder Wheel• Walker (ordinary)• Cervical traction (manual)• Exercise Bicycle• Lumbar Traction• Gait Training Apparatus• Infrared Lamp etc..



At RH/CHC level:

First level referral centre for medical care and rehabilitation services

Twice weekly health clinics for the elderly persons

Rehabilitation unit

Domiciliary visits for disabled persons by Multi rehabilitation worker

Referral Services to DH /RGC



At RH/CHC level:Following additional items will be made available at the CHC:• ECG Machine• Pulse Oximeter• Defibrillator• Multi - Channel Monitor• Shortwave Diathermy• Cervical traction (intermittent)• Walking for gait training equipment• Walking Sticks • Pulley



At District Hospital level:

Regular Geriatric OPD with Specialty Care for Elderly. Geriatric Ward (10-bedded) for in-patient care to the Elderly. Training to the Medical officers and paramedical staff of

CHC’s and PHC’s Camps for Geriatric Services in PHCs/CHCs and other sites Referral services for severe cases to tertiary level hospitals/

Regional Geriatric Centers



At District Hospital level:Following additional items will be made available at the District

Hospital:• Multi-channel Monitor• Non invasive Ventilator• Ultrasound Therapy• Pelvic traction (intermittent)• Trans electric Nerve stimulator (TENS)• Adjustable Walker.



At Regional Geriatric Centers level: Provide tertiary level services for complicated/serious

Geriatric Cases. Post graduate courses in Geriatric Medicine. Training to the trainers of identified District hospitals and

Medical Colleges. Specialized OPDs in all the specialties available with them for

the benefit of the Elderly30 bedded geriatrics ward



At Regional Geriatric Centers level:Following additional items will be made available at the

RGC:• Interferential therapy for pain• Continuous passive Motion units for Shoulder• Knee Modular monitor• Aero beds, Non-invasive ventilator• Invasive ventilator• Emergency trolleys (with multichannel monitors)• Portable X-ray unit, Portable ultrasound• Provision of Video conferencing unit


Regional Geriatrics CentersSr 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

132

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

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

Phasing of physical targets

Physical target 2010-2011 2011-2012

Establishment of Geriatric Department at 8 Regional Inst.

8 Regional Inst.Construction &Manpower deployment etc.

Fully functional Geriatric Dept in 8 Regional Inst.

Setting up of Geriatrics Unit at 100 District Hospitals

30 DistrictsConstruction and equipment &Manpower deployment etc

30 DistrictsFully functional Geriatric Unit70 DistrictsConstruction and equipment-Manpower deployment

Identified States and 30 districts (2010-11)

States Districts

Andhra Pr.

Nellore, Vijayanagram

Assam Dibrugarh, Jorhat

Bihar Vaishali, Rohtas

CH Bilaspur

GujaratGandhi Nagar, Surendranagar

Haryana Mewat

HP Chamba

J&K Leh, Udhampur

Jharkhand

Bokaro

Karnataka

Shimoga, Kolar

Kerala Pathanathitta

States Districts

Madhya Pr. Ratlam

Maharashtra

Washim, Wardha

Sikkim East Sikkim

Orissa Naupada

Punjab Bhatinda

Rajasthan Bhilwara, Jaisalmer

Uttrakhand Nainital

Tamil Nadu Theni

Uttar Pr. Rae Bareli, Sultanpur

West Bengal

Darjeeling

70 districts added in 2011-12States Districts

Andhra Pr.Srikakulam, Chittoor, Cuddapah, Krishna, Kurnool, Prakasham

Assam Lakhimpur, Sibsagar, Kamrup

BiharMuzaffarpur, Paschim Champaran, Poorva Champaran, Keimur

CH Jashpur Nagar, Raipur

GujaratRajkot, Jam Nagar, Porbandar, Junagarh

HaryanaYamuna Nagar, Kurukshetra , Ambala

HP Lahaul & Spiti , Kinnaur

J&K Kupwara, Doda (Erstwhile), Kargil

Jharkhand Ranchi, Dhanbad

Karnataka Udupi, Tumkur, Chikmagalur

KeralaKozikode (Calicut), Allappuzha, Idukki , Thrishur

States Districts

Madhya Pr.Hoshangabad, Chindwara, Jhabua , Dhar

MaharashtraGadchiroli, Bhandara, Chandrapur, Amaravati

Sikkim South Sikkim

OrissaBalangir, Nabrangpur, Koraput, Malkangiri

Punjab Gurdaspur, Hoshiarpur

RajasthanJodhpur, Ganga Nagar, Bikaner, Barmer, Nagaur

Uttrakhand Almora

Tamil NaduCoimbatore, Virudhnagar, Toothukudi, Tirunelveli

Uttar Pr.

Jhansi, Lakhimpur Kheri, Farookhabad, Firozabad, Etawah, Lalitpur, Jalaun

West Bengal Jalpaiguri, Dakshin Dinajpur

Proposed Monitoring Strategy

Integrated monitoring by NCD Cells at centre , States, districts

and CHCs.

Monthly Progress Report to be submitted by NCD cells.

Half yearly progress review meeting for assessing the status of

implementation of the programme activities.

Yearly Combined field visit by Central and State Cells for on the

spot assessment of progress of the activities.


Achievements

Developed operational guidelines 1st installment released to 27districts in 2010-11 and

48 districts in 2011-12 1st installment released to all the 8 RMI MOU signed with – 18 States Submitted 12th plan proposal- all the States/districts

proposed to be covered

Ref: Two years (2009-2011) Achievements and New Initiatives. , Ministry of Health and Family Welfare, GOI

Achievements

Release of Funds:

Year No. of districts

Amount released (crore)

No. of RMI

Amount released (crore)

2010-11 27 60 4 41.15

2011-12 48 75 4 30.31

Total 75 135 8 71.46

Issues for consideration

Create awareness among policy makers & programme officers

Training of manpower Utilization of released Budget Monitoring & Maintenance of

database

NGOs

NGOs for Older Persons in India

HelpAge India

Agewell Foundation

Maitri

GiveIndia

India Sponser

HelpAge India

- 33 offices across India.Mission: HelpAge India's mission is to work for the cause and care of

disadvantaged Older Persons, in order to improve the quality of their lives.

Objectives :• To foster the welfare of the aged in India especially the needy

aged• To raise funds for projects which assist the elderly irrespective

of cast or creed• To create in the younger generation and in society an

awareness about the problems of the elderly in India today

HelpAge India

Activities:• Focuses on

– improved access to health and – eye care facilities, – community-based services, and– livelihood support for the elderly. – Support-A-Grandparent scheme.

• Acts as the voice of the elderly and promotes their cause with the central and state governments.

• Endeavors to influence decision-makers to formulate policy that is beneficial to the elderly.

NGOS for Older Persons in Pune

• Adhar Sevavrat Old Age Home

• Apala Ghar Old Age Home• Apulaki Vriddhashram• Arpan Old Age Home• Goldage Ashram & Hospital• Janseva Foundation

Destitute Rehabilitation Centre

• Jiwhala Vriddhashram• Matoshri Vriddhashram

• Niwara• Olava Senior Citizens Home• Pitashri-old Age Home• Sahjeevan Ashram• Sankalp Sevadham• Savali• Tapodham• Umed Care Centre For Old

Age• Vanaprastha Ashram

NIWARA Niwara means ‘loving home’ Founded on 9th of August 1863, by visionaries

& eminent citizens of Pune• ‘Niwara’ – David Sasoon Anath Pangu Gruha

Charitable Trust devoted wholly & entirely to the welfare of old men & women, who – do not have near relatives like spouse, son/daughter,

– have no home to live in & – have no source of livelihood.

ie. offers home to the real destitutes in the society Take care of inmates till the end of journey; the Vaikuntha

crematorium ironically enough, just beyond the boundary walls!

NIWARA

Objectives of the trust :

1) To provide shelter, conducive food, clothes, bed, medicines & other facilities to elderly men & women 2) To extend co-operation to like minded institutions in pune or outside 3) To arrange entertainment programs for the inmates and to arrange for their orientation and training so that their inherent capacities and qualities are fastened and enhanced.4) To make efforts for rehabilitating the inmates among their relatives if possible 5) To undertake training and consultative programs for the elderly.6) To arrange and monitor studies and research regarding the issues of the old men and women.

NIWARA

Current No. of Inmates: 43 male & 84 female

Facilities: Rehabilitation centre Physiotherapy Homeopathy clinic Gymnasium Meeting Hall

Activities: Festivals Trips & Excursions Entertainment

REFERENCES• National Program for Health Care of the Elderly (NPHCE) : Towards

active and healthy ageing. Operational Guidelines. Director General of Health Services, MOHFW, Government of India.

• Situation Analysis of The Elderly In India, June 2011. Central Statistics Office, Ministry of Statistics & Programme Implementation, Government of India

• Rajan SI. Population ageing and health in India. The Centre for Enquiry into Health and Allied Themes (CEHAT), Mumbai. July 2006.

• National Policy on Older Persons (1999). Ministry of Social Justice and Empowerment, Government of India, Shastri Bhawan, New Delhi.

• Maintenance and Welfare of Parents and Senior Citizens Act – 2007, Ministry of Social Justice and empowerment Government of India

• Morbidity, Health care and the Condition of the aged. NSSO (64th

round)Jan-June 2004, National Sample Survey Organization, Ministry of Statistics and Programme Implementation, Government of India, March 2006.

• Two years (2009-2011) Achievements and New Initiatives. NRHM, Ministry of Health and Family Welfare, Government of India.

• Ingle GK, Nath A. Geriatric Health in India: Concerns and Solutions. Indian J Comm Med, 2008; 33 (4); 214-18.

• Prevention & Control of Non-Communicable Diseases (NCDs): Proposal for the 12th Plan, Report of the Working Group on Disease Burden: Non-Communicable Disease (NCDs), Director General of Health Services, MOHFW, Government of India.

• Planning Commission. 11th five year plan (Draft), Government of India; http://www.planningcommission.nic.in

http://www.planningcommission.nic.in/

Thank you!

Health & Medicine

Medico social problems of elderly