2. INTRODUCTION
Over the past few years, the world’s population
has continued on its remarkable transition path
from a state of high birth and death rates to low
birth and death rates coupled with improvement
in health services & standard of living.
At the heart of this transition has been the
growth in the number and proportion of older
persons.
Such a rapid, large and ubiquitous growth has
never been seen in the history of civilization.
The current demographic revolution is predicted
to continue well into the coming centuries.
2
3. BY Definition….
60-69 70-79 80+
Old Old - Old Oldest-
Old
Source: National Policy on Older Person 1999
GOI
60-74 75- 84 85+
Young Old Middle old Old-Old
4. Changing world Scenario
The world will have more
people who live to see their
80s or 90s than ever before.
The past century has seen
remarkable improvements
in life expectancy.
Soon, the world will have
more older people than
children.
The world population is
rapidly ageing.
Low- and middle-income Source :WHO 2010
countries will experience
the most rapid and dramatic
demographic change. 4
5. World Population trend of 60+ Years
1980-2020 (in millions)
1980 1990 2000 2010 2020
World 381.2 484.7 608.7 754.2 1011.6
Developed 173.3 203.6 234.6 232.4 308.2
Developing 207.9 281.8 374.1 491.8 703.4
Asia (excl. Japan) 160 218.2 290 377.7 539.9
China 78.6 101.2 131.7 167.9 238.9
India 44.6 60.2 81.4 107 149.7
United Nations,World Demographic Estimate and Projections
6. Ageing: The Indian Scenario…
India is one of the few
countries in the world where
sex ratio of aged is in favour of
males.
Population above 60 years-
10% suffer from impaired
physical mobility.
10% Hospitalized at given
point of time.
Age more than 70 years-
More than 50% suffer form 1
or more chronic conditions
like CHD, Cancer and HT .
6
7. Socio-demographic profile of the
elderly in India.
Elderly persons lives in rural
75% area.
48% Women
73% Illiterate and dependent.
Source : Census
66% BPL 2001
Were in vulnerable situation
66%
and without sufficient food.
7
10. Health risks of elderly
PRONE FOR
INCRASED INFECTIONS
RISK OF DEATH
INCREASED PRONE FOR
RISK OF
DISABILITY INJURIES
INCREASED PRONE FOR
RISK FOR PSYCHOLOGIC
DISEASE AL PROBLEMS
PRONE FOR
DEGENERATI
VE
DISORDERS
10
11. COMMON MORBIDITIES IN ELDERLY IN INDIA
Cataract &Visual
impairment- 88%
Arthritis & locomotion
disorder-40%
CVD &HT – 18%
Neurological
problems- 18%
Respiratory
problems
including Chronic
bronchitis- 16%
GIT pro
blems 9%
Psychi
Ref – ICMR study 2001 atric
proble
ms- 9% 11
Delhi & Hariyana
12. Prevalence of common health problems in
elderly
GOI study-2007
P
e
r
c
e
n
t
a
g
e
Health Problem 12
13. Mortality in elderly
33
% CVD
10
%
Respiratory diseases
10
% Infections,TB
6% Neoplasm
4% Accidents, poisoning and violence
17 deaths by chronic diseases by
% 2015
13
14. Need for Dedicated Health care for elderly ?
Decrease in physical ability / Economic inadequacy
Increase vulnerability to diseases
Chronic, disabling and multiple Health problems
Different approach and management
Degradation in family values
Rising Population
14
15. Major constraints for geriatric health care
Lack of
specialized and
trained
manpower
Geriatrics
No dedicated
not yet a
health care
popular
infrastructure
specialty
15
16. Major Govt. initiatives
National Policy On Older Persons (NPOP) -1999
Recommendations by working group of planning
commission -2006 for national programme
Maintenance and Welfare of Parents and Senior
Citizens Act – 2007
Announcement of National programme for Health
Care of Elderly during Budget speech (2008-09)
Approval of “National programme for Health Care
of Elderly” by Ministry of Finance - June 2010
16
17. NATIONAL POLICY ON OLDER PERSONS (1999)
Components
Support for financial security
Health Care
Shelter
Welfare and other needs of older persons
Protection against abuse and exploitation
Opportunities for development of the potential of
older persons
Improving quality of life
17
18. NPOP agenda for health care for the elderly
Geriatric ward for elderly at all DH
Treatment facilities for chronic, terminal and
degenerative diseases
Providing Improved medical facilities at CHCs
/ PHCs / Mobile Clinics
Inclusion of geriatric care in the syllabus of
medical courses including courses for nurses
Reservation of beds for elderly in public
hospitals
Training of Geriatric Care Givers
Research institutes for chronic elderly
diseases such as Dementia & Alzheimer
7 Aug 2012 18
19. Maintenance and Welfare of Parents and Senior
Citizens Act - 2007
Article (20) : The State Government shall ensure
The Government hospital or Govt. funded
hospitals shall provide beds for senior citizens
as far as possible.
Separate queues be arranged for senior
citizens.
Facility for treatment of chronic, terminal and
degenerative diseases is expanded for senior
citizens
Research activities for chronic elderly diseases
and ageing is expanded
Earmarked facilities for geriatric patients in
every district hospital.
19
20. Extract of Finance Minister’s Budget Speech 2008-09
“The other major intervention will be for the elderly. A
National Programme for the Elderly with a Plan outlay of
Rs. 400 crore will be started in 2008-09. Among other
measures, we will establish, during the XIth Plan Period
two institutes of aging eight Regional Centres and a
Department of Geriatric Medical Care in one of the Medical
Colleges/Tertiary level Hospitals in each State.”
20
22. SERVICES FOR ELDERLY
ALREADY IN INDIA
Constitutional and legal provisions.
Maintenance and welfare of parents and
senior and welfare of parents and senior
citizens Bill 2007
Ministry of Social Justice & Empowerment
22
23. National policy on older persons policy
on older persons
January, 1999. areas of intervention --
◦ Financial security, healthcare and
nutrition, shelter, education, welfare, protectio
n of life and property etc. for the wellbeing of
older persons in the country.
National Council for Older Persons
◦ Constituted by the Ministry of Social Justice
and Empowerment to operationalise the
National Policy on Older Persons
23
24. The Vision & Objectives of NPHCE
The Vision:
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;
Convergence of NRHM, AYUSH & all other dept.
24
25. Objectives
To provide an easy access to
promotional, preventive, curative and
rehabilitative services to the elderly 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. 25
26. Strategies for NPHCE 2010
District Hospital -
10 bedded
PHC/CHC level - wards, additional
human 8 RMC - PG
equipment, courses in
training, resources,
Geriatric
additional human Medicine, and
resources (CHC), training
IEC,
Community
level - IEC using mass
domiciliary Core media, folk media
visits by trained Strategies and other
health care communication
workers.
26
27. Supplementary Strategies for NPHCE
Mainstreaming
AYUSH and
Promotion of convergence with Reorienting
public private programmes of medical
partnerships in Ministry of Social education to
Geriatric Justice and support geriatric
Health Care. Empowerment in issues.
the field of
geriatrics.
27
28. EXPECTED OUTCOMES OF
NPHCE
Regional Geriatric Centres (RGC) in 8
Regional Medical Institutions
Post-graduates in Geriatric Medicine
(16) from the 8 regional medical
institutions;
Video Conferencing Units in the 8
Regional Medical Institutions to be
utilized for capacity building and
mentoring; 28
29. District Geriatric Units
Geriatric Clinics/Rehabilitation units
Sub-centres
Training of Human Resources
29
31. Package of Services
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
Home based care
Districts will be linked to Regional Geriatric Centers for
providing tertiary level care.
Integration with existing primary health care delivery
system and vertical at district and above as more
specialized health care are needed for the elderly.
31
32. Services at PHC
Weekly geriatric clinic by a trained Medical Officer
Conducting a routine health assessment
(eye, BP, blood sugar & record keeping).
Provision of medicines and proper advice on chronic
ailments
Public awareness on promotional, preventive and
rehabilitative aspects of geriatrics during health and
village sanitation day/camps.
Referral services.
32
34. Services at Sub-centre
Health Education related to healthy
ageing
◦ Domiciliary visits to home bound / bedridden
elderly persons .
◦ Arrange for suitable calipers and supportive
devices.
◦ Linkage with other support groups and day
care centers.
34
35. Services at Community health
centre
First Referral Unit (FRU) for the Elderly from
PHCs and below.
Geriatric Clinic for the elderly persons twice
a week.
Rehabilitation Unit for physiotherapy and
counselling
Domiciliary visits by the rehabilitation worker
for bed ridden elderly and counselling of the
family members on their home-based care.
Health promotion and Prevention
Referral of difficult cases to District
Hospital/higher health 35
36. Services at District Hospital
Geriatric Clinic for regular dedicated OPD services to
the Elderly with Lab facility & adequate medicine.
Ten-bedded Geriatric Ward with existing specialties
Provide services to referred by the CHCs/PHCs etc.
Conducting camps for in PHCs/CHCs and other sites.
Referral services to tertiary level hospitals
36
37. Services at Regional Geriatric
Centre
30-bedded Geriatric Ward for in-patient
care and dedicated beds for the elderly
patients in the various specialties.
Laboratory investigation required for
elderly with a special sample collection
centre in the OPD block.
Tertiary health care to the cases
referred from medical colleges, district
hospitals and below.
37
38. Activities under NPHCE at various levels
At Sub Centre level:
Health Education related to healthy
ageing, environmental
modifications, nutritional requirements, life
styles and behavioural changes.
Special attention to home bound / bedridden
elderly persons and provide training to the
family health care providers in looking after
the disabled elderly persons.
Arrange suitable callipers and supportive
devices from the PHC.
Linkage with other support groups and day
care centres etc. operational in the area. 38
39. Activities at SC level
Following items will be made available at
the Sub-centre level:
Walking Sticks
Calipers
Infrared Lamp
Shoulder Wheel
Pulley
Walker (ordinary)
No additional contractual staff.
39
40. At PHC level:
The weekly geriatric clinic
by trained medical officer.
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. 40
41. Following items will be made available at the
PHC:
Nebulizer
Glucometer
Shoulder Wheel
Walker (ordinary)
Cervical traction (manual)
Exercise Bicycle
Lumber Traction
Gait Training Apparatus
Infrared Lamp etc.
41
42. At RH/CHC level:
◦ First level medical referral centre for medical care
and rehabilitation services
◦ Twice weekly health clinics for the elderly persons
◦ Rehabilitation unit
◦ Domiciliary visits for care of disabled persons by Multi
rehabilitation worker
◦ Referral Services to DH
◦ Training of staff
42
43. Following items will be Cervical traction
made available at (intermittent)
the CHC: Walking for gait
Nebulizer training equipment
Glucometer Walking Sticks /
ECG Machine Calipers
Pulse Oximeter Shoulder Wheel
Defibrillator Pulley
Multi - Channel Walker (ordinary)
Monitor Cervical traction
Shortwave (manual).
Diathermy
43
44. 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 44
45. Following items will be made available at the
District Hospital:
Nebulizer
Glucometer
ECG Machine
Defibrillator
Multi-channel Monitor
Non invasive Ventilator
Shortwave Diathermy
Ultrasound Therapy
Cervical traction (intermittent)
Pelvic traction (intermittent)
Tran electric Nerve stimulator (TENS)
Adjustable Walker.
45
46. Regional Geriatrics Centers
Sr
No Regional Institutes States Linked
1 All India Institute of Medical Sciences, Delhi, Haryana, Uttarakhand,
New Delhi Punjab Himachal Pradesh, M.P.
2 Institute of Medical Sciences, Banaras Uttar Pradesh, Bihar, Jharkhand,
Hindu University, Uttar Pradesh West Bengal
3 Grant Medical College & JJ Hospital, Maharashtra, Goa, Northern
Mumbai, Maharashtra, Districts of Karnataka,Chattisgarh
4 Sher-e-Kashmir Institute of Medical Jammu & Kashmir
Sciences, Srinagar, Jammu & Kashmir
5 Govt. Medical College, Kerala, Southern Districts of
Tiruvananthapuram, Kerala, Karnataka & Tamil Nadu
6 Guwahati Medical College, Guwahati, Assam & NE States
Assam
7 Madras Medical College, Chennai, TN. Tamil Nadu, Andhra Pradesh, Orissa
8 SN Medical College, Jodhpur, Rajasthan Rajasthan & Gujarat 46
47. 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.
Developing evidence based treatment
protocols for Geriatric diseases prevalent in the
country.
Developing/and updating Training modules &
guidelines and IEC materials.
Research on specific elderly diseases.
47
48. 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 Medical7College, Patna
Aug 2012 48
50. Financial mangement
Financial management groups (FMG) of
Programme Management support units at state
and district level, which are established under
NRHM, will be responsible of maintenance of
accounts, release of funds, expenditure
reports, utilization certificates and audit
arrangements.
50
51. State level
State will monitor release of funds
and expenditure incurred under
various components of the
programme in the State.
Submit monthly statement of
expenditure in the prescribed format
to the State Health Society.
51
52. HOW TO ACHIEVE OPTIMUM
ELDERLY CARE?
Active advocacy at various levels
of planning
Need for reorganization of the
facilities and approach
Efforts to be made to revive
cultural values and reinforce the
traditional practice of
interdependence among
generations
Surveillance of the ongoing
programmes and evaluate for
effectiveness.
52