medico social problems of elderly in india
TRANSCRIPT
Medico-social problems of elderly and National Programmes for elderly
SpeakersDr 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.
Ref: WHO Fact File 2012
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.
Ref: WHO Fact File 2012
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
Ref: World health statistics 2011. Geneva, WHO
Year
s los
t due
to p
rem
atur
e de
ath
Diseases
Disability
Fig: Years Lost due to Disability (YLDs) per 100 000 adults over age 60 by country income group
Year
s los
t due
to d
isabi
lity
Ref: World health statistics 2011. Geneva, WHO
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
Ref: World health statistics 2011. Geneva, WHO
Total burden of Death and DisabilityDA
LY
Fig: Disability Adjusted Life years ( DALYs) per 100000 adults over age 60 by country income group
Ref: World health statistics 2011. Geneva, WHO
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.
Ref: World health statistics 2011. Geneva, WHO
Situation analysis of elderly in India
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
Situation analysis of elderly in India
• 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 fami
ly
Functionall
y impaire
d
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.
National Policies & Programmes for the Welfare of the Elderly
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
National Policies & Programmes for the Welfare of the Elderly
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.
Ref: Situation Analysis Of The Elderly in India, June 2011, Ministry of Statistics & Programme Implementation, GOI
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.
Ref: 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:
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.
Ref: Situation Analysis Of The Elderly in India, June 2011, Ministry of Statistics & Programme Implementation, GOI
4.National Policy on Older Persons (NPOP), 1999
Ref: National Policy on Older Persons (NPOP), 1999 Ministry of Social Justice & Empowerment, GOI
4.National Policy on Older Persons (NPOP), 1999
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
Ref: National Policy on Older Persons (NPOP), 1999 Ministry of Social Justice & Empowerment, GOI
4.National Policy on Older Persons (NPOP), 1999
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;
Ref: National Policy on Older Persons (NPOP), 1999 Ministry of Social Justice & Empowerment, GOI
4.National Policy on Older Persons (NPOP), 1999
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.
Ref: National Policy on Older Persons (NPOP), 1999 Ministry of Social Justice & Empowerment, GOI
4.National Policy on Older Persons (NPOP), 1999
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.
Ref: National Policy on Older Persons (NPOP), 1999 Ministry of Social Justice & Empowerment, GOI
4.National Policy on Older Persons (NPOP), 1999
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
Ref: National Policy on Older Persons (NPOP), 1999 Ministry of Social Justice & Empowerment, GOI
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.
Ref: Situation Analysis Of The Elderly in India, June 2011, Ministry of Statistics & Programme Implementation, GOI
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
Ref: Situation Analysis Of The Elderly in India, June 2011, Ministry of Statistics & Programme Implementation, GOI
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
Ref: Situation Analysis Of The Elderly in India, June 2011, Ministry of Statistics & Programme Implementation, GOI
7.Central Sector Scheme of Integrated Programme for Older Persons(IPOP)
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
Ref: Situation Analysis Of The Elderly in India, June 2011, Ministry of Statistics & Programme Implementation, GOI
7.Central Sector Scheme of Integrated Programme for Older Persons(IPOP)
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
Ref: Situation Analysis Of The Elderly in India, June 2011, Ministry of Statistics & Programme Implementation, GOI
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
8.Schemes of Other MinistriesII. 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
8.Schemes of Other Ministries
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
8.Schemes of Other Ministries
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
8.Schemes of Other MinistriesV. 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
8.Schemes of Other Ministries
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.
Ref: National Programme For Health Care Of The Elderly (NPHCE),Operational Guidelines, MOHFW, GOI
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 training
IEC using mass media, folk media
and other communication
Ref: National Programme For Health Care Of The Elderly (NPHCE),Operational Guidelines, MOHFW, GOI
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.
Ref: National Programme For Health Care Of The Elderly (NPHCE),Operational Guidelines, MOHFW, GOI
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
Ref: National Programme For Health Care Of The Elderly (NPHCE),Operational Guidelines, MOHFW, GOI
Operational Guidelines
A. Package of Services at
different levels
B. Institutional framework for implementatio
n
C. Management
StructureD. Activities at various levels
Ref: National Programme For Health Care Of The Elderly (NPHCE),Operational Guidelines, MOHFW, GOI
A. Package of Services
Health
promotion
Preventiv
e service
Diagnosis
& managemen
t
Day care services
Rehabilitative services
Home
based
care
Ref: National Programme For Health Care Of The Elderly (NPHCE),Operational Guidelines, MOHFW, GOI
A. Package of Services
Organizational Structure:
Ref: National Programme For Health Care Of The Elderly (NPHCE),Operational Guidelines, MOHFW, GOI
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:
Ref: National Programme For Health Care Of The Elderly (NPHCE),Operational Guidelines, MOHFW, GOI
B. Institutional Framework for the Implementation of NPHCE
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
Ref: National Programme For Health Care Of The Elderly (NPHCE),Operational Guidelines, MOHFW, GOI
B. Institutional Framework for the Implementation of NPHCE
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.
Ref: National Programme For Health Care Of The Elderly (NPHCE),Operational Guidelines, MOHFW, GOI
C. Management Structure
National NCD Cell
State NCD Cell
District NCD Cell
Ref: National Programme For Health Care Of The Elderly (NPHCE),Operational Guidelines, MOHFW, GOI
C. Management Structure
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
Ref: National Programme For Health Care Of The Elderly (NPHCE),Operational Guidelines, MOHFW, GOI
C. Management Structure
20% of the total expenditure
Provision of land
Support of lab services
Additional support for medicines
Maintenance of equipments,
wards and OPD
Ref: National Programme For Health Care Of The Elderly (NPHCE),Operational Guidelines, MOHFW, GOI
State contribution:
C. Management Structure
State Programme Officer
Programme Assistant
Finance cum Logistics Officer
Data Entry Operators (2)
Ref: National Programme For Health Care Of The Elderly (NPHCE),Operational Guidelines, MOHFW, GOI
State NCD Cell:Composition: State NCD Cell will be supported by following contractual staff:
C. Management StructureState 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
Ref: National Programme For Health Care Of The Elderly (NPHCE),Operational Guidelines, MOHFW, GOI
C. Management Structure
District Programme Officer
Programme Assistant
Finance cum Logistics Officer
Data Entry Operators
Ref: National Programme For Health Care Of The Elderly (NPHCE),Operational Guidelines, MOHFW, GOI
District NCD Cell:Composition: District NCD Cell will be supported by following contractual staff:
C. Management Structure
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.
Ref: National Programme For Health Care Of The Elderly (NPHCE),Operational Guidelines, MOHFW, GOI
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.
Ref: National Programme For Health Care Of The Elderly (NPHCE),Operational Guidelines, MOHFW, GOI
D.Activities under NPHCE at Various levels
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.
Ref: National Programme For Health Care Of The Elderly (NPHCE),Operational Guidelines, MOHFW, GOI
D.Activities under NPHCE at Various levels
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..
Ref: National Programme For Health Care Of The Elderly (NPHCE),Operational Guidelines, MOHFW, GOI
D.Activities under NPHCE at Various levels
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
Ref: National Programme For Health Care Of The Elderly (NPHCE),Operational Guidelines, MOHFW, GOI
D.Activities under NPHCE at Various levels
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
Ref: National Programme For Health Care Of The Elderly (NPHCE),Operational Guidelines, MOHFW, GOI
D.Activities under NPHCE at Various levels
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
Ref: National Programme For Health Care Of The Elderly (NPHCE),Operational Guidelines, MOHFW, GOI
D.Activities under NPHCE at Various levels
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.
Ref: National Programme For Health Care Of The Elderly (NPHCE),Operational Guidelines, MOHFW, GOI
D.Activities under NPHCE at Various levels
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
Ref: National Programme For Health Care Of The Elderly (NPHCE),Operational Guidelines, MOHFW, GOI
D.Activities under NPHCE at Various levels
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
Ref: National Programme For Health Care Of The Elderly (NPHCE),Operational Guidelines, MOHFW, GOI
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 College1 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, JorhatBihar Vaishali, RohtasCH Bilaspur
Gujarat Gandhi Nagar, Surendranagar
Haryana MewatHP ChambaJ&K Leh, Udhampur Jharkhand BokaroKarnataka Shimoga, Kolar
Kerala Pathanathitta
States Districts
Madhya Pr. RatlamMaharashtra Washim, Wardha
Sikkim East Sikkim
Orissa Naupada
Punjab Bhatinda
Rajasthan Bhilwara, Jaisalmer
Uttrakhand Nainital
Tamil Nadu Theni
Uttar Pr. Rae Bareli, SultanpurWest 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.
Ref: National Programme For Health Care Of The Elderly (NPHCE),Operational Guidelines, MOHFW, GOI
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.
NIWARACurrent 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
Thank you!