10^th July, 2021, 11am-12pm

Key points of HCFI Expert Round Table

• Care of the elderly is a concern especially during the pandemic. India has almost 120 million elderly people with various physical, mental, social, economic and spiritual problems.
• Government of India defines elderly as persons ≥60 years.
• The healthcare needs of the elderly are different from other age groups.
• About 8.6% of population is older than 60 years.
• 68% suffers from one or the other chronic disease; 40% suffers from one or the other disability of vision, movement, hearing, mental or other disabilities. About one in three elderly persons suffers from arthritis.
• 71% live in rural areas; 73% are illiterate and depend on physical labor for living.
• 66% of older people are in a vulnerable situation without adequate food, clothing or shelter and ~90% have no regular source of income.
• Most of them live alone and are lonely as they age.
• The elderly have more chronic conditions vs younger people; their aging immune system makes it harder to fight off infections and diseases. Recovery is also slower.
• Disease conditions such as Alzheimer’s, Parkinson’s and dementia are on the rise.
• Fear and uncertainty due to the Covid pandemic is particularly common in older adults. The lockdown may have left them feeling more vulnerable as they are at high risk of acquiring the infection.
• The pandemic has adversely affected management of chronic diseases resulting in anxiety, depression, insomnia etc.
• There are elderly care programs, but don’t seem to be a priority. There is a National Program for Health Care of Elderly (NPHCE) since 2011 with the objective 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 and convergence with National Rural Health Mission (NRHM), Ayush and other line departments like Ministry of Social Justice and Empowerment.
• The major components of NPHCE are the National Health Mission (NHM) Component (Primary & Secondary care service delivery through District Hospitals (DH), Community Health Centres (CHC), Primary Health Centres (PHC), Sub-Centre/Health & Wellness Centres), Tertiary Component (renamed as ‘RashtriyaVaristh Jan Swasthya Yojana’ in 2016-17. These services are being provided though Regional Geriatric Centres (RGCs) located at 19 Medical colleges in 18 states of India and two National Centres of Aging (NCAs) one in AIIMS, Ansari Nagar, New Delhi and another in Madras Medical College, Chennai) and research (Longitudinal Ageing Study in India (LASI) project; results were released last month).
• Challenges: Geriatric care is missing from medical education curriculum, there is no formal training of nursing and allied health staff on geriatric care, no specialised PG course so far, not enough number of old age homes and hospices and no priority for adult immunisation program (flu, pneumococcal etc).
• The elderly constitute almost 9% of the total population and it is expected to rise by several folds by 2050.
• Age 60-75 years are called “young old”; 75-85 years are called “old old” and ≥85 years are called “very old”. Care of the “old old” and “very old” is important during Covid.
• In India, the elderly (>60 years) were prioritised to receive the vaccine in the second phase of the Covid vaccination drive.
• Gender bias is common in our country.
• Geriatric care has social and emotional contexts in India, which cannot be ignored. The elderly worry more about their family than themselves.
• Elderly care services are a part of expanded range of services provided by Health and Wellness Centres, which form the base pillar of Ayushman Bharat.
• Geriatric postgraduation is in a very limited phase in our country and it needs to be developed along with creation of job opportunities. Courses such as PG Diploma, Fellowships attract candidates only when they work better monetarily.
• Capacity development in geriatric care has to take place in a big way
• Facilities for elderly population in our country are very inadequate especially with regard to old age homes, support groups, caretakers etc. the situation has worsened during the pandemic due to quarantine, reverse quarantine policies etc.
• Their care in homes is also affected as family members themselves may have Covid-19.
• Even if there are geriatric care clinics, they did not function during the pandemic due to non availability of staff.
• There is a need to have a long-term plan of elderly care and how to manage the elderly population in case a third wave arrives.
• There is a need to strengthen the healthcare systems to take care of the elderly, both formal and informal (within the home) and develop user-friendly services particularly in context of Covid.
• Role of families becomes very important in geriatric care, whether have they been given the vaccine by their family members, have they been made to follow Covid-appropriate behavior,
• At least 15 days of posting should be allocated to geriatric care during internship to sensitise them to the needs of the geriatric population.
• Instead of allocating more resources, efforts should be made to utilise the present resources more efficiently for geriatric care.
• There should be a feedback system for the elderly and they should be included in the beneficiaries of Ayushman Bharat.
• There should be some compensation for Covid for those living below the poverty line.
• It is important to sensitise the younger members of the family towards taking care of the elders in the family.
• There are 4-5 systems of healthcare in the rural areas hence, care is better in rural areas. Anxiety, depression etc. are more common in the urban aging population vs rural.
• A presentation on Geriatric healthcare with AI and technology was given by Dr Arun Jamkar. Few examples of IoT in healthcare are headsets that measure brain waves, clothes with sensing devices, BP monitors, pulse oximeters, glucose monitors, ECG monitors, sensors embedded in the medical equipment, wearable devices like the Apple watch. “I-Doctor”, an intelligent drug dispensing ATM based on symptom based algorithm was briefly discussed. The system presently covers 50 systems and dispenses drugs.

Participants

Dr AK Agarwal

Dr Suneela Garg

Dr Anita Chakravarti

Dr Russell D’Souza, Australia

Dr DR Rai

Dr Arun Jamkar

Dr Jayakrishnan Alapet

Prof Bejon Misra

Dr Anil Kumar

Dr KK Kalra

Ms Ira Gupta

Mr Saurabh Aggarwal

Dr S Sharma