Elderly in India — Needs and Issues
The goal of geriatric care considering the highprevalence of chronic illnesses in these patients isfocussed on detecting and managing disease rather thancuring disease. Crucial to that, in addition is themeasurement and promotion of physical function.1 Theelderly tend to be cared for in a variety of settings: home,nursing home, day-care centre, senior citizens out patientdepartment, medical units or intensive care unitdepending on the nature of the clinical problem.Anelderly patient may have his/her own bias or prejudiceabout ageing.2
Ageing of the population is a significant product ofdemographic transition.3 In India the proportion of olderpersons has risen from 4.9% in 1901 to 5.5% in 1951,6.5%in 1991, 7.7% in 2001 and will be 12% in 2025.4Increased human longevity (currently 64 yrs. in thecountry) has given rise to greater expectation of healthand services necessitating vigorous research in variousaspects of health and disease in old age and innovationsin providing social and economic services. Further,separate academic departments established in developedsocieties/countries conduct research and may be in aposition to provide comprehensive medicare in intensivesetting, rehabilitation and long term care. Dhar5 haspointed out the relative neglect in provision of facilitiesfor patient care as well as training and development ingeriatrics in the Indian context. However, the picture isnow changing with the increased awareness at severaldecision-making levels in relation to multiple healthissues related to ageing and care. The awareness,progress and the tempo of medical care and welfare ofthe elderly is receiving fair attention, though in theinterior and rural part of the country, they may continueto face a rather grim situation. The family pattern, the dwelling unit members and the overall mindset andattitudes of individuals have undergone a sea changein the last decade due to urbanization, economicliberalization and consumerism that prevails and thrives.
It is true that both the challenges and opportunitiesfor geriatric medicine are enormous.6 Innovativeapproaches and new models of service for health care inthe elderly are being practiced in different parts of thecountry. Adequate and comprehensive data indicatingthe disease burden and the experience gathered in such set-ups is lacking. However several booklets /directoriesappear in different regions of the country in several locallanguages indicating the nature and range of servicesavailable. The growth of geriatric medicine as a formalacademic discipline in medical schools has been ratherslow and needs concerted efforts at the university/council for a for the process to be hastened.
However, concurrent with the advancement ofgeriatric medicine/services arises an issue –a perplexingdilemma of longevity and compromised quality of lifethat needs to be considered and resolved to the extentpossible.
LONGEVITY AND COMPROMISED QUALITYOF LIFE : A PERPLEXING DILEMMA
Very few people reach old age completely free ofdisease .An epidemiological transition prevails wherebybecause of longer survival of man, more and morechronic degenerative diseases will have to be managed.Old age also tends to be characterized by concurrentpresence of multiple diseases. Advanced age in fact is arisk factor by itself in the causation of several diseasesparticularly vascular.
In developing countries infectious diseases andtropical conditions like pneumonias, septicemia andprotozoal diseases that tend to get complicated coexistsimultaneously with diseases such as hypertension,diabetes mellitus, coronary artery disease,cerebrovascular stroke and neoplasm, situations thatwere hitherto predominantly associated with thedeveloped nations. Degenerative conditions such asosteoarthritis, cataract and dementia tend to be universal.Nutritional problems do co exist either due to deficiencyor poor digestion /absorption.
Of the global population of over 6 billion almost 10 %are elderly. Further it is projected that the olderpopulation in developing countries will rise much fasterthan the developed countries. It has to be realised,however that the apparent success of the medical scienceis invariably accompanied by several social, economicand psychological problems in older persons, inaddition to the medical problems referred above. It needsto be understood that many of the problems require lifelong drug therapy, physical therapy and long-termrehabilitation.
It needs to be appreciated that there is greatheterogeneity in the older population.7 A seventy year old can run or be just capable of a slow walk or plainwheel chair bound. Geriatrics thus focusses on functionrather than the disorder persay. It concentrates on carerather than cure because the diseases tend to be chronic.It stresses on independence rahter than freedom fromdiseases. Maintenance of independent living is thecentral and core issue in geriatrics.
In spite of all that is stated hitherto, the inescapablefact remains that wherever there is functional declineand debility, the quality of life does get compromised.Economic dependence and social restriction further addsto the gravity of situation. Being cut off from theprofessional, occupational, social – neighborhood,environ and even from the busy near and dear ones mayserve as the last straw on the breaking back. The dilemmaof dichotomy of longevity on one hand and anenormously compromised quality of life on the other isindeed perplexing!
A probable solution to the dilemma is themultidimensional approach that comprises not onlycurative but also non-curative methods of care that areessentially preventive, rehabilitative and ones thatpertain to terminal and respite care.4
Frailty is defined as the loss of person’s ability towithstand minor environmental stresses because ofreduced reserves in the physiological function of severalorgan systems.8 The frail people are at increased risk ofdisability and death because they do not have thereserves to respond and maintain adequate homeostasis.In functional terms frailty is defined as dependence on thers for activities of daily living (ADL s)- bathing,dressing, feeding, continence, toiling and mobility. Bothfrailty and disability frequently coexist and theprevalence increases with increasing age. Impairedcognitive function may add to the complexity of thesituation.
All in all, the medical/health and social serviceinstitutions in the country need to prepare for thedemands of care of the frail/disabled senior citizens tominimize the gap between the longevity and associatedpoorer quality of life.
1.Duthie EH. History and physical examination. In practice ofgeriatrics. Duthie EH, Katz PR (eds), WB Saunders : Philadelphia. 1998:3-14.
2.Schneidermann H. Physical examination of the aged patient.Conn Med 1993;57:3-10
3.Population projections for India and States 1996-2016.Census of India 1991(Report), New Delhi:RegistarGeneral, India, 1996.
4.Vinod Kumar. Geriatric Medicine in API Textbook of Medicine.Shah SN (API,Mumbai 2003):1459-1462.
5.Dhar HL. Emerging geriatric challenge. J Assoc Physic India2005;53:867-72.
6.Sharma OP, Dey AB. Geriatric care in India – Introduction.Sharma OP (ed) A N B Publishers, Delhi 1999:3-7
7.Rosenblatt DE, Jothydev K, Geriatric principles. In Primeron Geriatric Care. Rosenblatt DE, Natarajan VS (eds) Kochin2002:19-26.
8.Colledge NR. Frail older people in Davidsons Principles andpractice of Medicine. Haslett C, Hunter JAA(eds) ChurchillLivingstone : Edinburg 2002:237-244.
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