ELDERLY CARE IN INDIA-CHANGING PERSPECTIVES DR. K.L.SHARMA INDIAN GERONTOLOGICAL ASSOCIATION, INDIA

TRADITION SPEAK… One who always serves and respects elderly is blessed with four things : Long Life, Wisdom, Fame and Power” Manusmriti Chapter 2:121

Worldwide Trend of Population of 60 Years and Above : 1980-2020 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 Africa 23.4 30.9 41.8 57 82 Latin America 31.7 41.9 56.4 80.7 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

Proportion of Aged 60 and Over Population (in Per cent) 1980 1990 2000 2010 2020 World 8.6 9.2 9.9 10.8 12.9 Developed 15.2 16.8 18.4 19.7 22.4 Developing 6.3 7 7.7 8.7 10.9 Africa 4.9 4.8 5.6 Latin America 6.5 8.8 11 Asia (excl. Japan) 7.4 8.5 9.8 12.8 China 9 10.5 12.4 16.6 India 7.3 8.4 12.6 United Nations,World Demographic Estimate and Projections

Elderly Population-Facts! Aging of population is an end product of demographic transition. The number of elderly people in developing countries is almost 3-4 times of that of developed countries. The developed countries have already experienced the consequences of this transition.

Elderly Population-Facts! World population of 6.1 billion at the dawn of 21st century is likely to become 9.3 billion in 2050 (UN 2004). Global aged population from 595 million to 2 billion – a four fold rise-by 2050! In terms of proportion -10% in 2000, 15% by 2025, rising to 21.6% by 2050.

Elderly Population-Facts! 73 % of deaths in the elderly are related to heart diseases, smoking and cancers. 20% of doctor’s visits, 30 % of hospital days and 50% of bedridden days are ascribed to elderly patients. ‘Expansion of morbidity’ even though increased life expectancy due to chronic non-communicable diseases.

Elderly in India -Facts! 24 million in 1961 increased to 77 million in 2001 Projected to rise to 179 million in 2031 and 301 million in 2051. 70 and above projected to increase from 29 million in 2001 to 132 million in 2051. 80+ would be fastest to grow – 8 million in 2001 to 32 million in 2051.

Elderly in India -Facts! 2nd largest elderly (60+) population in the world (2001) 80% are in rural areas 40% are below poverty line over 73 per cent are illiterate. about 90 % of the old people have no official social security (i.e., without PF, Gratuity and Pension etc).

Elderly in India -Facts! Life expectancy 31.7 years in 1941 increased to 60.5 years in 2000. 55% of the women of 60 years and above are widows. Older women most vulnerable. Elderly poverty is a major risk of ageing in developing countries.

Not just the numbers… Family structure is changing to nuclear/small unit families. Without the safe, secure and dignified status in the family, the elderly are finding themselves vulnerable. Welfare of the elderly has been a low priority with the state…

Distribution of Aged Persons by State of Economic Dependence (n=1000)   Not Dependant Partially Fully No Response Rural Male 485 180 313 22 Female 121 146 706 27 Urban 515 169 297 19 115 110 757 18 National Sample Survey 52nd Round Survey, 1995-96

Distribution of Care Provider of Economically Dependent Aged   Spouse Own Children Grand Others Rural Male 113 766 50 71 Female 159 717 52 72 Urban 105 792 54 49 182 695 56 67 National Sample Survey 52nd Round Survey, 1995-96

The Support… The major thrust has been on improving the health status of children and women Geriatric services are largely unorganized. There are 186 old age homes, 233 day care centers and 28 medical vans These are managed by NGO/network of PHC and subentries in the rural areas.

Geriatrics in India Most hospitals do not have a special geriatric facility. At present most elderly patients are still being treated in general medical wards. There is only one hospital in Chennai that gives post-graduate (M.D.) education in geriatric medicine! Similarly the nursing and other para-medical staff are not formally trained in providing care for elderly patients.

Distribution of Chronic Diseases in Aged (n=1000) India   Rural Urban Chronic Disease M F Cough 250 1958 179 142 Piles 33 16 32 18 Joint Problems 363 404 285 393 High/low BP 108 105 200 251 Heart Disease 34 27 68 53 Urinary Problem 38 23 49 24 Diabetes 36 28 85 66 Cancer 2 3 4 Any of the above 527 514 528 560 National Sample Survey 52nd Round Survey, 1995-96

Distribution of Physical Disability in Aged (n=1000) India   Rural Urban Disability M F Visual 249 291 225 260 Hearing 139 156 111 132 Speech 32 38 29 3 Locomotor 107 115 80 94 Amnesia/Senility 96 113 61 Any Disability 380 425 333 367 National Sample Survey 52nd Round Survey, 1995-96

The policy Initiative in India 1999 Indian Government announced a National Policy on Older Persons policy implementation is to be monitored by  National council for Older Persons (NCOP). joint responsibility of the state and Central governments in December 2007 Indian parliament has passed a bill known as Maintenance of parents and Senior citizens Act

Policy aims to…. to encourage geriatric units in hospitals and clinics infirmary care units emphasis on family care of the aged through incentives and schemes for the needy families promotion of values through formal education and media subsidizing old age homes and day care centers

Geriatric Nursing Care Workshop (November ’07) In collaboration with NICE/ICCE 5 day workshop Attended by nursing staff of different hospitals in the state of Rajasthan, India.

Aims of the Workshop… Provide improved ideas and practices in the Care of elderly Refine existing practitioner’s skill in the care of elderly Draw attention of general practitioners to the needs of care of elderly Positively influence Government policy initiatives on geriatric care

Indian Gerontological Association www.gerontologyindia.com Established in 1968 Devoted to well being of Senior citizens & research on ageing Indian Journal of Gerontology -1969 Affiliated to IAGG in 1971

Indian Gerontological Association Runs a Day Care Centre Runs a counselling centre for elderly Organises training for family care givers Organises lectures on diseases common in old age Consultancy for NGOs working for elderly

In Summary… Elderly population in India is increasing. Status of elderly changing in family. Geriatrics is in incipient stage. NGOs have important role to play in creating awareness, imparting information and training of support services. We need to learn from the model of geriatric care in the developed countries.

THANKS Thanks to DR. K.L.SHARMA INDIAN GERONTOLOGICAL