Healthcare of geriatrics

While many geriatric patients appreciate advancements in healthcare, they also express their concern on the cost of treatment which is a challenge for them, says Sivakumaran J

India has a twin challenge of rising population and old age dependents currently.  A recent study reveals that globally the ageing population is growing faster than the population rate. Indian aged population is expected to increase from 8 percent in 2015 to 20 percent in 2050. By the end of this century, it may go up to 34 percent. When population age rapidly, governments are unable to face the consequences. Three major changes contributed to this – declining fertility, mortality reduction and increasing survival rate of older population.  Thanks to the technological advancements and Indian talents which has improved the healthcare delivery and medical care, as a whole. But on the other hand the cost of health care during old age is increasing the economic burden of the family. While many geriatric patients appreciate advancements in healthcare, they also express their concern on the cost of treatment which is a challenge for them.  From getting an appointment to reaching home back after treatment is cumbersome for them. They prefer to have home based health care services from experts, who are well versed with age related issues. Are we really geared up to handle at individual level, state level and national level to handle these aged population? How many of us are really spare funds to spend for their old age members?

Broadly, geriatric population could be classified into three groups. The first classification is group of elders who are independent and mostly fit mentally and physically.  They are willing to engage themselves in taking up assignments but with limited working hours. They can access health centres to take care of themselves. Age related ailments like hearing impairment, vision deficiency, rheumatoid arthritis and other common diseases like diabetes, blood pressure need to be screened periodically to ensure their fitness. This will not only make them to be independent but will encourage peers to be active.  A recent reading about a Chinese village reveals that the average survival age of that village is 110 . The secret of longer life is their active  engagement in one or other activities. They do in groups and socialise each other to feel that they are energetic and peers are there to share their feelings.

The second group of geriatric are those who cannot be independent, but can take care of their daily routines with assistance from others, as they will have functional limitations.   This group need frequent medical assistance and rehabilitative treatment.  They prefer to have home rehabilitation rather than travelling to the hospitals or clinics.  Generally this group will have more than one disease and may require frequent admissions to hospitals.  Preferably an attendant is needed most of the times, to make them feel secured and meet their psychological need. Dedicated rehabilitative equipment like wheel chair, walker etc and transport system for medical assistance is required for their day to day activities.

The third group of geriatrics are those who are having serious functional limitations.  Many a times they have cognitive limitations too.  An attendant with 24x7 is needed to take care of their needs.  Taking them to clinics and hospitals is little cumbersome. It would be nice to engage a home care healthcare team.  Very aggressive medical interventions needs to be avoided but palliative care to be provided to reduce sufferings. India do not have much hospice care setups, though popular in Western countries. Hospice care will be more suitable for these patients but challenges will be the cost of care and expertise  in handling them. Since the expenses will be taken care either by insurance or by government in Western countries, hospice care is popular there. They are treated and looked after by the service provider in a dignified way with human touch.  Hence old age population of this group chooses to go to such care in those countries.

In India, the geriatric care is a neglected area and few bigger hospitals in urban only will have.  Few unorganised service providers extend sub-optimal care to them. More over the affordability is a challenge.  There are restrictions on age limit, pre-existing disease coverage, outpatient expenses reimbursement and coverage limitations.  Also the scheme on pension and social security is limited to only public sector employees and with few corporates. Hence the old age population feel the unaffordability, social isolation and dependency on their kids and relatives.  The current system of nuclear family  has decreased the confidence of elders against the joint family system prevailing then, in which the social and economic security was taken care.

In India, many old age homes are picking up and there is a reasonable response from geriatric population.  Many of these homes do not have sufficient medical back up and there is a challenge in providing healthcare to them.  Unless they have a tie up with good medical centre nearer to the home, the needs cannot be met. Other challenge is providing food for their taste. Since occupants are from various regions, providing different menu is also a challenge for the care takers. But elders enjoy their stay as they socialise with the same age group with others having same habits and activities. They share their past, present and future incidents with peers and spend their time.

Requirements of geriatrics health need to be fulfilled by addressing them in toto.  Physical, social, economic, psychological and spiritually needs to be taken care.  Though there are few government schemes available, that may not be sufficient to meet their need.  To support the government, NGOs and private players can also come forward to bridge the gap. Few specialised short term courses could be introduced to have sufficient man power to handle them. Rural population are totally neglected, while compared to the urban population. Apart from healthcare facilities, they need to be respected, assisted and be with them.  Abusing, neglecting and exploiting of geriatric population is a global problem, which will hurt them seriously. Family members, relatives, friends and caregivers need to be very cautious in handling them with tolerance and patience.
Sivakumaran J is COO of KMCH Hospitals.