How to improve geriatric care in India
Specialised geriatric care is the need of the hour. For the first time in recorded history, the number of people aged 65 or older is set to outnumber children below the age of 5 years. The aging population is accelerating, driven by falling fertility rates and increased life expectancy. It is expected to grow from 524 million (2010) to nearly 1.5 billion in 2050, largely in developing countries, including India.
When we talk about geriatric care, it is not right to classify people just by their chronological age. We need to classify older adults by their functional and cognitive status, since different individuals have different healthcare needs. Stereotyping and bunching up all the elderly into one group is not right.
The needs of the functionally and cognitively fit elderly are completely different from those of elders with mild or severe functional limitations or cognitive impairment.
In the case of the former, the goal is to keep them physically and mentally active, perform periodical screening for common disease conditions such as diabetes, hypertension, cancer, vision and hearing issues; promote bone health and ensure vaccination. Comprehensive geriatric assessment with a coordinated screening program and management of chronic diseases becomes important for this group so that they remain active and independent well into their later years.
For the latter group, i.e., those with impaired functional and cognitive abilities, their healthcare needs could be extensive. They would need special geriatric clinics, where they are comprehensively assessed and rehabilitated. They may need physiotherapy, psychological support and constant medical help. They could require hospitalization for acute illnesses, since their cognitive status and functional status would decline with each acute illness. The goal of care here is to help them live independently with assistance. Those with severe impairment would require hospice care or home care.
This is where focussed training in geriatric healthcare becomes key. It is a common misconception that any nurse or even an untrained care-giver can provide quality healthcare to the elderly.
Geriatric care is conspicuously missing from the medical education curriculum. Nursing and other paramedical staff members are not formally trained in providing care to elderly patients. There is no specialized training in geriatrics in most medical schools in India. Geriatrics is a low-profile specialty that lacks visibility in academia and finds the least favor among medical students. Only selected facilities have a dedicated geriatric unit, but they are concentrated in urban areas and are highly expensive. Very few hospitals provide inpatient geriatric care. Although there are hundreds of old age homes, day care centers and mobile medicare units that provide care to the elderly population, these facilities are managed by NGOs or funded partially by government, and are city-based, expensive or focused on tertiary as opposed to primary care.
Noticing this lacuna in medical education, EduMed has introduced a course to specifically train nurses in elderly care the Clinical Nurse Specialist in Elderly Care program, co-certified by Global Health Alliance, UK. The biggest aspiration of the elderly in India is to live independently with dignity, and preferably in the comfort of their own home. It is our duty to help our elderly achieve this.