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

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

3. Worldwide Trend of Population of 60 Years and Above : 1980-2020 19801990200020102020 World 381.2484.7608.7754.21011.6 Developed 173.3203.6234.6232.4308.2 Developing 207.9281.8374.1491.8703.4 Africa 23.430.941.85782 Latin America 23.431.741.956.480.7 Asia (excl. Japan) 160218.2290377.7539.9 China 78.6101.2131.7167.9238.9 India 44.660.281.4107149.7 United Nations,World Demographic Estimate and Projections

4. Proportion of Aged 60 and Over Population (in Per cent) 19801990200020102020 World8.69.29.910.812.9 Developed15.216.818.419.722.4 Developing6.377.78.710.9 Africa4.94.8 4.95.6 Latin America6.577.78.811 Asia (excl. Japan)6.57.48.59.812.8 China7.4910.512.416.6 India6.57.38.49.912.6 United Nations,World Demographic Estimate and Projections

5. 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.

6. Elderly Population-Facts! World population of 6.1 billion at the dawn of 21 st 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.

7. 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.

8. 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.

9. Elderly in India -Facts! 2 nd 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).

10. 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.

11. 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…

12. Distribution of Aged Persons by State of Economic Dependence (n=1000) Not Dependant Partially Dependant Fully Dependant No Response Rural Male48518031322 Female12114670627 Urban Male51516929719 Female11511075718 National Sample Survey 52nd Round Survey, 1995-96

13. Distribution of Care Provider of Economically Dependent Aged Spouse Own Children Grand Children Others Rural Male1137665071 Female1597175272 Urban Male1057925449 Female1826955667 National Sample Survey 52nd Round Survey, 1995-96

14. 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.

15. 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.

16. Distribution of Chronic Diseases in Aged (n=1000) India Rural Urban Chronic DiseaseMFMF Cough 2501958179142 Piles 33163218 Joint Problems 363404285393 High/low BP 108105200251 Heart Disease 34276853 Urinary Problem 38234924 Diabetes 36288566 Cancer 2324 Any of the above 527514528560 National Sample Survey 52nd Round Survey, 1995-96

17. Distribution of Physical Disability in Aged (n=1000) India Rural Urban Disability MFMF Visual 249291225260 Hearing 139156111132 Speech 3238293 Locomotor1071158094 Amnesia/Senility961136180 Any Disability380425333367 National Sample Survey 52nd Round Survey, 1995-96

18. 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

19. 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

20. 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.

21. 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

22. 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

23. 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

24. 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.

25. THANKS By: Dr. K.L. SHARMA