Medico social problems of elderly

Medico-social problems of elderly
and National Programmes for elderly
Speakers
Capt Dr Naveen Phuyal
Dr Amol

Medico social problems of the elderly

• There's one advantage to being 102.
There's no peer pressure.
Dennis Wolfberg
• I truly believe that age –
if you're healthy -- age is just a number.
Hugh Hefner
• If I knew I was going to live this long, I'd
have taken better care of myself.
Mickey Mantle

And now the end is near And so I face
the final curtain, I’ll state my case of
which I’m certain. I’ve lived a life that’s
full, I traveled each and ev’ry
highway, And more, much more than
this. I did it my way.

200 kms and
3 weeks long
walk at the
age of 61 is
not
impossible
for the fight
of freedom.

Was Not 92 when
he passed away but
10 years old with
82 years of
experience

Top of the world ??? No big deal !!!
We were just 73 and 76 years old when we
climbed it.

Olga Kotelko ,
92
Super Athlete
Who says I
can’t play?

Daphne Selfe
83, Worlds
Oldest
Supermodel

Scheme of Presentation
1. Introduction
2. 10 Facts on ageing (WHO)
3. The epidemiology of population ageing (WHO)
4. Situation analysis of ageing in India
5. Demography of ageing population in India
6. Studies on ageing in India
7. Fighting stereotypes
8. Challenges and opportunities

Introduction
• Ageing is a natural process that begins at
birth, or to be more precise, at conception, a
process that progresses throughout one’s life
and ends at death.

Who are the elderly or aged?
United Nations Organization
(UNO)
> 65 years of age as senior
citizens.
The Indian Census >60 years and above as
old.

Population 2012 Total >65 yrs
Global > 7 billion >56 million
India >1.2 billion 7 million
(United states population bureau)
India population > 60 > 10 million
Population proportion above 60 8%
(WHO)

10 facts on ageing
1. The world population is rapidly ageing.
2. The number of people aged 80 and older will
quadruple in the period 2000 to 2050.
3. By 2050, 80% of older people will live in
low and middle-income countries.
Ref: WHO Fact File 2012

10 facts on ageing
4. The main health burdens for older people are from
non-communicable diseases.
5. Older people in low- and middle-income countries
carry a greater disease burden than those in the rich
world.
6. The need for long-term care is rising.
7. Effective, community-level primary health care for
older people is crucial.

10 facts on ageing
8. Supportive, “age-friendly” environments allow
older people to live fuller lives and maximize the
contribution they make.
9. Healthy ageing starts with healthy behaviors in
earlier stages of life.
10. We need to reinvent our assumptions of old age.

1. Add Life to Years (1982)
2. Healthy Living: Everyone a winner (1986)
3. Active ageing makes the difference (1999)
4. Good Health adds life to years (2012)
WHO and Geriatric Health

The epidemiology of population
ageing
• Life expectancy
• Years lost due to premature death
• Years lost due to disability
• Disability adjusted life years

Life expectancy at birth
WHO Region Male ( Years) Female ( Years)
World 66 71
Africa 52 56
Americas 73 79
Eastern Mediterranean 64 67
Europe 71 79
South – East Asia 64 67
Western Pacific 72 77
Ref:World health statistics 2011. Geneva, WHO

Life expectancy at age 60
WHO Region Male ( 2009) Female ( 2009)
World 18 21
Africa 14 16
America 21 24
Eastern Mediterranean 16 18
Europe 19 23
South- East Asia 15 18
Western Pacific 19 22
Ref: World health statistics 2011. Geneva, WHO

Premature Death
Fig: Years of life lost
due to death per
100000 adults aged
60 yrs and
older by country
income group
Yearslostduetoprematuredeath
Diseases

Disability
Fig: Years Lost due
to Disability (YLDs)
per 100 000 adults
over age 60 by
country income
group
Yearslostduetodisability
Disability causes

Disability
High Income countries Low Income Countries
Visual Impairment 15.0 94.2
Hearing Loss 18.5 43.9
Osteoarthritis 8.1 19.4
Ischemic Heart Disease 2.2 11.9
Dementia 6.2 7.0
COPD 4.8 8.0
Cerebrovascular
Disease
2.2 4.9
Depression 0.5 4.8
Rheumatoid Arthritis 1.7 3.7

Total burden of Death and Disability
DALY
Fig: Disability
Adjusted Life years
( DALYs) per 100000
adults over age 60
by country income
group
Diseases

Other health problems
• Approximately 28-35% of people over the age
of 65 fall each year.
• Falls may lead to post-fall syndrome, which
includes increased dependence, loss of
autonomy, confusion, immobilization and
depression.
• Within the year following a hip fracture from a
fall, 20% of older people will die.

Other health problems
• Around 4-6% of elderly people have
experienced some form of maltreatment at
home.
• While depression is identified as a significant
cause of disability and a likely problem in
older age, social isolation and loneliness are
not recorded in these databases.

Situation analysis of elderly in India

• Majority population aged less than 30
• The problems and issues of its grey population has
not been given serious consideration
• Focus - on the children and the youth
• Rapid changes in the social scenario -nuclear
families
• Elderly - emotional, physical and financial insecurity

• Ageing of population - downward trends in
fertility and mortality.
• Low birth rates coupled with long life
expectancies, push the population to an ageing
humanity.
• Mounting pressures on various socio economic
fronts including pension outlays, health care
expenditures, fiscal discipline, savings levels etc.

Demography of ageing population in
India
Ref: Situation analysis of the elderly in India, 2011
Fig: Age
distribution of
population in
India over
decades

Fig 3: More Older parents to
support
Fig 2: Dependency ratios, India
1961-2026
Fig 1: Population by broad age groups, India,
1961-2026
Ref: Situation analysis of the elderly in India, 2011

Studies on ageing in India
• Economic aspects of ageing
• Social aspects of ageing
• Psychological aspects of ageing
• Health conditions of elderly
• Malnutrition in elderly
• Mental Health in elderly
• Elder Abuse
• Crime in elderly

Economic aspects
• Are elderly a burden on the family and the
nation?
• 40 % of the elderly > 60 are working.
• While adults (in the age group 15-59) who are
not working and are dependants.
• Inadequate income is a major problem of the
elderly in India .

Economic aspects
• Nearly 90 per cent of total workforce
employed in the unorganized sector.
• Retire without any financial security
like pension and other post-
retirement benefits.
• Women depend more on others.

Social aspects
• Individualism in modern life
• Materialistic thinking among young
generation
• Greater alienation and isolation of the elderly
• Decline in value system, respect, honor, status
and authority for elderly
• Elderly relegated to an insignificant place in
our society

Social aspects
• The loss of the decision-making power by those
who have surrendered their property in favor of
younger members.
• The loss of status and decision-making power is
felt more by ageing women than men.

Social aspects
Provide support
Aid relationship
building
Maintenance, fa
cilitate coping
with stress
Issues in relation
to death and
dying.
Religiosity seems to have increase with age.
Spirituality was perceived to

Psychological aspects
The prominent thrust areas
resulting in socio-psychological
frustration among the elderly are
• Attitude towards old age
• Degradation of status in
community
• Problems of isolation
• Loneliness
• Generation gap

Psychological aspects
Shortage of money
Passing time
Widowhood
Feeling of physically weak
Fear of death
Mental tension
Feeling of social neglect
The problems of retirees mainly include:

Health conditions of elderly
• More and more susceptible to
chronic diseases, physical disabilities
and mental incapacities in their old
age.
• Illnesses are multiple and chronic in
nature.
• Arthritis, rheumatism, heart
problems and high blood pressure are
the most prevalent chronic diseases
affecting them.

How elderly describe their disease?
Elderly Poor Upper-class elderly
Describe their health problems,
on the basis of easily
identifiable symptoms, like
chest pain, shortness of breath,
prolonged cough,
breathlessness/ asthma, eye
problems etc.
In view of their greater
knowledge of illnesses, mention
blood pressure, heart attacks,
and diabetes which are largely
diagnosed through clinical
examination.

Malnutrition in elderly
• 50 % are at risk in low income group
• Both macro and micronutrient deficiencies are
common in elderly
• Malnutrition is due to
a. Lack of financial resources
b. Reduced ability to go to market
c. Reduced ability to cook nutritious meals
d. Difficulty in mastication

Mental health in elderly
The worries among the poor are usually about:
Inadequate
economic
support
Poor health
Inadequate
living space
Loss of respect
Unfinished
familial tasks
Lack of
recreational
facilities and
The problem
of spending
time

Multiplicity of disease
• Multiplicities of diseases are normal among
the elderly and that a majority of the old are
often ill with
 Chronic bronchitis
 Anemia
 Hypertension
Digestive troubles
Rheumatism

Health, Literacy and Income
• Elderly members are confronted with various
nutritional, physiological and other general
problems.
• The men are more literate, economically
independent and face less physiological and
nutritional problems as compared to their
female counterparts.

Illness and treatment
• Most of the ailments of the elderly are not
medically treated.
• The two most important reasons for not
seeking care were
1.Financial problems
2.Perception that the ailment was not serious.

Elder abuse
A female
of very
advanced
age
Role-less
in family
Functionally
impaired
Lonely
The most likely victim of elderly abuse is a

Elder abuse
• The prevalent patterns of elder abuse include
1. Psychological abuse in terms of verbal assaults
2. Threats and fear of isolation
3. Physical violence
4. Financial exploitation
• More women than men complain of maltreatment
in terms of both physical and verbal abuse.

Elder abuse
• Person suffering from physical or mental
impairment and dependent on the caretakers for
most of his or her daily needs is likely to be the
victim of elder abuse.
• Old people with high educational background and
sufficient income are also found to be subjected
to abuse.

Elder abuse
• Who are the abuser?
• Factors for Abuse
Son and daughter in
law
Daughter in law and
spouse
Spouse
Dependent position of the older
Perceived powerlessness
Social isolation
Drug or alcoholic addiction
Anti-social behavior of the abusers

Crime against elderly
• These crimes range from hurt, robbery, murder
and even sexual assault.
• Most remain unreported.
• Female victims outnumber male victims
• More in urban areas as compared to rural
areas.
• 60 per committed indoors during the day.
• 25 percent by family members.

Elderly are heterogeneous group
• Rural elderly
• Urban Poor elderly
• Urban Middle Income and well to do elderly
• Female elderly

Rural elderly
Unorganized
sector.
Insecure
employment
Insufficient
income.
Lack access to any
form of social
security and good
quality or reasonably
priced health care
Have to pay more
for even the most
basic healthcare
services.

Urban poor elderly
Poor Infrastructure Poor physical condition Low income levels
High rates of
unemployment
/underemployment
Crime, alcoholism,
mental illness
Lack of public and
community facilities
Lack of access to affordable
healthcare services.

Urban middle income and well-to-do
elderly
• The impact of urbanization has touched many
a life leading to migration of children to cities
or abroad.
• Many elderly are well-off due to their
prosperous children but are left alone to take
care of themselves.

Female elderly
• Feminization of later life.
The female elderly are more likely to be
Widowed
Have low
economic
security
Lower
educational
attainment
More care
giving
responsibilities
than their male
counterparts.

Female elderly
• The absence of gender-specific health services
• Poor health due to child bearing
• Less nutrition
• Economic deprivation throughout their lives

Female elderly
• The loss of status at the death of their
husband only increases the situation of
dependency in old age.
• This dependency can become more complex
as the woman grows older
• Her relationship with her son and daughter-in-
law decides her fate in old age

Common stereotyping of elderly
1. Older people are "past their sell-by date“
2. Older people are helpless .
3. Old people are afraid of dying.
4. Older people will eventually become senile .
5. Older women have less value than younger
women .
6. Older people don't deserve health care

1.Older people are
"past their sell-by
date"
• On 16 October
2011, Fauja Singh
became the first 100
year-old to complete a
marathon by running the
Toronto Waterfront
Marathon in Canada.

2.Older people are helpless
• 2007 Cyclone in Bangladesh
• Older people’s committees
disseminated early warning
messages to people and
families most at risk
• Identified who were worst hit
• Compiled beneficiary lists and
notified them when and where
to receive relief goods

3.Old people are afraid of dying
• 2011 earthquake and Tsunami in Japan
• Older people and retirees came forward to
volunteer at the nuclear disaster sites

4.Older people will eventually
become senile
• Occasional memory lapses occur at any age
• Some types of our memory stay the same or
even continue to improve with age
• Our semantic memory, which is the ability to
recall concepts and general facts that are not
related to specific experiences

5.Older women have less value than
younger women
• People often equate women’s worth with
beauty, youth and the ability to have children.
• The role older women play in their families
and communities, caring for their partners,
parents, children and grandchildren is often
overlooked.
• Women tend to be the family caregivers.
• Many take care of more than one generation.

6.Older people don't deserve health
care
• Treatable conditions -often overlooked or
dismissed as being a "normal part of ageing".
• Age does not necessarily cause pain, and only
extreme old age is associated with limitation of
bodily function.
• The right to the best possible health does not
diminish as we age.

• It is not age that limits the health and participation of
older people.
• It is individual and societal misconceptions,
discrimination and abuse that prevent active and
dignified ageing.
6.Older people don't deserve health
care

Challenges and opportunities
• Elderly people are a heterogeneous group.
• It is essential to recognize this heterogeneity in
defining need, assessing the effects and relevance
of intervention, and planning for the future.
• Ageing population will change society at many
levels and in complex ways, creating both
challenges and opportunities.

Opportunities of ageing
• Older people already make a significant
contribution to society, whether it is through
the formal workforce, through informal work
and volunteering or within the family.
• We can foster this contribution by helping
them maintain good health and by breaking
down the many barriers that prevent their
ongoing participation in society.

Challenges of ageing
• Towards the end of life, many older people
will face health problems and challenges to
their ability to remain independent.
• We need to address these too, and do it in a
way that is affordable and sustainable for
families and society.

• Good health must lie at the core of any successful
response to ageing.
• If we can ensure that people are living healthier as
well as longer lives, the opportunities will be greater
and the costs to society less.
Challenges of ageing

• Recognize them as a resource group
• Develop suitable policies

National Policies & Programmes
for the Welfare of the Elderly

National Policies & Programmes for the
Welfare of the Elderly: Introduction
1. Majority (80%) of them are in the
rural areas, thus making service
delivery a challenge
2. Feminization of the elderly
population ( 51% of the elderly
population would be women by the
year 2016),
3. Increase in the number of the
older-old ( persons above 80years)
and
4. A large percentage (30%) of the
elderly are below poverty line.

Welfare of the Elderly
1. Administrative set-up
2. Relevant Constitutional Provisions
3. Legislations
4. National Policy on Older Persons (NPOP), 1999
5. National Council for Older Persons
6. Inter-Ministerial Committee on Older Persons

Welfare of the Elderly
7. Central Sector Scheme of Integrated Programme for Older
Persons (IPOP)
8. Schemes of Other Ministries
I. Ministry of Health & Family Welfare
– National Programme For Health Care Of The Elderly (NPHCE)
II. Ministry of Rural Development
III. Ministry of Railways
IV. Ministry of Civil Aviation
V. Ministry of Finance
VI. Department of Pensions and Pensioner Grievances
Ref: Situation Analysis Of The Elderly in India, June 2011, Ministry of Statistics & Programme Implementation, GOI

1.Administrative set-up
 Ministry of Social Justice
& Empowerment
 Nodal Ministry which focuses on policies &
programmes for the Senior Citizens in close
collaboration with State governments, NGOs and
Civil society.

2.Relevant Constitutional Provisions
 Article 41 of the Constitution provides that
the State shall, within the limits of its economic
capacity and development, make effective
provision for securing the right to work,
to education and to public assistance in cases of
unemployment, old age, sickness & disablement,
& in other cases of undeserved want.

3.Legislations
Maintenance and Welfare of Parents and Senior
Citizens Act, 2007:
 To ensure need based maintenance for parents and senior
citizens and their welfare.
The Act provides for:-
 Maintenance of Parents/ senior citizens by children/ relatives
made obligatory and justiciable through Tribunals
 Revocation of transfer of property by senior citizens in case of
negligence by relatives
 Penal provision for abandonment of senior citizens
 Establishment of Old Age Homes for Indigent Senior Citizens
 Adequate medical facilities and security for Senior Citizens

3.Legislations
Maintenance and Welfare of Parents and Senior
Citizens Act, 2007:
– The Act has to be brought into force by individual State
Government.
– As on 3.2.2010, the Act had been notified by 22 States and
all UTs.
– The Act is not applicable to the State of Jammu & Kashmir
– The remaining States yet to notify the Act are -
Bihar, Meghalaya, Sikkim and Uttar Pradesh.

4.National Policy on Older Persons
(NPOP), 1999
Ref: National Policy on Older Persons (NPOP), 1999 Ministry of Social Justice & Empowerment, GOI

(NPOP), 1999
 Announced in January 1999 to reaffirm the commitment to
ensure the well-being of the older persons.
 Envisages State support to ensure
– financial and food security,
– health care,
– shelter,
– equitable share in development,
– protection against abuse and exploitation,
– availability of services to improve the quality of their lives

(NPOP), 1999
Objectives:
 To encourage individuals to make provision for their own as
well as their spouse’s old age;
 To encourage families to take care of their older family
members;
 To enable and support voluntary and non-governmental
organizations to supplement the care provided by the family;
 To provide care and protection to the vulnerable elderly
people;

(NPOP), 1999
Objectives:
 To provide adequate healthcare facility to the elderly;
 To promote research and training facilities to train geriatric
care givers and organizers of services for the elderly;
 To create awareness regarding elderly persons to help them
lead productive and independent live.

(NPOP), 1999
Implementation Strategy :
 Preparation of Plan of Action for operationalisation of the
National policy.
 Setting up of separate Bureau for Older Persons in Ministry of
Social Justice & Empowerment.
 Three Yearly Public Review of implementation of policy.

(NPOP), 1999
Implementation Strategy:
 Setting up of a National Council for Older Persons
 Establishment of Autonomous National Association of Older
Persons
 Encouraging the participation of local self-government

5. National Council for Older
Persons(NCOP)
 Constituted in 1999
 Under the Chairpersonship of the Minister for Social Justice &
Empowerment to oversee implementation of the Policy
 Highest body to advise the Government in the formulation and
implementation of policy and programmes for the aged
 Last re-constituted in 2005 with members comprising Central and State
governments representatives, representatives of NGOs, citizen’s groups,
retired person’s associations, and experts in the field of law, social welfare,
and medicine
 With a view to have a more definite structure, the Council was
reconstituted and renamed as National Council for Senior Citizens (NCSrC)
vide a Resolution dated 17.02.2012 to this effect which was published in
the Gazette of India on 22.02.2012.

6.Inter-Ministerial Committee on
Older Persons
 Comprises of twenty-two Ministries/Departments,
 Headed by the Secretary, Ministry of Social Justice &
Empowerment
 Another coordination mechanism in implementation of the
NPOP.
 Considers Action Plan on ageing issues for implementation by
various Ministries/ Departments concerned, from time to
time

7.Central Sector Scheme of Integrated
Programme for Older Persons(IPOP)
 Implemented since 1992
 Objective of improving the quality of life of senior citizens by
providing basic amenities like
– shelter,
– food,
– medical care and
– entertainment opportunities

 Encouraging productive and active ageing through providing
support for capacity building of Government/ Non-
Governmental Organizations/Panchayati Raj Institutions/ local
bodies and the Community at large.
 Under the Scheme, financial assistance up to 90% of the
project cost is provided to nongovernmental organizations for
establishing and maintaining old age homes, day care centres
and mobile medicare units

Other projects for Financial Assistance under revised
scheme from 2008:
– Maintenance of Respite Care Homes;
– Running of Day Care Centres for Alzheimer’s Disease Patients,
– Physiotherapy Clinics for older persons;
– Sensitizing programmes for children particularly in Schools &
Colleges;
– Training Centres of Caregivers to the older persons;
– Awareness Generation Programmes for Older Persons & Care
Givers;
– Formation of Senior Citizens Associations etc

8.Schemes of Other Ministries
I. Ministry of Health & Family Welfare
– Separate queues for older persons in government
hospitals.
– Started Geriatric clinic in several Govt. hospitals
– National Programme For Health Care Of The Elderly
(NPHCE)
Ref: Ministry of Health & Family Welfare, GOI

II. Ministry of Rural Development
– Implementing Indira Gandhi National Old-age
Pension Scheme.
– For persons above 60 years belonging to a household
below poverty line,
– Central assistance @ Rs. 200/- per month, which is meant
to be supplemented by at least an equal contribution by
the States so that each beneficiary gets at least Rs.400/-
per month as pension.
Ref: Ministry of Rural Development, GOI

III. Ministry of Railways
– Separate ticket counters for senior citizens of age 60 years
and above at various (Passenger Reservation System) PRS
centres
– Provision of lower berth to male passengers of 60 years
and above and female passengers of 45 years and above.
– 40% and 50% concession in rail fare for male passengers
aged 60years and above and female passengers aged 58
years and above respectively.
– Wheel chairs at stations for old age passengers.
Ref: Ministry of Railways, GOI

IV. Ministry of Civil Aviation
– Air India provides concession up to 50% for male senior
citizens of 65 years and above, and female senior citizens
of 63 years and above in air fares.
Ref: Ministry of Civil Aviation, GOI

V. Ministry of Finance
– Income tax exemption for senior citizen of 65 years and
above up to Rs. 2.50 lakh per annum.
– Deduction of Rs 20,000 under Section 80D is allowed to an
individual who pays medical insurance premium for his/
her parent or parents, who is a senior citizens of 65 years
and above.
– An individual is eligible for a deduction of the amount
spent or Rs 60,000, whichever is less for medical treatment
(specified diseases in Rule 11DD of the Income Tax Rules)
of a dependent senior citizen of 65 years and above
Ref: Union Budget 2012-13, Ministry of Finance, GOI

VI. Department of Pensions and Pensioner Grievances
• A Pension Portal has been set up to enable senior citizens to
get information regarding the status of their application, the
amount of pension, documents required, if any, etc.
• The Portal also provides for lodging of grievances.
As per recommendation of the Sixth Pay Commission,
additional pension to be provided to older persons
Age Group % pension to be added
80+ 20
85+ 30
90+ 40
95+ 50
100+ 100

National Programme For Health Care Of
The Elderly (NPHCE)

National Programme For Health Care Of
The Elderly (NPHCE)
NPHCE 2010

The Vision
Ref: National Programme For Health Care Of The Elderly (NPHCE),Operational Guidelines, MOHFW, GOI
To provide accessible, affordable, and high-quality long-
term, comprehensive and dedicated care services to an
Ageing population;
Creating a new “architecture” for Ageing;
To build a framework to create an enabling environment for
“a Society for all Ages”;
To promote the concept of Active and Healthy Ageing;

Objectives
• Provision of dedicated health care facilities at various level
of State health care delivery system with referral support
• Human resource development in geriatric Health
• Strengthening of preventive, promotive and rehabilitative
services.
• Promotion of Research in geriatric health care
• Convergence with NRHM, AYUSH & all other dept.

Strategies
Core
Strategies
Community
level -
domiciliary
visits by trained
health care
workers.
PHC/CHC level -
equipment,
training,
additional human
resources (CHC),
IEC,
District Hospital -
10 bedded
wards, additional
human resources,
8 RMC - PG
courses in
Geriatric
Medicine, and
training
IEC using mass
media, folk media
and other
communication

Supplementary Strategies
Promotion of
public private
partnerships in
Geriatric Health
Care.
Mainstreaming AYUSH
and convergence with
programmes of
Ministry of Social
Justice and
Empowerment in the
field of geriatrics.
Reorienting
medical education
to support
geriatric issues.

Major Components:
1. Geriatric Department in 8 Regional Medical Institutions/
State Medical Colleges
2. Dedicated Health Care in 100 Districts(21 states)
 Geriatric unit at District hospitals
 Rehabilitation Units at CHCs
 Weekly Geriatric Clinic at PHCs
 Provision of supportive devices/equipments at Sub
centers

Operational Guidelines
A. Package of
Services at
different levels
B. Institutional
framework for
implementation
C. Management
Structure
D. Activities at
various levels

A. Package of Services
Health
promotion
Preventive
service
Diagnosis &
management
Day care
services
Rehabilitative
services
Home based
care

A. Package of Services
Organizational Structure:

B. Institutional Framework for the
Implementation of NPHCE
Funds from Government of
India (80%)
State Health Society
District Health Society
(NCD Cell)
CHC / PHC /SC
State Level Activity
District Level Activity
Funding for Program:

State Health Society (SHS):
Under the NRHM framework different Societies of national
programmes such as RCH, Malaria, TB, Leprosy, NBCP have
been merged into a common State Health Society.
– Chairperson- Chief Secretary/Development commissioner
– Vice chair person -Principal Secretary (H&FW)
– Mission director - Member –Secretary of SHS

District Health Society (DHS):
 All programme societies have been merged into the District
Health Society (DHS).
 The Governing Body
– Chairperson - Chairman of the Zilla Parishad.
– Member -Secretary - DHO
 The Executive Body
– Chair person - District Collector
– Member -Secretary - DHO.

C. Management Structure
National NCD Cell
State NCD Cell
District NCD Cell

National NCD Cell:
 The NCD Cell constituted at the central level for planning,
monitoring and implementation of the National Programme
for Prevention and Control of Cancer, Diabetes, CVD and
Stroke (NPCDCS) will also be responsible for NPHCE.
Main functions:
 MOU with the States/UTs.
 Preparation and dissemination of operational guidelines.
 Plan for capacity building of health functionaries.
 Monitoring and review of programme activities at each level.
 Release of funds and monitoring of expenditure under NPHCE

20% of the total
expenditure
Provision of land
Support of lab
services
Additional support
for medicines
Maintenance of
equipments, wards
and OPD
State contribution:

State Programme Officer
Programme Assistant
Finance cum Logistics Officer
Data Entry Operators (2)
State NCD Cell:
Composition:
State NCD Cell will be supported by following contractual staff:

State NCD Cell:
Role and responsibilities of the State NCD Cell:
Preparation of State action plan for implementation.
Organize State & district level trainings
for capacity building
Liaison with Regional Geriatric Centre for
tertiary Care, Training & Research.
Monitoring of the programme

District Programme Officer
Programme Assistant
Finance cum Logistics Officer
Data Entry Operators
District NCD Cell:
Composition:
District NCD Cell will be supported by following contractual staff:

District NCD Cell:
Role and responsibilities of the District NCD Cell:
 Preparation of District action plan.
 Engage contractual personnel sanctioned for various facilities
in the district
 Maintain fund flow
 Convergence with NRHM activities & Other Depts.
 Ensure availability of rehabilitative services for the Elderly.

D.Activities under NPHCE at Various levels
At Sub Centre level:
 Provision of walking sticks, calipers & other supportive
equipments to the needy elderly
 Information on healthy diet, yoga, and life style diseases
through charts, pamphlets
 Domiciliary visit to the house of elderly by ANM/ Male worker
and maintenance of record
 Arrangement of ambulance for disabled bed ridden elderly for
referral to PHC/CHC.

At PHC level:
The weekly geriatric clinic.
Coordination with CHC, district hospital, sub centers, other National
Health Programmes/ Departments for medicines, ambulances
Training of manpower & Separate registration counter for elderly.
 Public awareness during health and village sanitation day/camps.
 Provision of medicine to the elderly for their medical ailments.

At PHC level:
Following items will be made available at the PHC:
• Nebulizer
• Glucometer
• Shoulder Wheel
• Walker (ordinary)
• Cervical traction (manual)
• Exercise Bicycle
• Lumbar Traction
• Gait Training Apparatus
• Infrared Lamp etc.
.

At RH/CHC level:
 First level referral centre for medical care and rehabilitation
services
 Twice weekly health clinics for the elderly persons
 Rehabilitation unit
 Domiciliary visits for disabled persons by Multi rehabilitation
worker
 Referral Services to DH /RGC

At RH/CHC level:
Following additional items will be made available at the CHC:
• ECG Machine
• Pulse Oximeter
• Defibrillator
• Multi - Channel Monitor
• Shortwave Diathermy
• Cervical traction (intermittent)
• Walking for gait training equipment
• Walking Sticks
• Pulley

At District Hospital level:
 Regular Geriatric OPD with Specialty Care for Elderly.
 Geriatric Ward (10-bedded) for in-patient care to the Elderly.
 Training to the Medical officers and paramedical staff of
CHC’s and PHC’s
 Camps for Geriatric Services in PHCs/CHCs and other sites
 Referral services for severe cases to tertiary level hospitals/
Regional Geriatric Centers

At District Hospital level:
Following additional items will be made available at the District
Hospital:
• Multi-channel Monitor
• Non invasive Ventilator
• Ultrasound Therapy
• Pelvic traction (intermittent)
• Trans electric Nerve stimulator (TENS)
• Adjustable Walker.

At Regional Geriatric Centers level:
 Provide tertiary level services for complicated/serious
Geriatric Cases.
 Post graduate courses in Geriatric Medicine.
 Training to the trainers of identified District hospitals and
Medical Colleges.
 Specialized OPDs in all the specialties available with them for
the benefit of the Elderly30 bedded geriatrics ward

At Regional Geriatric Centers level:
Following additional items will be made available at the
RGC:
• Interferential therapy for pain
• Continuous passive Motion units for Shoulder
• Knee Modular monitor
• Aero beds, Non-invasive ventilator
• Invasive ventilator
• Emergency trolleys (with multichannel monitors)
• Portable X-ray unit, Portable ultrasound
• Provision of Video conferencing unit

Regional Geriatrics Centers
Sr
No Regional Institutes States Linked
1 All India Institute of Medical Sciences,
New Delhi
Delhi, Haryana, Uttarakhand,
Punjab Himachal Pradesh, M.P.
2 Institute of Medical Sciences, Banaras
Hindu University, Uttar Pradesh
Uttar Pradesh, Bihar, Jharkhand,
West Bengal
3 Grant Medical College & JJ Hospital,
Mumbai, Maharashtra,
Maharashtra, Goa, Northern
Districts of Karnataka,Chattisgarh
4 Sher-e-Kashmir Institute of Medical
Sciences, Srinagar, Jammu & Kashmir
Jammu & Kashmir
5 Govt. Medical College,
Tiruvananthapuram, Kerala,
Kerala, Southern Districts of
Karnataka & Tamil Nadu
6 Guwahati Medical College, Guwahati,
Assam
Assam & NE States
7 Madras Medical College, Chennai, TN. Tamil Nadu, Andhra Pradesh, Orissa
8 SN Medical College, Jodhpur, Rajasthan Rajasthan & Gujarat

Developing Geriatric Department in Medical college
of each States/UTs
It is proposed to develop 12 additional Regional Geriatric
Centers in selected Medical Colleges of the country
132
Sr No State Medical College
1 Punjab PGIMER, Chandigarh
2 Uttar Pradesh KGIMS, Lucknow
3 Jharkhand Ranchi Medical College, Ranchi
4 West Bengal Kolkatta Medical College, Kolkata
5 Andhra Pradesh Nizam Institute of Medical Sciences, Hyd.
6 Karnataka Bangalore Medical College, Bangluru
7 Gujarat B.J.Medical College, Ahmadabad
8 Maharashtra Government Medical College, Nagpur
9 Orissa S.C.B.Medical College, Cuttack
10 Tripura Agartala Medical College, Agartala
11 Madhya Pradesh Gandhi Medical College, Bhopal
12 Bihar Patna Medical College, Patna

Phasing of physical targets
Physical target 2010-2011 2011-2012
Establishment of
Geriatric Department
at 8 Regional Inst.
8 Regional Inst.
Construction &
Manpower deployment
etc.
Fully functional
Geriatric Dept in 8
Regional Inst.
Setting up of
Geriatrics Unit at 100
District Hospitals
30 Districts
Construction and
equipment &
Manpower
deployment etc
30 Districts
Fully functional
Geriatric Unit
70 Districts
Construction and
equipment
-Manpower
deployment

Identified States and 30 districts (2010-11)
States Districts
Andhra Pr. Nellore, Vijayanagram
Assam Dibrugarh, Jorhat
Bihar Vaishali, Rohtas
CH Bilaspur
Gujarat Gandhi Nagar, Surendranagar
Haryana Mewat
HP Chamba
J&K Leh, Udhampur
Jharkhand Bokaro
Karnataka Shimoga, Kolar
Kerala Pathanathitta
States Districts
Madhya Pr. Ratlam
Maharashtra Washim, Wardha
Sikkim East Sikkim
Orissa Naupada
Punjab Bhatinda
Rajasthan Bhilwara, Jaisalmer
Uttrakhand Nainital
Tamil Nadu Theni
Uttar Pr. Rae Bareli, Sultanpur
West Bengal Darjeeling

70 districts added in 2011-12
States Districts
Andhra Pr.
Srikakulam, Chittoor, Cuddapah,
Krishna, Kurnool, Prakasham
Assam Lakhimpur, Sibsagar, Kamrup
Bihar
Muzaffarpur, Paschim Champaran,
Poorva Champaran, Keimur
CH Jashpur Nagar, Raipur
Gujarat
Rajkot, Jam Nagar, Porbandar,
Junagarh
Haryana
Yamuna Nagar, Kurukshetra ,
Ambala
HP Lahaul & Spiti , Kinnaur
J&K Kupwara, Doda (Erstwhile), Kargil
Jharkhand Ranchi, Dhanbad
Karnataka Udupi, Tumkur, Chikmagalur
Kerala
Kozikode (Calicut), Allappuzha,
Idukki , Thrishur
States Districts
Madhya Pr.
Hoshangabad, Chindwara,
Jhabua , Dhar
Maharashtra
Gadchiroli, Bhandara,
Chandrapur, Amaravati
Sikkim South Sikkim
Orissa
Balangir, Nabrangpur,
Koraput, Malkangiri
Punjab Gurdaspur, Hoshiarpur
Rajasthan
Jodhpur, Ganga Nagar,
Bikaner, Barmer, Nagaur
Uttrakhand Almora
Tamil Nadu
Coimbatore, Virudhnagar,
Toothukudi, Tirunelveli
Uttar Pr.
Jhansi, Lakhimpur Kheri,
Farookhabad, Firozabad,
Etawah, Lalitpur,
Jalaun
West Bengal Jalpaiguri, Dakshin Dinajpur

Proposed Monitoring Strategy
 Integrated monitoring by NCD Cells at centre , States, districts
and CHCs.
 Monthly Progress Report to be submitted by NCD cells.
 Half yearly progress review meeting for assessing the status of
implementation of the programme activities.
 Yearly Combined field visit by Central and State Cells for on the
spot assessment of progress of the activities.

Achievements
 Developed operational guidelines
 1st installment released to 27districts in 2010-11 and
48 districts in 2011-12
 1st installment released to all the 8 RMI
 MOU signed with – 18 States
 Submitted 12th plan proposal- all the States/districts
proposed to be covered
Ref: Two years (2009-2011) Achievements and New Initiatives. , Ministry of Health and Family Welfare, GOI

Achievements
Release of Funds:
Year
No. of
districts
Amount
released
(crore)
No. of
RMI
Amount
released
(crore)
2010-11 27 60 4 41.15
2011-12 48 75 4 30.31
Total 75 135 8 71.46

Issues for consideration
 Create awareness among
policy makers & programme
officers
 Training of manpower
 Utilization of released Budget
 Monitoring & Maintenance of
database

NGOs for Older Persons in India
 HelpAge India
 Agewell Foundation
 Maitri
 GiveIndia
 India Sponser

HelpAge India
- 33 offices across India.
Mission:
 HelpAge India's mission is to work for the cause and care of
disadvantaged Older Persons, in order to improve the quality
of their lives.
Objectives :
• To foster the welfare of the aged in India especially the needy
aged
• To raise funds for projects which assist the elderly irrespective
of cast or creed
• To create in the younger generation and in society an
awareness about the problems of the elderly in India today

HelpAge India
Activities:
• Focuses on
– improved access to health and
– eye care facilities,
– community-based services, and
– livelihood support for the elderly.
– Support-A-Grandparent scheme.
• Acts as the voice of the elderly and promotes their cause with
the central and state governments.
• Endeavors to influence decision-makers to formulate policy
that is beneficial to the elderly.

NGOS for Older Persons in Pune
• Adhar Sevavrat Old Age
Home
• Apala Ghar Old Age Home
• Apulaki Vriddhashram
• Arpan Old Age Home
• Goldage Ashram & Hospital
• Janseva Foundation
Destitute Rehabilitation
Centre
• Jiwhala Vriddhashram
• Matoshri Vriddhashram
• Niwara
• Olava Senior Citizens Home
• Pitashri-old Age Home
• Sahjeevan Ashram
• Sankalp Sevadham
• Savali
• Tapodham
• Umed Care Centre For Old
Age
• Vanaprastha Ashram

NIWARA
 Niwara means ‘loving home’
 Founded on 9th of August 1863, by visionaries
& eminent citizens of Pune
• ‘Niwara’ – David Sasoon Anath Pangu Gruha
Charitable Trust devoted wholly &
entirely to the welfare of old men & women, who
– do not have near relatives like spouse, son/daughter,
– have no home to live in &
– have no source of livelihood.
 ie. offers home to the real destitutes in the society
 Take care of inmates till the end of journey; the Vaikuntha
crematorium ironically enough, just beyond the boundary
walls!

NIWARA
Objectives of the trust :
1) To provide shelter, conducive food, clothes, bed, medicines &
other facilities to elderly men & women
2) To extend co-operation to like minded institutions in pune or
outside
3) To arrange entertainment programs for the inmates and to
arrange for their orientation and training so that their inherent
capacities and qualities are fastened and enhanced.
4) To make efforts for rehabilitating the inmates among their
relatives if possible
5) To undertake training and consultative programs for the elderly.
6) To arrange and monitor studies and research regarding the issues
of the old men and women.

NIWARA
Current No. of Inmates: 43 male & 84 female
Facilities:
 Rehabilitation centre
 Physiotherapy
 Homeopathy clinic
 Gymnasium
 Meeting Hall
Activities:
 Festivals
 Trips & Excursions
 Entertainment

REFERENCES
• National Program for Health Care of the Elderly (NPHCE) :
Towards active and healthy ageing. Operational Guidelines.
Director General of Health Services, MOHFW, Government of
India.
• Situation Analysis of The Elderly In India, June 2011. Central
Statistics Office, Ministry of Statistics & Programme
Implementation, Government of India
• Rajan SI. Population ageing and health in India. The Centre for
Enquiry into Health and Allied Themes (CEHAT), Mumbai. July
2006.
• National Policy on Older Persons (1999). Ministry of Social
Justice and Empowerment, Government of India, Shastri
Bhawan, New Delhi.
• Maintenance and Welfare of Parents and Senior Citizens Act –
2007, Ministry of Social Justice and empowerment Government
of India
• Morbidity, Health care and the Condition of the aged. NSSO (64th
round)Jan-June 2004, National Sample Survey Organization,
Ministry of Statistics and Programme Implementation,
Government of India, March 2006.

• Two years (2009-2011) Achievements and New
Initiatives. NRHM, Ministry of Health and Family
Welfare, Government of India.
• Ingle GK, Nath A. Geriatric Health in India: Concerns and
Solutions. Indian J Comm Med, 2008; 33 (4); 214-18.
• Prevention & Control of Non-Communicable Diseases
(NCDs): Proposal for the 12th Plan, Report of the
Working Group on Disease Burden: Non-Communicable
Disease (NCDs), Director General of Health
Services, MOHFW, Government of India.
• Planning Commission. 11th five year plan
(Draft), Government of India;
http://www.planningcommission.nic.in

Medico social problems of elderly

Recomendados

Recomendados

Más contenido relacionado

La actualidad más candente

La actualidad más candente (20)

Similar a Medico social problems of elderly

Similar a Medico social problems of elderly (20)

Último

Último (20)

Medico social problems of elderly

Notas del editor