1. Geriatric Health in IndiaNeeds and Gaps
Dr. Bireshwar Sinha
Moderator: Dr. SK Rasania
Facilitator: Dr. Niraj Roy

2. Plan of presentation
•
•
•
•
Definition of elderly
Demography : geriatric population
Socio-economic profile of the elderly
Health issues: to be addressed
–
–
–
–
–
Social issues
Psycho-emotional aspects
Financial issues
Issues related to health care system
Medical problems
• Need for dedicated health programmes in the elderly and
the major constraints

3. Plan of presentation
• Major Govt. initiatives for elderly
• Other schemes and benefits
• Strategies & Recommendations: to fill the gaps related to
geriatric health
• Conclusion
• References

4. Definition of elderly
• According to WHO ,most developed countries have accepted
the chronological age of 65 years and above as a definition of
'elderly' or older persons.
• According to UN : 60+ years will be referred as the older
population or elderly.
• In India ,"senior citizen" means any person being a citizen of
India, who has attained the age of sixty years or above*
* National Policy for Older Persons Year 1999 .Ministry of Social Justice and
Empowerment.GOI.

5. Definition of elderly
(cont..)
1. Age group 60-69 years -Young old or 'not so old'
2. Age group 70-79years -Old old
3. Age group 80 years and over -'older old' or 'very old' category
 The medical study of the ageing process is called gerontology
 The study of diseases that afflict the elderly is geriatrics
National Policy for Older Persons Year 1999 .Ministry of Social Justice and Empowerment.GOI.

6. Demography: Geriatric population
• Advances in medicine have increased the life expectancy
resulting in an increase in the geriatric population and their
proportion will only continue to rise in the coming years.
• Globally, elderly constitute 11% of total population (United Nations
Population Division report, 2010)
• In India : adults over 60 years constitute 8 percent of
total.(census 2011)
• In the years 2000-2050, the overall population in India will
grow by 55%, whereas population growth of elderly people
above 60 years - 326% and those in the age group of 80+ by
700%,- the fastest growing group. [World population aging: 1950-2050.United
Nations: Population Division, Department of Economic and Social Affairs, United Nations 2002]

7. Demography: Geriatric population (contd..)
Situation Analysis of The Elderly in India, 2011.Central Statistics Office,Ministry of Statistics & Programme
Implementation,Government of India

8. States with more than 8% elderly population
( SRS 2010)
India : elderly population
constitute 8 percent of total.

9. Proportion of Elderly aged 60 yrs and above in India
Geriatric population (millions)
350
300
300.96
(20%)
250
236
Geriatric population(millions)
200
178.59
150
133.2
100
96.3
77.1
50
24.71
43.17
(8.2%)
56.68
0
1961
1981
1991
2001
2011
2021
2031
2041
2051

10. Socio-economic profile of the elderly in India.
75%
Elderly persons lives in rural area.
48%
Women
73%
Illiterate and dependent on
physical labor
66%
BPL; vulnerable situation and
without sufficient food.
90%
Unorganized sector: irregular
income; no pension
Source : Census 2001
& NSSO,2004

11. Socio- economic profile (contd..)
• Feminization of the elderly population (currently 48.2% are
women, out of whom 55% are widows; and by 2016 they will
constitute 51% of the elderly population.)
 The sex ratio among elderly people was 1028 in 1951 but reached
972 in 2001.
 Life expectancy (at birth) for women is 67.57 yrs as against 65.46
yrs for men. Life expectancy at age 60 was found to be about 18
years (16.7 for males, 18.9 for females)
• Increase in the number of the “older-old” (above 80 years)

12. Health issues of the elderly- Needs to be
addressed
• Health problems in the elderly cannot be seen in isolation.
• Wide gamut of social, psycho-emotional and financial
correlates determine the medical problems - Needs to be
addressed.

13. Social issues
• As industrialization progresses- children move out and take
up the vocation in other places the problems of isolation and lack of physical support of the
old parents.
 Disintegration of joint family support systems.
• Societal modernization - elderly abuse leading to a host of
psychological illnesses.
• Lack of social security and inadequate facilities for health
care, rehabilitation, and recreation.

14. Psycho-Emotional Aspects
•
•
•
•
•
•
One of the Spouses may pass away
Friend circle gets restricted
Retirement - worsens isolation
Negligence by younger generation
the old persons find it difficult to keep themselves occupied.
This complex interplay:
– increase the risk of mental stress
– also aggravate the impact of stress related diseases as IHD
and hypertension.

15. Financial Issues
• Old Dependency Ratio: increasing over time.
Currently : every 8 working individuals have to take care of 1
elderly but by 2050 every 3 have to take care of 1 elderly.

16. Financial Issues (contd..)
• 70% of the elderly women and 30% of the elderly men are
totally dependant on others economically.
• Inadequate financial savings or pension plans- 90% of the
working individuals are not covered under any old-age income
security plan.
• Pension and social security is restricted to those who worked
in the public / organized sector of industry.
• Urbanization, migration – further economic insecurity for the
elderly.

17. Issues Related to Health care System
• The current health care system lacks adequate number of trained
medical, paramedical personnel in geriatric medicine - adversely
affect the health care of the elderly.
• Mobile health services for the elderly and ambulance services are
limited in the rural & peripheral areas making the health care
facilities difficult to reach.
• Not a very effective health insurance system in our country.
• At present, most of the geriatric OPD services are available at
tertiary care hospitals and are urban based. At the primary care
level, the infrastructure is grossly deficient.
• Low awareness regarding the services available.

18. Medical Problems of the Elderly
• The burden of morbidity in old age is enormous.
• Non-communicable diseases (life style related and degenerative)
are extremely common in elderly irrespective of SE status.
• In population over 70 years, ≥50% suffer from one or more chronic
conditions- hypertension, coronary heart disease, cancer & joint
problems. [Reddy PH. The health of the aged in India. Health Transit Rev. 2006;6:233–44.]
• The treatment/ management of these chronic diseases is also
expensive (e.g. cancer treatment, joint replacements, heart
surgery).
• Decline in immunity as well as age-related physiologic changes
leads to an increased burden of communicable diseases in the
elderly. (e.g. TB)

19. • Disabilities are very frequent which affect the functionality in
old age compromising the ability to pursue the activities of
daily living.
• Among the elderly, 10% suffer from impaired physical
mobility and 10% are hospitalized at any given time, both
proportions rising with increasing age. [Reddy PH. The health of the aged
in India. Health Transit Rev. 2006;6:233–44]
• Over 10% of India’s elderly suffers from depression and 4050% requires psychiatric or psychological intervention at
some point in their twilight years- due to ageing of the
brain, socio-economic factors such as breakdown of the family
support systems, and decrease in economic independence.

20. Health Problems Important for Both Genders
•
•
•
•
•
•
•
•
•
•
•
•
•
Ocular Diseases: Cataract, Glaucoma, Presbyopia
Reduced Muscular Strength and Coordination
Accidents and Injuries
Cardiovascular Diseases: IHD, Stroke and Hypertension
Chronic respiratory illness: COPD, Asthma, bronchitis
Mental problems: dementia, depression and mood disorders.
Complication of Diabetes
Cancers : Oral, gastric, lung and colorectal cancers
Nutritional Deficiencies
Dental Problems
Hearing Defects
Increased Susceptibility to Infections : RTI, UTI
Degenerative Neurological Diseases: Alzheimer’s disease and
Parkinsonism

21. Problems which mainly affect the Elderly Male
• Benign Prostatic Hypertrophy (BPH)
• Prostatic Cancer
• Male Sexual Dysfunction : libido, erectile or ejaculation
problems.

22. Problems mainly concerning Elderly Females
• Menopausal Problems: Atrophic vaginitis, Dysparuenia, Pruritis
vulvae, hot flushes
• Urinary Incontinence
• Cancers and Other Disease of Female Genital Tract :
breast, uterine (endometrial), ovarian, cervical cancers, Prolapsed
uterus.
• Osteoporosis: Osteoporosis occurs in both sexes (Type-II
Osteoporosis) but the incidence as well as the impact is much
higher among females especially after menopause (Type-I
osteoporosis).
-Weight of <58 kg may indicate risk.
-In fact, a rough guide is to calculate an index as {0.2 X (Body weight
in Kg - Age in years)}; if the result is less than 2, the same indicates
increased risk.

23. COMMON MORBIDITIES IN ELDERLY IN INDIA
Cataract &Visual
impairment- 88%
Arthritis & locomotion
disorder-40%
CVD &HT – 18%
Neurological
problems- 18%
Respiratory problems
including Chronic
bronchitis- 16%
GIT problems
9%
ICMR report- survey 1984-85
Psychiat
ric
problem
s- 9%
23

24. Number of persons aged 60 years and above reporting a chronic
disease (per 1,000 persons)
NSSO, 2004

25. Number of disabled per 100,000 elderly persons for different types of
disability
NSSO, 2004

26. Need for Dedicated Health care programme
for elderly
Decrease in physical ability / Economic inadequacy
Increase vulnerability to diseases
Chronic, disabling and multiple Health problems
Different approach and management
Degradation in family values
Rising Population

27. Major constraints for geriatric health care
Lack of
specialized and
trained
manpower
No dedicated
health care
infrastructure
Geriatrics not
yet a popular
specialty
27

28. Major Govt. initiatives
National Policy On Older Persons (NPOP) -1999
Recommendations by working group of planning
commission -2006 for national programme
Maintenance and Welfare of Parents and Senior
Citizens Act – 2007
Announcement of National programme for Health
Care of Elderly during Budget speech (2008-09)
Approval of “National programme for Health Care
of Elderly” by Ministry of Finance - June 2010
28

29. GOVT. STRATEGIES FOR ELDERLY
Ministry of Social Justice & Empowerment
National Policy on Older Persons (NPOP), 1999
The Policy envisages State
• support to ensure financial and food security, health
care, shelter and other needs of older persons,
• equitable share in development, protection against abuse and
exploitation, and availability of
• services to improve the quality of their lives.

30. Maintenance and Welfare of Parents and Senior
Citizens Act, 2007
• A senior citizen including parent who is unable to maintain
himself from his own earning or property owned by
him, then it is an obligation of the children or relative, to
maintain his needs so that he / she may lead a normal life.
• If children or relatives, neglect or refuse- Tribunal may order
them to make a monthly allowance which shall not exceed
10,000/month.
• Establishment of old age homes- one must accommodate
minimum of 150 senior citizens.
• Separate beds for elderly in all Govt. hospitals.
• Separate queue for the elderly in hospitals.
• Treatment facilities for chronic degenerative diseases &
research

31. NATIONAL PROGRAMME FOR HEALTH CARE OF
ELDERLY (NPHCE-2010)
NPHCE 2010
31

32. Ministry of Health & Family Welfare
National Programme for the Health Care of
Elderly (NPHCE)-2010
Objectives
• Easy access to promotional, preventive, curative and
rehabilitative services - through community based primary
health care approach.
• Identify health problems - provide appropriate health
interventions in the community & strong referral support.
• Capacity building- medical and paramedical professionals;
the care-takers within the family for providing health care.
• Referral services through district hospitals, regional
medical institutions

33. Strategies for NPHCE 2010
PHC/CHC level equipment, traini
ng, additional
human resources
(CHC), IEC,
Community level
- domiciliary
visits by trained
health care
workers.
District Hospital 10 bedded
wards, additional
human
resources,
Core
Strategies
8 RMC - PG
courses in
Geriatric
Medicine, and
training
IEC using mass
media, folk
media and other
communication
33

34. Supplementary Strategies for NPHCE
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.
34

35. 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
35

36. Schemes under other Ministries
Ministry of Railways
• Separate ticket counters for senior citizens at various
(Passenger Reservation System) PRS centres if the
average demand per shift is more than 120 tickets
• Concession in rail fare for male-30% and
female-50%
Ministry of Civil Aviation
Air India provides concession up to
50% - male (65 years and above)
- female ( 63 years and above) in air fares.

37. Ministry of Finance
Some of the facilities for senior citizens of 65 years and
above
• Income tax exemption up to Rs. 2.40 lakh per annum.
•Deduction of Rs 20,000 (Section 80D) is allowed to an
individual who pays medical insurance premium for his/
her parent or parents, who is a senior citizen.
•An individual is eligible for a deduction of the amount
spent or Rs 60,000, whichever is less for medical treatment
of a dependent senior citizen .
• Extra 0.5% interest for the elderly on fixed deposit.

38. Privileges and Benefits
Annapurna Scheme
 Launched 2000-2001
 By Ministry of Rural Development
 10 kgs of food grains per month is provided free of cost to the
person >65 yrs but not getting pension under IGNOAPS
 4,66,286 beneficiaries-in year 2011-2012
Indira Gandhi National Old Age Pension Scheme (IGNOAPS)
 Launched in 2007
 Beneficiaries: ≥ 60 years and belonging to BPL family
 Pension amount : Rs 400 (Rs 200 from central and 200 from
state govt.)

39. Strategies & Recommendations to fill the Gaps in
Geriatric health
Geriatric care – as a part of primary health services
• Care at rural areas should be strengthened.
• Training of Medical Officers, Peripheral health workers &
volunteers
• Screening camps & mobile clinics for reaching out to the
elderly population- particularly focussing on NCD’s and chronic
diseases of the elderly.
• Involve NGO’s particularly in difficult to reach areas.
• Conduct a comprehensive baseline morbidity survey- Ensure
good quality geriatric health care services according to felt
needs in the area concerned.

40. Strategies & Recommendations
Primary health services (contd..)
• “Community Geriatric Health Workers” may be trained to
provide home care to the disabled elderly population. (e.g.
community based project in Cochin, known as “Urban
Community Dementia Services”)
• Employment of a trained female medical officer to address
the increasing health problems of elderly women.
• Strengthening the elderly in the process of self-help by means
of physical, psychosocial, and vocational rehabilitation
• Capacity building of the community leaders

41. Strategies & Recommendations
Strengthen secondary level health facilities
• Set up geriatric wards
• Distinct OPD services providing screening services as well as
curative and rehabilitative services
At the tertiary care level
• Set up a comprehensive multidisciplinary team- providing
specialist services.
• Separate facility: Everything under one roof

42. Strategies & Recommendations
Prevention of health problems
• Geriatric health problems must be addressed at all three
levels of prevention.
• Health promotion measures (such as avoidance of alcohol
and smoking, physical activity, immunization for
influenza, tetanus, and injury prevention);
• screening for noncommunicable diseases, such as
diabetes, hypertensions, cancers, psychiatric
disorders, nutritional anemia, and tuberculosis;
• rehabilitation: visual aids/mobility aids , physiotherapy

43. Strategies & Recommendations
• Focus on vulnerable groups - Below Poverty Line or other
marginalized sections of the society.
• Professional training in Geriatrics and Gerontology needs to
be promoted – gross lack of expertise in the field.
• Economic security: At the national level, mixture of pension
schemes and social security schemes can help to the elderly.
 Review BPL categorisation
 Improve present allocations in Social Pensions (NOAPS)
 Age Limit for Annapurna to be made 60 years and not 65 years.
 Strict implementation of “Maintenance and Welfare of
Parents and Senior Citizens Act, 2007”

44. Strategies & Recommendations
• Role of Media : Make the people aware about the problems
and services available. and create of positive perception of
the senior citizens in the society.
• Research in Geriatrics and Gerontology: common chronic and
neuro-degenerative disorders like Alzheimer's disease, the
process of ageing, pharmacokinetics and pharmacodynamics
of drugs, health system research and research in alternative
medicine.

45. Conclusion
• The steady increase in life expectancy- as witnessed – actually a
triumph brought about by advances in medical knowledge.
• This current trend in demographics coupled with rapid urbanization
and lifestyle changes have led to an emergence of a host of
problems faced by the elderly in India.
• Old age can’t be cured but we can prevent the health problems in
the elderly by increasing the awareness and timely interventions.
• Improving the quality-of-life of the elderly calls for a holistic
approach and concerted efforts by the health and health-related
sectors - the policy makers and health planners must be well
prepared to face this challenge.

46. References
• Bhalwar R. Textbook of Community Medicine.1st edition. Dept of
Community Medicine, AFMC in collaboration with WHO; 2009
• Situation Analysis Of The Elderly in India. Central Statistics Office Ministry
of Statistics & Programme Implementation. Government of India. 2011.
• World population aging: 1950-2050. United Nations, New York: Population
Division, Department of Economic and Social Affairs, United Nations 2002
• National Programme for the Health Care of Elderly. An Approach towards
Active and Healthy Aging Directorate General Health Services, Ministry of
Health and Family Welfare, Government of India; 2009.
• National Sample Survey Organization (NSSO) 60 th Round. Report no. 507:
Morbidity: Health Care and Condition of Aged; 2004.
• GK Ingle, A Nath. Geriatric Health in India: Concerns and Solutions. Indian J
Community Med. 2008 October; 33(4): 214–218.

47. • Prakash IJ . Ageing in India. World health organization. Geneva,1999.
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and Opportunities. Society of Actuaries.2005.
• Vibha, AR Laskar. Women’s Health- beyond reproductive years. Ind J of
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• Singh Z. Ageing: The triumph of humanity- are we prepared to face the
challenge? Ind J of Public Health. July 2012; 56(3):189-95
• Reddy PH. The health of the aged in India. Health Transit Rev. 2006;6:233–
44.]
• SI Rajan. Population ageing and health in India. The Centre for Enquiry into
Health and Allied Themes (CEHAT), Mumbai. 2006
• K. Park. Textbook of Preventive and Social Medicine. 22nd edition. M/s
Banarasidas Bhanot publishers.2013;10:549-51

48. “You
do not heal old age. You
protect it; promote it;
extend it”
Thank you