As a result of the improvements in health and medical care, declining fertility & improving mortality rates, worldwide proportion of elderly population is growing manifold. With economic development, advancement in medical services – technology, better education and living conditions, the average life expectancy of Indian populace too, has increased from around 30 years in 1947 to 68.35 years in 2015.
This indeed is a welcome improvement. Indian senior citizen population is second largest in world. With increase in life expectancy most people can expect to live into their sixties and beyond. A longer life represents an important opportunity, not only for older people but also for our society as a whole as these additional years provide the chance to pursue new activities. But, the scope of these opportunities heavily depends on one factor – Health.
Currently India has 103.9 million elderly. The number of people above 60 years of age is about 8.5% of the population & by 2026, this is expected to be about 12%. By 2020 16% of world’s elderly population will be in India. Thus according to classification of United Nations, India acquires tag of ‘An ageing Nation’.
The increasing number of elderly population and thus increase in old age dependency ratio and shrinking proportion of working population will be the major challenge for near future health care system in India. Population ageing is an important emerging phenomenon in India, warranting a strong multi-sectoral policy and programmed response, so that our future generations benefit and live longer with happiness and security.
In the changing family patterns wherein younger people are migrating to cities in search of work, a large number of elders are being left alone, ill-equipped to meet the debilitating effects of advanced age. Moreover, 80% of elderly reside in rural India, 40% are below poverty line, Over 70% are illiterate & about 90% of old age people have no official social security.
Octogenarians are fastest growing segment of elderly (i.e. 8 million in 2001 to 32 million in 2051). Old female outnumber old males & are most vulnerable. Even though life expectancy has increased, the morbidity too has expanded due to chronic non communicable diseases.
According to 60th round of the NSSO, The proportion of aged persons who cannot move and are confined to bed or home, is ranging from about 77/1000 people in urban areas and 84/1000 in rural areas. Over 10% of India’s elderly suffer from depression and 40 to 50% of elderly requires psychiatric or psychological intervention.
The cost of health care during old age appears to be very high and this in turn increases the out of pocket expenditure on health care particularly when private health care facilities are availed. When older person are economically dependent, increasing health expenditure adds to the economic burden on the family.
Joint family structure is changing to nuclear small unit families. Due to lack of safe, secure and dignified status in family the elderly are finding themselves far more vulnerable.
In urban areas, adults find themselves so preoccupied with work and the stress of city life, that a large yet lonely & silent population of elders who are bereft of financial-medical-emotional support is unwittingly left unattended & frightened.
From the point of view of the health sector in India, inadequate provision of primary geriatric care services leads to heavy consumption of secondary and tertiary health care services. Since the expenditure on the provision of secondary and tertiary health care services is much higher than that of primary care services, the financial burden placed on the community grows in the long run.
Hence, community nursing and other health services are needed for patients who no longer require hospital care but have difficulty in attending clinics for routine follow up. They need skilled nursing care aimed at preventing them from relapse. This shall be helpful in reducing pressure on hospital beds and shall alleviate overcrowding in public hospitals by providing domiciliary medical & nursing care such as health assessment, injections, dressings, counselling etc to qualified discharged patients.
People with lower awareness about the need to prevent disease or promote health are more vulnerable to health deterioration.
If Primary health care providers fail to perform the function of ‘Gate keepers’, this will further increase the pressure on secondary and tertiary care services. Once the patients are treated and discharged by hospital, the insufficient rehabilitation services and inadequate institutional care placement will induce unnecessary or more frequent readmission to hospitals. The final result is increase in the demand for our public health care resources.
Effective primary health services can lower the demand for secondary and tertiary health care services. Knowledge about disabilities and the avoidance of preventive complications such as pressure sores, infection, and contracture can reduce the frequency of readmission to hospitals, length of hospital stay and unnecessary attendance at OPD and emergencies.
Traditionally, Family is responsible for caring elderly, but with nuclear family structure this responsibility is shifting to society as a whole. That’s where the need arises for home delivered health care services.