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Elder Care

How to ensure better well-being of India’s elderly

On this International Elders’ Day, success of an intervention offering social bonding, and health cards providing the elderly easy access to health care, point the way for effective elder care

India’s sizeable elderly population needs medical care and emotional care (Photo courtesy Sugandhi Baliga)

By 2050, India’s elderly population will be nearly 300 million, and will account for 20% of India’s population. Today, an estimated 130 million individuals are above the age of 60 years in India. Many of them need emotional care, protection from abuse, and medical care.

Population ageing is one of the most distinctive demographic events in India today. Currently, family continues to be the main provider for elders in India, and also one of the main reasons for disputes. Empirical evidence suggests that society as a whole, and the government in particular, have had to step in for expeditious redressal of the elders’ grievances.

Expectations of the elderly

As per a baseline survey conducted in rural areas of Medak, Chandrapur and Yadgir districts in 2018- 19 as part of a program of Tata Trusts – St. Johns Medical College, Bengaluru, a high prevalence of probable depression and hypertension/diabetes was noted among elders above 60 years of age. There were high rates of illiteracy and financial dependence.

Single elderly women appeared more vulnerable than men. As per a baseline survey conducted by Tata Trusts and Symbiosis Institute, Pune in early 2018, more than one third of the elderly in Bhubaneswar, the urban intervention area, were willing to work if provided with an opportunity. 35% of the surveyed had some skill for productive work engagement.

More than three fourth of the elderly surveyed were interested to have a multi-activity center in their locality. Around 50% of the respondents were willing to get retrained in the activity center for improving their skills. It shows that elderly in urban settings areas are willing to explore opportunities so as to remain independent and lead a dignified life.

Rural health care

Nearly 70% of the elderly in India are in rural areas. A focused approach of healthcare services is one of the urgent needs of the elderly in villages. National Program for Health Care of Elderly (NPHCE), a central government scheme, has been created to address the healthcare needs of the elderly in rural areas.

Engaging elders in activities such as yoga and meditation, as seen in an activity center in Chandrapur, helps them overcome psychological issues (Photo courtesy Sugandhi Baliga)

In October 2017, Tata Trusts conceptualized a program in rural and urban settings to authenticate a concept in addressing the needs of the elderly. In addition, it picked up two areas that could influence the overall ecosystem for the elderly.

To bring the attention back to the importance of primary level health care for elderly, Tata Trusts has supported elderly care programs of state governments in Chandrapur district of Maharashtra, Yadgir district of Karnataka and Medak district of Telangana.

In these districts, the focus was on early detection of non-communicable diseases in elderly, spreading awareness about health issues, and improved adherence to the treatment of these diseases by starting weekly dedicated geriatric clinics by trained medical officers at primary health center (PHC) level. Capacity building of public health staff is an important component of the program.

Health cards

As part of the rural program to support NPHCE, a comprehensive Health Card (medical records) was issued to the elderly members of villages. The card consists of medical and surgical history of the elderly with their disease profile, blood sugar, blood pressure readings and medication details noted over the period.

The comprehensive health card was developed with inputs from the Department of Community Medicine Department, St. John’s Medical College, Bengaluru, and health officials from state and central government departments.

“I am happy that I enrolled and they gave me this card, it’s been faster and easy to get check up and get medication. I don’t have to wait and they do not even take money from us for checkup when we show this card,” said one of the elderly beneficiaries.

Since the start of lockdown, the health cards turned out to be a ray of hope for the elderly. The elderly told that either they were visiting the health facility on a designated day for geriatric outpatient department or any of their family members collected the required medicines after showing the card.

For those with severe health issues and could not travel, PHC staff deliver medicines at their doorstep without any charge. Also, with the help of the panchayat, other essentials such as grocery and pension too are being provided to elders in need at their doorstep.

Activity centers

Community participation is a must in health care of the elderly. Village activity centers run by community health care workers, with the support of the panchayat and village volunteers, can play a crucial role in creating this awareness. The centers provide an opportunity for the elders to get active and enjoy various social activities together.

Coming together and engaging in various activities helps the elderly people in urban hubs bond with each other and overcome stress (Photo courtesy Sugandhi Baliga)

This helps to improve their overall quality of life. A total of 67 such centers were set up in intervention districts, 52 in Maharashtra, 12 in Telangana, and three in Karnataka, using spaces of the panchayat, community halls, or health and wellness center. The centers operate for 3-4 days a week for 2-3 hours a day and are run by volunteers or accredited social health activists (ASHAs).

“Coming here gives me a chance to chitchat with friends and draw in with other people; staying idle at home makes me feel depressed,” said an elderly person at an activity center. “I participate in various activities like prayers and exercise at the center. It feels refreshing and lightens the mood.”

Improving capacity and infrastructure

The ongoing pandemic faces of social distancing, restricted mobility, Isolation, unemployment in rural settings have affected the elders not only health-wise but psychologically too. They need gentler handholding in enlivening their normal routine.

There is scope for improving the existing public health infrastructure, processes for making them elder-friendly, capacity building of public health staff, regular medicine supply, and transport facility for elders for visiting the facility. All of these need funding too.

With the help of state health departments, private and philanthropic organizations need to step in to augment institutional capacity – geriatric capacity from primary healthcare to tertiary care level and build awareness around issues of the elderly in the community.

Urban multi-activity centers

One of the most common issues that the elderly face is loneliness. Happy and healthy aging of the elderly population in urban areas can be ensured through multi-activity centers in urban hubs, just like the activity centers in villages.

The place can offer activities like yoga, meditation, health check-ups, intergenerational bonding and other engaging opportunities. Multi-activity centers have the potential to become a place where elders could meet each other, and converse and share their opinions, feelings and emotions with each other, and in turn, be happy and stress free.

As part of the intervention, such multi-activity centers exist in Hyderabad, wherein elders start re-discovering themselves. A few drew and painted for the first time in their lives, and were surprised to find that they could do it with such ease. Others pursued their dream of dancing, and becoming a yoga teacher, and so on.

Intergenerational bonding, such as this in Chandrapur, helps the elderly remain happy and stress free (Photo courtesy Sugandhi Baliga)

During the lockdown, activities were virtual using their own or a family member’s smart phone. The approach of having spaces for the elderly has demonstrated a qualitative change in the overall well-being of the elderly members. There is a need to set up such spaces in every ward as part of city plans.

National helpline

Much like the 14567 helpline set up by Vijayavahini Charitable Foundation, with the support of Government of Telangana and Tata Trusts, there is a need for a dedicated helpline for senior citizens across India, covering even the rural pockets.

The helpline addresses the issues of the elderly with the help of a connect center and a field team, and offers services like counseling the elderly, providing information pertaining to elderly care, guidance on legal and pension related issues, field support for homeless elderly and victims of abuse.

The helpline has great potential to add various services that are emerging and to track every call and also provide the right resolution. Knowledge and information generated can pave the way to make shifts and amendments to the existing acts and schemes for the elderly.

Information platform

Besides various platforms for the elderly, a digital platform, which is easy to use, trusted, and is a space solely for the elderly and their caregivers, needs to be created. With the advent of digital technologies, the platform will emerge as a single source for all information pertaining to happy aging.

In COVID-19 times, or any unforeseen pandemic-like situations, the digital platform may be used for virtual activities – creating new possibilities to socialize. With the right kind of content, and getting the elderly closer to the digital world will help them engage, participate, and be an active part of the society.

A need to pay greater attention to aging issues and develop innovative programs for dealing with the aging society is the need of the hour. Public and private institutions and the civil society should be involved in the attempt to address the pressing issues that the elderly face.

Sugandhi Baliga is Head – Geriatric Program at Tata Trusts. She has over two decades of experience in the corporate and development sectors. Views are personal.

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