Geriatric care in India still in its infancy

Living to a ripe old age calls for celebration. But it isn't so for Suraj Pratap Singh, 85, who was once a disciplined and forbidding jail superintendent in Uttar Pradesh, but today needs help even for the routine things such as bathing and brushing teeth. Singh, who has been living in Thane for eight years now, suffers from Alzheimer's.

"It began to surface when he started to forget my name or whether he had lunch. Slowly, he would face difficulty in recollecting the year of his birth and even what's my relation with him," said his son, who works for an IT company and did not wish to be named.

The son took Singh to a neurologist who, after conducting a cognitive ability test, prescribed medication. "We continued it for three years. We did not mind the cost [Rs 3,000 a week], but we saw no improvement, so we stopped it. I don't know if it was a wrong decision, but my father hardly remembers anything now," he said.

Singh's son has now sought the help of a nurse trained in geriatrics -- the branch of medicine that focuses on healthcare for the elderly -- who provides the nursing care to the patient while attending to his emotional needs. "My father is more stable now, though he continues to be absent-minded. It's a great relief for us as we can focus on our work," he said.

Like Singh's son, there are many who are waking up to the need for skilled aid for the elderly. And the demand is huge: 160 out of every 1,000 elderly suffer from heart diseases, and 55 out of every 1,000 elderly in urban areas have some sort of disability such as poor vision, hearing difficulty or locomotive impairment, said a 2011 report by the Ministry of Social Justice. According to NGO HelpAge's report in 2014, more than one-quarter of the existing 100 million Indian seniors are underweight and nearly one-third have undiagnosed hyper¬tension. Depression has emerged as the newest common ailment, with about one-fifth of the Indian elderly depressed, according to a study published in Neurosciences in Rural Practice in 2011.

India, despite being a young country with more than half the population below 25 years of age, is ageing fast as birth rates go down and life expectancy increases; the number of seniors is likely to treble by 2050. Experts said healthcare for the elderly thus needs special attention and government policies. This is no less important for Maharashtra, which has the fourth-highest number of elders with 9.2%, the other being Tamil Nadu (10%), Himachal Pradesh (10.1%) and Kerala (11.8%).

"The country needs eight lakh geriatric care professionals," according to Nasreen Rustomfram, professor and chairperson of Centre for Lifelong Learning at the Tata Institute of Social Sciences (TISS), which will see the passing out of the first batch for a certificate in geriatric care out from its Mumbai's Deonar centre in October. TISS also runs centres at Pune and Aurangabad that has been offering the course for the past few years. "There is a vast difference between general nursing and geriatric care. A person trained to deal with elders will be mindful of and sensitive to their needs. For instance, we harbour a common stereotype that elders are generally problematic, fussy, forgetful and rigid. Training dispels these notions," she said, adding the screening process for candidates for the course involves questioning them about stereotypes. "We ask them 'do adults become like children in old age?' Those who say yes, earn negative grading," said Rustomfram.

Not many institutes offer the course, and even takers are few, leaving elder care-homes little option but to hire the general nurses, said Shailesh Mishra, founder of NGO Silver Innings Foundation that runs an assisted care-home in Nalasopara. "We don't get trained staff, so we depend on on-the-job training," said Mishra, who suggested the government should include geriatrics in its skill-development project so trained staff can be even sent abroad for opportunities.

Dr Aniruddha Malpani, a consultant IVF specialist and an active advocate of patient rights, however, cautions against boiling down the healthcare needs of the elderly to medication or skilled aid alone. "Elderly healthcare has taken a hit mainly because of the crumbling social structure, which includes the slow death of joint families and the family doctor. We focus too much on medication today, with too many specialists prescribing multiple treatments," said Malpani, adding what elders need most is support from the family. At the same time, he recognises the need for trained geriatric care providers, but rues that as the field is not very financially viable, it fails to attract many students.

In India, the concept of geriatric care has drawn a blank, says a consultant physician at Breach Candy Hospital

A World Health Organisation report published last year highlighted the large number of older people in some countries (India and China in particular) will challenge national infrastructure and health systems in particular. While the country is to inescapably witness a gigantic paradigm shift in ageing, what is unfortunate is that Indian Medical Science does not even offer geriatrics as a branch of study. Dr Rohit Barman, consultant physician at Breach Candy Hospital talks about the concept of geriatric care why it has remained a neglected area of medicine.

How aware and sensitive are we about geriatric care in our country and are there enough geriatricians to cater to the ageing population?

Over the years, as the average longevity of humans increased, so has the need for specialised care in older age. But unfortunately in our country the concept has drawn a blank. In the west, it is a specialised field and you have doctors who specialise in tending to older people. In our country, however, it is we the physicians who cater to the older people as well.

Why are geriatrics important and why can't physicians alone look after older people?

It is not that physicians don't or can't look after older people. However, just the way you have paediatricians for children, similarly you have geriatrics for older people. As the body ages, it undergoes many changes and generally become more vulnerable and that is what a geriatric specialises in. For instance, hygiene becomes an issue in people who have other medical conditions like a cardiac condition or urinary bladder problem. They need advanced care. Moreover, older people need patient hearing. As they grow old and weak, their concerns need to be heard, which is why you also have geriatric psychiatrists also.

Why is it that despite the increasing population of older people and given that the numbers are going to increase at a faster rate, we do not have geriatrics?

Honestly, geriatrics is not lucrative. Second, it is also a systematic issue because we do not have the specialisation built in our medical education system. That said, there are many physicians like myself who look after older people and over years of experience and acumen we have come to understand their problems and need and treat and care for them accordingly.

Is there an age or symptoms and sign when one should start thinking of seeking geriatric care?

Actually, it is difficult to set a cut-off age. It would depend from person to person. However, when self-dependency becomes an issue, when a person starts feeling handicapped mentally or physically, then it is the time to seek geriatric care.

(With inputs from HT correspondent)