Transitioning India's health systems to address complex health needs of the elderly – The Financial Express

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By Dr. Ritu Rana
India, the world’s second most populous country, has experienced a dramatic demographic transition in the past 50 years, with the population over the age of 60 years (i.e., the elderly) almost tripling (Government of India, 2011). This trend looks set to continue. According to the Report of the Technical Group on Population Projections for India and States 2011-2036, there are nearly 138 million elderly persons (60 years and above) and the number is expected to increase by 56 million elderly persons in 2031.
An analysis of morbidity patterns by age clearly indicates that the elderly experience a greater burden of ailments (which the National Sample Survey Organisation defines as illness, sickness, injury, and poisoning) compared to other age groups, across genders and geographical locations.
HelpAge India’s recent report ‘Bridge the Gap – Understanding Elder Needs’ has revealed some important issues pertaining to healthcare for the elderly. Post the pandemic the need for better health protection has strongly emerged with 49% elderly expressing their aspiration for improved health, through better health insurance and better health facilities and 42% stating there should be more support from home. There needs to be an inherent systemic investment in elder healthcare, with more elder friendly facilities and healthcare schemes for elders.
Sustainable development Goal (SDG 3) says: ‘Ensure healthy lives and promote well-being for all at all ages’. The SDG declaration emphasizes that to achieve the overall health goal, ‘we must achieve universal health coverage (UHC) and access to quality health care. Age is a known factor for inequitable access to health. Elderly, particularly in rural India & below the poverty line, are invariably the last in line to receive health care.
Although privileged elders do have better access to quality healthcare in India, disadvantaged elders experience the opposite. Studies have also shown that widows are disproportionately vulnerable to disability, illness, and poor healthcare utilization due to a number of mobility, comorbidities, employment, property and financial constraints – referred to as the genderization of ageing.
Studies on the cultural perceptions of mental health needs among the aged have revealed, that despite being observed, certain mental health deficits are not addressed as requiring healthcare support. There is limited access to mental health services with most care and support being provided only by the family and immediate community. Consequently, ‘dependency anxiety’ is a common phenomenon among the elderly, i.e., elderly feeling the need to reduce their dependence upon the family and feeling anxious about informing them about their health issues. A key physical barrier to healthcare access is that many elderly require home-based care, a need arising largely from illness-related confinement. Furthermore, there is a huge gap that exists between rural and urban India in terms of knowledge and practice of geriatric care.
Understanding the medical profile of the elderly is essential for planning and implementation of policy related to geriatric healthcare. Certain diseases are more common among elderly, than among the younger people particularly chronic non-communicable diseases like diabetes, hypertension, Chronic Obstructive Pulmonary Disease (COPD) and cardiovascular diseases. Other than this, there is a progressive decline in sensory functions like eye sight and hearing, unless corrective measures are taken.
Failing health and financial dependence of older person calls for higher health insurance coverage but the reality is different. Recent research on equity and elderly health in India has revealed that only 18.9 % elderly had any health insurance, however the expenditure on emergency situations were quite high.
Recommendations under the Universal Health Coverage (UHC) framework have prioritized primary and secondary prevention and health promotion, with the goal of creating enabling environments for healthy lifestyles, early detection, and routine screening among the aged. It is critical to note that geriatric care cannot be solely managed by the government and public sector organizations, primarily because of the huge numbers involved, which will keep increasing as the years go by. A partnership of ideas and services from public, private, and NGOs is needed to tackle this challenge successfully.
Any program related to elderly needs to involve and include the primary caregiver within the family or community, as they are still the main support for elderly in India. Adequate counselling, support groups, creating a bridge between community health workers/volunteers in geriatric care and families are some of the ways in which this can be done. Education of the family and community is indispensable in preventing social isolation of the elderly which will help in their integration into society, with dignity and respect.
This is a technology era, every day we witness and struggle to keep up with newer technology. Digital health technologies are being increasingly developed. In a recent survey by HelpAge, 77.6 % elders residing in cities admitted having no access to digital health, one can only imagine the gap in rural. It is high time to figure out the mechanism to make healthcare accessible to elderly residing in remote villages.
Our country needs to be further sensitized toward the need for comprehensive geriatric care. Active campaigning and advocacy is required to educate the general public on issues of elder healthcare and caregiving, conduct research on gaps, promote legislations, monitor implementation and understand the evolving needs.
In brief, a transition in the health system is needed for comprehensive health care of elderly, including preventive, promotive, curative and rehabilitative services that is accessible, available, affordable and acceptable to them.
(The author is Mission Head – Healthcare, HelpAge India. Views expressed are personal and do not reflect the official position or policy of
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