A current update on Geriatric Palliative Care in India

Dr. Prince John, Pune

The Elderly population is an integral part of any country to whom we owe respect and must extend equal attention like any other section of the population. Changing family dynamics and modern living arrangements which are usually accompanied by a host of factors such as loneliness, negligence, illness due to ageing etc., make it difficult for the elderly population to cope and live life respectfully with the constantly evolving and inevitable challenges. The unavailability of appropriate treatment and the unavoidable need to visit several doctors to manage their various co-morbidities compound to their existing woes.

The quantum of ageing population in India has increased exponentially due to the impressive gains made by the society in terms of longer life expectancies. A growing elderly population automatically demands a corresponding growth for holistic treatment and care provision.

It is predicted that by 2025 the geriatric population from developing countries alone will be at 840 million. Projections indicate that the proportion of Indians aged 60 and older will rise from 7.5% in 2010 to 11.1% in 2025.

The ‘Elderly in India 2016’ report by the Ministry of Statistics and Programme Implementation discloses that ‘The sex ratio among elderly people in 1951 to be as high as 1028 women (per 1,000 males), which subsequently dropped and again rose to 1033 women (per 1,000 males) in2011. The report goes on to add that the life expectancy at birth during 2009-13 was 69.3 for women as against 65.8 years for men. At the age of 60, the average remaining length of life was found to be about 18 years (16.9 for men and 19.0 for women) and that at age 70 was less than 12 years (10.9 for men and 12.3 for women).

The majority of our country’s population is below the age of 30. Our focus has therefore been directed towards fulfilling the basic needs for the proper development of children and youth. Our enthusiasm and eagerness to reap the benefits of the demographic dividend, has resulted in us not giving a serious thought to the problems and issues of our grey population. To this date, only a handful of research has been done on this segment of the population. Sadly, Geriatric care is also conspicuously missing from our medical education curriculum. The traditional Indian society’s age-old joint family systems, safeguarded and upheld the social and economic security of the elderly people in the country. An unfortunate trend characterised by a rapid change in the social scenario due to the increased prevalence of nuclear family systems also bring with it, the empty nest syndrome. All of these contribute to exposing the already vulnerable elders to huge emotional, physical and financial voids over the years to come.

Restricted mobility accompanied with other debilitating illnesses forces elders to become dependent on others to do things for them. The steadily growing acceptance of nuclear families with double income and no kids or one child in the family highlights the critical need to provision care for the elderly segment of the population. The rapid mushrooming of old-age homes are a testimony to the country’s current state of affairs. We must also immediately design and adopt a plan to safeguard the elderly who are absolutely neglected, ill-treated and vulnerable. The plan can be designed to include the establishment of a care giving unit which will solely work towards meeting the needs of the elderly.

The novel COVID-19 pandemic has not only initiated lifestyle changes but has also caused significant distress among individuals. A major proportion of the elderly population with existing co-morbidities, now face an escalated risk of contracting the corona virus disease along with an increased risk of dying. It is also unfortunate that several of them presenting with severe illnesses will not be eligible for aggressive and intensive treatment. This calls for supportive treatment and provisioning quality palliative care is the best option for people of this age group. The role of palliative care in the geriatric population is now heightened as the spotlight now showcases our pivotal role as providers of palliative care. The lack of emergency services, the unavailability of long term care and the current quality of the existing assisted living facilities for the elderly definitely sounds an alarming sign for the large elderly population of our country.

The need of the hour is to therefore adopt a holistic approach of care and provide the elderly with the best quality of life by creating and designing customised living spaces, that will enable them to spend their sunset years comfortably and with access to supportive treatment care plans.

About the Author: Dr. Prince John is the Medical Director at Pallex Healthcare. He is also a Consultant of Palliative Medicine at the Deenanath Mangeshkar Hospital and Sahyadri Hospital in Pune.

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