National Program of Health-Care for the Elderly in India: A Hope for Healthy Ageing

Population ageing is one of the most discussed global phenomena in the present century. Countries with a large population like India have a large number of people now aged 60 years or more. The population over the age of 60 years has tripled in last 50 years in India and will relentlessly increase in the near future. According to census 2001, older people were 7.7% of the total population, which increased to 8.14% in census 2011. The projections for population over 60 years in next four censuses are: 133.32 million (2021), 178.59 (2031), 236.01 million (2041) and 300.96 million (2051). The increases in the elderly population are the result of changing fertility and mortality regimes over the last 40-50 years. [1,2] The elderly process is considered to be an end product of demographic transition or demographic achievement with a decline in both birth and mortality rates and consequent increase in life expectancy at birth and older ages. The expectancy of life at birth during the year 2006-2011 was 65.65 and 67.22 for male and female respectively while projected expectancy of life at birth during the year 2011-2016 will be 67.04 and 68.8 years for males and females respectively. Irrespective of socio-economic status, the non-communicable diseases (NCDs) requiring large quantum of health and social care are extremely common in old age. Disabilities resulting from these NCDs are very frequent, which affects the activities of daily living. The management of these chronic diseases is also very costly, especially for cancer treatment, joint replacements, heart surgery, neurosurgical procedures etc., thereby making it out of pocket for elderly persons. The 60th round of National Sample Survey provides a comprehensive status report on older persons. According to this survey, the prevalence and incidence of diseases as well as hospitalization rates are much higher in older people than the total population. It also reported that about 8% of older Indians were confined to their home or bed. The proportion of such immobile or home bound people rose with age to 27% after the age of 80 years. Women were more frequently affected than males in both rural and urban areas. The survey revealed that a good or fair condition of health was reported by 55-63% of people with a sickness and 77-78% of people without one. In contrast about 13-17% of the survey population without any sickness reported ill-health. It is possible that many older people take ill health in their stride as a part of “usual/normal ageing. ” This observation has a lot of significance as self-perceived health status is an important indicator of health service utilization and compliance to treatment interventions. [3] However, very little effort has been made to develop a model of health and social care in tune with the changing need and time. The developed world has evolved many models for elderly care, e.g., nursing home care, health insurance etc., As no such model for older people exists in India, as well as most other societies with similar socio-economic situation, it may be an opportunity for innovation in the health system development, though it is a major challenge. The requirements for health-care of the elderly are also different for our country. India still has family as the primary care giver to the elderly and scope for training this lot provide support to the program. Presently, the elderly are provided health-care by the general health-care delivery system in the country. As the elderly population is likely to increase in the future, and there is a definite shift in the disease pattern, i.e. from communicable to non-communicable, it is high time that the health care system gears itself to growing health needs of the elderly in an optimal and comprehensive manner. There is a definite need to emphasize the fact that disease and disability are not part of old age and help must be sought to address the health problems. The concept of Active and Healthy ageing needs to be promoted among the elderly, which includes preventive, promotive, curative and rehabilitative aspects of health. [4]