Hospitals treat patients of all age groups. In the recent years, two distinct patient age groups have been identified who need special consideration while treatment. One is paediatric and the other is geriatric. While paediatric is a widely accepted specialised medical stream and paediatric consultants dominate most private and public hospital OPDs; geriatric is little known and in fact not even taught formally at most medical colleges in India.
Of late, the healthcare needs of elderly has come into focus, with the government announcing various schemes and allocating Rs 150 crores for ‘The National Programme for the Health Care of Elderly’ which is being implemented in 100 selected districts of 21 states. Subsequently, private hospitals have also started taking notice of this population.
Ageing India
The percentage of elderly people who require care in a hospital or home setting is increasing in India. “By 2050, India’s population of those aged 60 and above is expected to total 323 million, a number far greater than the entire US population in 2012,” says Amit Mookim, Partner & Head of Healthcare, KPMG, India.
In addition to this, the elderly population in India is not uniform. They have different causes of morbidity spanning across several dimensions like gender, location and socio-economic status in particular, as well as great diversity in cultures, religions, and languages. This presents a huge challenge for delivering healthcare services to this population.
‘Attitudes and practices that fail the elderly may be reinforced by cultural values that reject long-term hospitalisation of the old because it is viewed as a sign of disrespect; traditionally younger family members tend to the needs of their elderly relatives,’ says a study on geriatric care in India. [Evans et al.: Activating the knowledge-to-action cycle for geriatric care in India. Health Research Policy and Systems 20119:42.]
Pioneering centres
 “It becomes imperative to set up a geriatric care facility keeping in mind the emotional requirements of elderly. Some facility for enabling social interaction must also be there.”(Prof) Dr P K Dave HOD-Orthopaedics, Rockland Hospitals, Delhi |
Few centres have taken the bold step to establish geriatric care facilities and are doing well. “Currently we have eight regional centres across the country with geriatric care facility,” says (Prof) Dr PK Dave, HOD, Orthopaedics, Rockland Hospitals, Delhi. “These are at All India Institute of Medical Sciences (AIIMS), New Delhi; Institute of Medical Sciences, Banaras Hindu University, Uttar Pradesh; Sher-e-Kashmir Institute of Medical Sciences, Srinagar, Jammu & Kashmir; Government Medical College, Thiruvananthapuram, Kerala; Guwahati Medical College, Guwahati, Assam; Madras Medical College, Chennai, Tamil Nadu; SN Medical College, Jodhpur, Rajasthan, besides Grant Medical College and JJ Hospital, Mumbai, Maharashtra,” he explains.
“In the corporate sector, Apollo Hospital, Chennai has a department of geriatric medicine. Hyderabad-based Heritage Hospitals also have a separate geriatric department. Many hospitals in the metro cities including Max, Fortis, Rockland, Pushpanjali Crosslay and Jaipur Golden in Delhi have started programmes targeting geriatric care. Small standalone geriatric hospitals such as Vindhya Geriatric Hospital in Bangalore and Aastha Hospital in Lucknow have been started,” he further adds.
Unrecognised needs
It is known that there are very few dedicated geriatric care facilities are available in India where it is most required. “Geriatric service across the country is very patchy, very few hospitals (metropolitan cities) have set up a geriatric department with in-patient geriatric care,’ says Dr Dominic Benjamin, who is associated with Baptist Hospital, Bangalore.
 “Mental block (in healthcare providers) of being not very remunerative is depriving geriatric care at hospitals. Earning (in geriatric care) is by referral to super-specialities.”Dr Ramneek Mahajan Orthopaedic Surgeon, Nova Specialty Surgery |
Adding to this, Dr Ramneek Mahajan, Orthopaedic Surgeon – Nova Specialty Surgery; Advisory Board – Geriatric Society of India says, “Mental block [in healthcare providers] of being not very remunerative is depriving geriatric care at hospitals.” “Earning is by referral to super-specialities like cardiology, orthopedics, ophthalmology, gastroenterology, renal and oncology surgery,” he adds. Agreeing, Dr Benjamin says, “Most of the healthcare in India is provided by the private sector and most of these hospitals promote speciality which generates seemingly larger monetary returns rather than specialities like geriatric.”
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| The geriatric services market is estimated to be worth about $250 million in India |
This is because healthcare providers fail to recognise the needs of elderly patients and treat them as other adult patients. “Most healthcare organisations and individual providers in India fail to prioritise elderly patients and provide them with continuous and comprehensive geriatric care, which contributes to poor quality of care and poor health outcomes for the elderly,” explains Jenna M Evans, Researcher with the Institute of Health Policy, Management & Evaluation in Toronto, Canada. “This gap is due, in part, to the limited human and material resources available to manage the growing number of patients with complex chronic conditions,” she adds.
Money matters
It is evident from the numbers that the need for elderly care in India is huge though the niche market for this service is large enough for corporates to sit up and take notice. “The geriatric services market is estimated to be worth about $250 million in India and expected to grow to over $1 billion by 2013 and $2 billion by 2017,” informs Mookim.
 “Geriatric service across the country is very patchy, very few hospitals (metropolitan cities) have set up a geriatric department with in-patient geriatric care.”Dr Dominic Benjamin Associated with Bangalore Baptist Hospital |
This alone presents an untapped potential for focusing on geriatric care. In addition, life expectancy at the age of 60 has increased for both men and women in India, according to the UN report (2009) the present life expectancy at 60 for men is 16.3 years while for women it is 17.2 years. “There is definitely a market for hospitals to set-up purpose-built geriatric ward. There is a huge variation in the healthcare standards across the country, in big cities a significant proportion of older people come from upper class or middle class who will be willing to pay for comprehensive geriatric care, so it makes business sense to set-up a geriatric ward to cater to these patients,” opines Dr Benjamin.
However, few experts disagree and feel that geriatric care is more of a home care domain and may not substantiate a hospital set-up. “No, we do not see a market for a standalone geriatric hospital as it’s very important for the teams of doctors to have a mix of patients. It will also be wrong to assume that ‘old’ means ‘sick’,” argues Dr Dave. “All age groups have similar diseases nowadays, however the old have their own challenges and are prone to certain age related disabilities. The old require home care more than hospital care if there is a old age related disability,” he adds after thought.
Road-blocks to geriatric facilities
 “The primary problem is the lack of awareness about geriatric care and what it entails. However, people are becoming more aware of the need for specialised elderly care services.”Dr Anoop Amarnath Director & Consultant- Geriatric Medicine, Apollo Hospitals, Bangalore |
There are many reasons why geriatric care is not picking up in India. One of the reasons is that it is fairly unknown to caregivers as well as care-seekers. “The primary problem is the lack of awareness about geriatric care and what it entails. However, over the last few years this seems to have been changing with people becoming more aware of the need to have specialised elderly care services,” Dr Anoop Amarnath, Director and Consultant- Geriatric Medicine, Apollo Hospitals, Bangalore.
“In Baptist Hospital, we have a purpose built geriatric ward but we still feel the biggest challenge is to overcome attitude of lay people and professionals, most of them think that illness after 60 years is not worth treating as it is better to endure it,” adds Dr Benjamin.
Another important consideration is the fact that the service make-up should be therapeutic along with rehabilitative and supportive. “Elderly does not need medical support alone but also require emotional support,” says Dr Dave. “Thus it becomes imperative to set up a geriatric care facility keeping in mind the emotional requirements of elderly. Some facility for enabling social interaction must also be there,” he adds.
 “To set up a geriatric care facility one needs dedicated beds, specialists round the clock and nurses trained to handle geriatric in patients.”Vinay Kaul VP – Sales & Marketing, Columbia Asia Hospitals |
“To set up a geriatric care facility one needs dedicated beds, specialists round the clock and nurses trained to handle geriatric in patients. CAH is a multi-speciality hospital and we treat all old age related problems. However we are not a dedicated geriatric care hospital and do not provide rehabilitation for dementia and other related diseases,” offers Vinay Kaul, VP-Sales & Marketing, Columbia Asia Hospitals.
Adding to this, Dr Benjamin says,“Setting up an inpatient geriatric care facility needs a purpose built geriatric ward with multiple therapist input as most of the individuals have significant co-morbid illness. Most of the hospitals in the private sector would think long and hard to allocate entire ward for geriatric patients.”
The big A
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| Elderly on average take six prescription drugs concurrently and often suffer from adverse drug reaction |
Affordability is also a major road-block to geriatric care. “It has been reported that a majority of India’s elderly – about 80 per cent – live in rural areas, of which 40 per cent live below the poverty line.” says Mookim. “Most crucial of all is to set up a geriatric facility which is affordable. Large geriatric population cannot afford healthcare,” adds Dr Dave.
“Help Age India undertook a survey couple of years back in 12 big cities of people above 80 years, they found that 70 per cent of the individuals depended on the family for financial support. Most of the insurance providers do not provide comprehensive coverage if an individual is over 65 years, this hinders most of the older people to utilise medical services because of financial constraints.” explains Dr Benjamin.
Ref: Chaubey PC, Vij A. Planning consideration of comprehensive geriatric care in India. J Acad Hosp Admin 1999;11:22-4. |
Lack of manpower
The other prominent reason for not having geriatric care at hospitals is lack of trained manpower. “There are lack of properly trained geriatricians, although some institutions have started a structured geriatric training programme. Hopefully this situation will improve in the coming years,” says Dr Benjamin. Adding to this, Dr Amarnath says, “The second major issue is the lack of qualified personnel. As of today, the only fully trained personnel that are available are the ones who have qualified abroad.”
Talking about the demand and supply gap in geriatric care in India, Dr Dave says, “There are a handful of doctors who specialise in geriatric medicine. The government must start training doctors in geriatric care to cater to the needs of the increasing number of elderly. Both, the medical and emotional needs of the geriatric population differ from the young population and to cater to their needs doctors and paramedical staff must specialise in geriatric medicine.”
Lack of training facilities
There is a lack of formal training in geriatric medicine in India. It is very unfortunate that out of 206 medical colleges in India only one college provides full-time geriatric MD programme. “Madras Medical College, has a full-time geriatric MD program. Indira Gandhi National Open University offers a one-year part-time Post-Graduate Diploma in Geriatric Medicine with four-weeks of practical training to doctors working in different streams of medicine,” informs Dr Mahajan.
In a recent study of senior-level students from medical, nursing, and social work colleges in India, about 50 per cent were unaware of policies relating to the health and well-being of the elderly. None of the students demonstrated recognition of the clinical and functional implications of ageing. [Evans et al.: Activating the knowledge-to-action cycle for geriatric care in India. Health Research Policy and Systems 20119:42.] This shows why capacity building is important and why geriatric training is important in India.
In future
Healthcare delivery in India has evolved rapidly in the past few years, imbibing the trends in disease and treatments. If stand-alone diabetes centres are now seen in many cities, special centres for day-surgeries, or dialysis are also coming up. Different models of healthcare delivery, from bare minimum to five-star experience, exists in the Indian healthcare landscape.
There is a need for development of healthcare facilities for geriatric patients and hopefully Indian providers will understand the need and come-up with innovative, cost-effective and accessible services for the elderly population.
There is a need for comprehensive all around development in geriatric care in India entailing home-based care, institutional care, education and training, non-medical resource development, sensitisation and involvement of NGOs and voluntary organisation and most importantly health insurance programme for elderly.
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