1 December 2020 08:49 PM

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ABHISH K. BOSE | 2 NOVEMBER, 2020

Failing the Elderly: Public Health Systems Need Revamping, Experts Say

34% of Keralites will be older than 60 by 2051


KOTTAYAM: The nature of the pandemic and nuclear family structures demand that we institutionalise adequate protective mechanisms for elderly Indians. Here in Kerala no less than 13% of people are older than 60, the highest share of all states, projected to grow to 34% by 2051.

The recurrent onslaught of unnatural disasters in the state over the past few years has further worsened the condition of elderly Keralites, many of whom have no one to look after their needs.

Given the situation after Covid-19 the state government’s social justice department has put in place a three tier program. Anganwadi workers, ASHA workers and Kudumbasree activists will keep in touch with elderly people staying in old-age homes over the phone to better understand their situation.

According to the department 21,000 elderly people are staying in 619 such homes in the state.

However, going by the current pace of isolation they are experiencing, governments should do more. After Kerala it is Goa and Tamil Nadu that are home to the highest proportion of senior citizens, at 11% and 10% respectively.

The Union government announced a National Policy on Older Persons in 1999 and Article 41 of the Constitution requires the state to ensure the well being of senior citizens. A National Policy on Senior Citizens in 2011 is intended to focus especially on older women and bring their concerns into national development debates.

However, most of their recommendations remain ignored, despite the fact that senior state officials are rather elderly themselves.

The 2011 policy says that age-friendly barrier-free access will be created in buses and bus stations, railways and railway stations, airports, banks, places of worship, hospitals, parks, cinema halls, shopping malls and other public places.

The policy also wants to promote bonding between generations and create multi-generational support systems by incorporating relevant educational material into school curriculums and promoting “value education”.

Another proposal is to establish a Department of Senior Citizens which will be the nodal agency for implementing programs and services for senior citizens.

According to Dr M.R Rajagopal, chairman of palliative care charity Pallium India:

“The existing policy has never been implemented as it was not translated into action. The laws for protecting the elderly are more of a paper tiger than something that is effectively implemented on the ground. What we need is an implementation framework for translating the policies into action.

“This cannot not be Covid specific, because so many people are suffering as a result of the accentuation of their existing problem due to the lockdown that was due to Covid 19.”

According to Rajagopal the Kerala government’s palliative care policy does provide a good framework for care of the elderly:

“Every panchayath, that is more than 950 of them in Kerala, has a primary health centre and each one of them has one full time trained palliative care nurse visiting bedridden patients in their homes at least once a month.

“Once a month is not much but it is a million times more than nothing. In fact this turns out to be such a huge blessing.

“The policy actually also has a supportive system at the primary, secondary and tertiary care centres which is not quite well developed yet, but the way it is envisaged, that would take care of elders and of course other people with serious illnesses,” he said.

He believes the Union and state governments do not allocate enough resources to healthcare, let alone care for elders. “Why only caring for elders, allocation for health care in our country is abysmally small. India has the unfortunate system where only 1.3% of GDP is spent on healthcare. The policy is very short sighted.”

Even the Union government’s current healthcare policy “envisages that it would be increased to 2.2% or so of GDP by 2022; but it is very doubtful if this is achievable and even if it is, 2.2% is still very inadequate.”

As the pandemic has shown, Rajagopal said that strengthening the public health systems is indeed the answer, and is an achievable target if we give due importance to people’s health and well being.

It is well known that Covid-19 has aggravated the sufferings of the elderly. According to Dr Sherin Susan Paul, who teaches community medicine at the Pushpagiri Institute of Medical Sciences and Research:

“Older population are generally considered as vulnerable group. However, the current pandemic has proved particularly challenging for them. Common diseases associated with ageing such as diabetes, hypertension, cardiovascular diseases, malignancies along with senescence of immune system, will considerably affect one’s ability to survive emerging diseases.”

“Besides, the prolonged restrictions currently prevailing will hamper their social connectedness with friends, and access to care and social support systems. It will also affect their employability, and thereby source of income.

“Any decision or programs by the authorities, with respect to tackling Covid-19 should actively and consciously be age-friendly,” said Paul.

She believes it is time to consider “radical measures” such as transferring cash on a monthly basis directly to older people, especially those living alone and to women without a partner.

“States which have effective Self-Help Groups may try to avail their services in providing basic health needs such as home delivery of medicines and monitoring of blood pressure and sugar, assessing food availability and liaising with officials. States which do not have SHGs can try to redirect their anganwadi workers to deliver such services,” as Kerala is doing.

Sources say the relevant national policies also need revising.

According Dr Pradeep Kumar, who heads the community medicine department at the GMERS Medical College in Gujarath:

“The policy has not been revised for more than 20 years. It needs to spell out the definite steps and strategies to be adopted by the governments. We need a separate desk for the elderly everywhere, especially for those who are above 80, hospitals, police stations, courts, all offices.

“Mediclaim after 70 years of age is either not there or is very costly. The government must support it,” Kumar stated.

According to an upcoming book, Senior Citizens of India: Emerging Challenges and Concerns by S. Irudaya Rajan and Udaya S. Misra, declining fertility and mortality and augmented life expectancy have significantly contributed to population ageing in India.

The book says that states with higher economic dependency and disability have more of a burden to address than those without such constraints. Rajasthan and Orissa are more disadvantaged, with the double burden of physical disability and financial disability.

“The socially and demographically more advanced South Indian states also have relatively higher levels of elderly, with complete economic dependence in the household as in the case of Rajasthan and Orissa, even though the former shows lower disability rate in old age,” the authors argue.

They add that the traditional Indian family structure provided the environment required for the comfortable life of the elderly. The joint family usually consisted of two generations wherein the elderly would have a well-respected status that differentiated them from other members of the household.

However, with the rising prominence of nuclear families, they have been deprived of a familial support structure. Rajan and Misra argue that the present living arrangements of the elderly must be re-examined.

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