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"Of all the forms of inequalities, injustice in healthcare is the most shocking and inhumane," said Martin Luther King, Jr. Echoing his sentiments, here’s a medical professional suggesting some improvements in the healthcare of the elderly in India, in order to enhance their lives. A fruitful partnership with the Govt, professionals and NGOs can bring a radical change, says Dr Shanta Haridasan.
Our country is only just waking up to the problems of senior citizens. So far, India was always termed a ‘young nation’ with the majority of our population below 15 years of age. But the demographic pattern is fast changing. India currently has around 70 million citizens above 60+. Life expectancy is expected to rise from the present 64.7 to 75.6 by 2050. Population ageing is expected to be among the most prominent global demographic trends in the 21st century. It is related to the decline in fertility and increase in life expectancy. Add to this the vanishing joint families and we have an enormous burden on our hands which, if not addressed quickly and effectively, will have tremendous socio-economic implications. To begin with, it is necessary to compile a proper registry of senior citizens in every locality, with regular updating of additions and deletions. The Longitudinal Ageing Study in India (LASI) launched recently, will give the correct picture of the greying population of our country.
Prevention Is Better Than Cure
Dealing specifically with health related issues of the elderly; it goes without saying that, prevention is always better than cure. Also, when speaking of health, we have to take a comprehensive view of all aspects which include physical, mental and spiritual health, not just illnesses and their solutions. Therefore, we have to begin by promoting positive health. It is important to generate the awareness of healthy lifestyles which include good nutrition, exercise, early detection of illnesses etc. Special sections in parks for walks and yoga, and reading rooms in every locality will encourage the older persons to come out, exercise and also interact socially. These measures, if implemented well with the help of Govt and/or NGOs, will eventually prove cost effective if one takes into account the savings in terms of curative treatment. Clubs and gyms could be encouraged to provide concessional membership to Senior Citizens. Mid-day meals could be sponsored for those not able to afford nutritious food.
Periodic Medical Checkup
Further, to establish the health status and create awareness, free or subsidised annual health checkup, just like the executive health checkups, should be made mandatory. Such clinics could run say, once a month in hospitals or other convenient locations, and will help in early detection of common diseases like hypertension, diabetes, cancer, osteoporosis, tuberculosis, dementias and even nutritional deficiencies. These clinics need to be equipped with facilities for basic investigations such as blood tests, and tests for lung function, mental and language function etc. This will result in huge savings in curative healthcare costs.
These clinics could be sponsored by the Govt, NGOs or even private organisations including the pharmaceutical industry. Or, it could be made part of some health insurance schemes. There are also existing contributory schemes like the Central Government Health Scheme, presently catering to only central govt employees and pensioners .These could be extended to cover all pensioners and senior citizens and will help cover the cost of outpatient treatment, since mediclaim policies only cover hospitalisation expenses.
Let us now look at the infrastructural drawbacks of hospitals and what can be done about those. In one word, hospitals are very ‘confusing’ places, even for people in full possession of their faculties! One suggestion is to club the special provisions for Senior Citizens with that for handicapped people as both suffer from problems like restricted mobility, hearing and visual impairment. So we need ramps for wheelchairs and walkers, more toilets with convenient support handles etc and clinics situated on the ground floor. Separate counters and waiting areas will avoid jostling and competing with the rushed younger crowd. The clinic timings can also be separate and there should be a single window system for making payments to the different departments and collecting reports. There is a crying need for dedicated medico-social workers, to bridge the communication gap between the patients and the consultants. They can be the coordinators to explain and interpret what the doctor has advised and even write out instructions in detail in a language the patient and his/her caregiver can follow. Wherever possible, capable senior citizens can themselves be volunteers to help the less fortunate ones.
Maintaining a Health Diary
Ideally, every Senior Citizen should have a health diary containing relevant data and instructions and space for marking when the medicines have been consumed. More than the rest, they are likely to be forgetful, which can lead to serious consequences as a result either of not taking the medicines or overdosing.
Making Healthcare Affordable
Regarding the cost of medicines, one unpleasant reality in our country is that the same formulation or molecule is marketed by different companies at varying rates. To give only a few examples, Amlodepine 5mg, commonly prescribed for hypertension, varies in cost from Rs 9.14 to Rs 77 for a strip of 10 tablets. Atorvastatin 10mg, for lowering lipids, ranges in cost from Rs 30 to Rs 80.52 for 10 tablets. Therefore, it is necessary for those dealing with limited-income populations, to use their discretion in prescribing effective but lower priced medicines. The medico-social worker can also explain what the really essential medicines are, that have to be taken mandatorily and which may be omitted if there is a cash crunch. For instance, there may be no harm if some vitamins, antacids or sedatives are missed for a few days while the anti-hypertension, anti-diabetic drug or antibiotic should be taken in the correct dose.
Many essential drugs are being sold at subsidised rates by a Govt order, but there is need for more. Pharma companies could give rebates to economically weaker seniors on production of ID cards, and they could reimburse the chemist. Similar subsidies are required for hearing aids, spectacles, and other appliances specially for these seniors.
At the end of the day, we have to realise that improving the health status of Senior Citizens, optimising healthcare infrastructure and bringing down the cost of medicines and appliances will require concerted efforts from various agencies. It has to be remembered that due to the pressure of numbers, our facilities are already stretched beyond capacity. It would be useful to tap the alternative systems of medicine also when dealing with chronic illnesses like arthritis to which many seniors are prone.