With the country’s population continuing to age, there has been an exponential rise in the demand for geriatric care services. This demographic shift has been pushing healthcare systems to come up with ways to care for the rising ageing population. While the availability of geriatric care is steadily improving, health is not the only concern: elderly citizens face numerous social and economic challenges too.
The evolution of geriatric care
There was a time when not many knew about geriatric care, says V. S. Natarajan, a Chennai-based senior geriatrician. Dr. Natarajan had started an outpatient unit at the Government General Hospital in the late 1970s, and in 1996, he started an MD in Geriatrics at the Madras Medical College with two seats. “This speciality that caters to the elderly has grown over the years, and the services have improved. Now, with longevity increased, there is a greater need for special care for the elderly,” he adds.
However, over the decades, the disease pattern in the elderly has also changed notes Dr. Natarajan, who also established the Dr. V.S. Natarajan Geriatric Foundation. “When I started the outpatient unit, I used to see patients with infectious diseases such as tuberculosis, cholera, typhoid and dysentery. Now, 40 years later, we are seeing a lot of non-communicable diseases (NCDs) owing to lifestyle changes including food habits and lack of exercise. As a result, people are developing multiple diseases during the ageing process. Cataracts, mild memory loss and arthritis are associated with ageing. Now though, with people living longer, they are experiencing degenerative diseases: longstanding diseases that require life-long medications.”
This, in turn, causes financial burdens for the elderly as well as a social burden for caregivers, Dr. Natarajan says, adding: “Financial constraints, multiple diseases and dependency are the main challenges for an elderly person today.”
Priyanka Rana Patgiri, Consultant-Geriatrics, Apollo Hospitals, Chennai, adds on: “It is estimated that the elderly population (persons aged above 60) will cross 300 million by 2050 in India. This increased longevity is due to the availability of good healthcare services and accessibility to lifesaving drugs. The lifespan is increasing, not the health span, as chronic diseases such as diabetes and hypertension are also on the rise.”
Unmet need
That a high but unmet need for services existed became evident with the opening of Chennai’s National Centre of Ageing, a standalone geriatric health facility. Inaugurated in February 2024, the patient inflow to this centre steadily grew with 1,000 outpatients a day on most weekdays and 800 to 900 during the weekends. The 200-bed facility has been drawing elderly patients from across Tamil Nadu including southern districts.
S. Deepa, director (full additional charge), National Centre of Ageing (NCA), attributes this to increased awareness among the people. “I think that people have recognised the field of geriatric medicine. Many are approaching us without even being referred,” she says. NCA has 14 geriatricians, 27 geriatric medicine postgraduates and various specialists to take care of older people.
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Multiple health issues
One of the major issues when it comes to the health of the elderly is that many of them have multiple ailments. These includes hypertension, diabetes and osteoarthritis. They require multiple doctor visits. This is where the NCA helps, as all services are provided under a single roof. “At NCA, patients are first seen by a geriatrician. They are assessed and then referred to the respective specialist,” Dr. Deepa says.
Dr. Priyanka further explains: “While chronic diseases are among the common problems faced by the elderly, polypharmacy is another concern. By the age of 75, many elderly persons start taking at least eight to nine medications and have to consult different doctors such as neurologists and cardiologists. Over-the-counter medications are also commonly used by them. Falls, age-related issues such as urinary incontinence and memory loss are the other key issues.”
She also touches upon the mental health of the elderly. “We know that older persons may suffer from dementia and Alzheimer’s but there are other mental health issues as well. These include depression due to loneliness; something that we are seeing after COVID-19. We often fail to see symptoms of mental illness in the elderly,” she adds.
Need for a holistic approach
Approaching issues concerning the elderly through the lens of health alone, could be insufficient. Dr. Priyanka observed that with the rising trend of nuclear families, the older population is impacted in more than one way. “They are left in isolation physically, emotionally and financially. Though the demand for geriatric medicine is rising, many are unable to come to hospitals due to various factors including immobility or lack of support at home, with many being accompanied to hospitals by their elderly spouses. We are seeing this on a regular basis,” she notes.
Edwin Babu, director, HelpAge India Tamil Nadu, said isolation is one of the major issues faced by the elderly now. With a lot of migration happening and children moving abroad or to other cities, more elderly persons are living alone, he said.
“A lot of abandonment is also happening as families are unwilling to take care of, and spend on medical care for the elderly. Insurance for the elderly is also expensive. Earlier, following calls received at our helpline, we used to rescue homeless and destitute elderly. Now, our helpline is getting calls about elderly persons deserted, families disowning them on roads or at railway stations or by admitting them in hospitals. This is on the rise,” he said.
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Caregiver shortage
Supporting the elderly by way of caregivers is another major challenge. To address the growing demand for elderly care services in their homes, the Tamil Nadu government has started a certificate course for home-based elderly care support assistants in government medical college hospitals.
What should be the path ahead? Understanding and addressing the many needs of the elderly is key. As governments and institutions step up care for the elderly, existing gaps should be identified and addressed.
One such recommendation to the Tamil Nadu government is to start geriatric medicine departments in every medical college hospital, according to Mr. Edwin. “Old-age homes are limited. In our policy, we have recommended that the State government take up a financial commitment for this purpose,” he adds.
On its part, NCA, which offers specialist consultations such as cardiology and orthopaedics, is performing elective surgeries, and is equipping itself to take up orthopaedic surgeries shortly. This is not all. Realising the importance of certain services for the elderly, the hospital, as a part of a State government pilot initiative, took up eye screening and is providing free spectacles. It also recently administered pneumococcal vaccines to 600 older patients. “Adult vaccination is not popular, and it is also costly too. Hence, we vaccinated elderly persons,” Dr. Deepa notes.
With hospital-based care in place and drug distribution at the doorsteps available through the Makkalai Thedi Maruthuvam (medical care at the doorstep) scheme, she raises the need for community-level assessment to look at other age-related health issues in the elderly. “Not all the elderly will be able to visit hospitals. Hypertension and diabetes are a priority, and we should also assess and address other age-related issues such as hearing impairment, vision loss, mobility and memory. We have to screen senior citizens at the community level,” she adds.
Family support plays a crucial part
Dr. Deepa says that family support is crucial for the elderly. Intergenerational bonding should be promoted. Children, starting at the school level, should be sensitised to the needs of the elderly.
There is also a limitation of the workforce, Dr. Priyanka says, adding: “We need more doctors trained in geriatric medicine. There is a need for geriatric nursing – nurses specialised in geriatric care. In addition, primary care physicians should also take up short term courses in geriatric medicine.”
Noting that some hospitals now have geriatric wards, she says, “Hospitals also need to have safe environments for the elderly, a fall-safe environment is essential. Once an elderly person is discharged after treatment, there is fragmented care at home. Continuation of care at home is very important.”
She stressed on the need to think about long-term care options. Though assisted living facilities are coming up, they are scarce, unregulated and unaffordable for many.
“We should incorporate geriatric medicine at all levels of medical education. We should have age-friendly infrastructure everywhere and ensure that standard guidelines are brought in for home care and assisted living. There should be awareness that ageing is not only a medical issue but has social and emotional impacts too.” she says.
Published – April 15, 2025 12:22 pm IST
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