NATIONAL PROGRAMME FOR

HEALTH CARE OF ELDERLY

1
 INTRODUCTION
 Over the past few years, the world’s population has
continued on its remarkable transition path from a
state of high birth and death rates to low birth and
death rates coupled with improvement in health
services & standard of living.
 At the heart of this transition has been the growth
in the number and proportion of older persons.
 Such a rapid, large and ubiquitous growth has never
been seen in the history of civilization.
 The current demographic revolution is predicted to
continue well into the coming centuries.

2
 BY Definition….
60-69 70-79 80+
Old Old - Old Oldest-
Old
Source: National Policy on Older Person
1999 GOI

60-74 75- 84 85+

Young Middle
Old-Old
Old old
Changing world Scenario
 The world will have more
people who live to see their
80s or 90s than ever before.
 The past century has seen
remarkable improvements in
life expectancy.
 Soon, the world will have
more older people than
children.
 The world population is
rapidly ageing. Source :WHO 2010
 Low- and middle-income
countries will experience the
most rapid and dramatic 4
 World Population trend of 60+ Years
1980-2020 (in millions)

1980 1990 2000 2010 2020

World 381.2 484.7 608.7 754.2 1011.6

Developed 173.3 203.6 234.6 232.4 308.2

Developing 207.9 281.8 374.1 491.8 703.4

Asia (excl. Japan) 160 218.2 290 377.7 539.9

China 78.6 101.2 131.7 167.9 238.9

India 44.6 60.2 81.4 107 149.7

United Nations,World Demographic Estimate and Projections

 Ageing: The Indian Scenario…
 India is one of the few countries
in the world where sex ratio of
aged is in favour of males.
Population above 60 years-
 10% suffer from impaired
physical mobility.
 10% Hospitalized at given
point of time.
Age more than 70 years-
 More than 50% suffer form 1
or more chronic conditions like
CHD, Cancer and HT .
6
 Socio-demographic profile of the
elderly in India.
75 Elderly persons lives in
% rural area.

48 Women
%

73
%
Illiterate and dependent.

Source : Census
66 2001
% BPL

Were in vulnerable
66
%
situation and without
sufficient food. 7
 States with more than 7% elderly
population ( SRS 2010)

r al
c Ke a
m a 8%
H i al s .
h e 11
rad
il P h
a m 1%
T d u 0 .
a 1
N .0%
h ar 10
Ma htra
as .2%
n ja 9
Pu b
.9 %
sa 8
i s
Or .7%
h ra 8
d s
An ade
Pr 7.7%
8
h
STATEWISE ELDERLY POPULATION IN INDIA, CENSUS 2001.

9
 Health risks of elderly

PRONE FOR
INCRASED INFECTIONS
RISK OF
DEATH

INCREASED PRONE
RISK OF FOR
DISABILITY INJURIES

INCREASE PRONE FOR

D RISK PSYCHOLOGI
FOR CAL
DISEASE PROBLEMS

PRONE FOR
DEGENERA
TIVE
DISORDERS

10
 COMMON MORBIDITIES IN ELDERLY IN INDIA

Cataract &Visual
impairment- 88%

Arthritis &
locomotion
disorder-40%

CVD &HT – 18%

Neurological
problems-
18%
Respiratory
problems
including
Chronic
bronchitis- 16%
GIT pro
blems
9%
Psychi
atric
Ref – ICMR study 2001 proble
11
Delhi & Hariyana ms-
9%
 Prevalence of common health problems in
elderly
GOI study-2007

50
P 45
e 40
r
c
35
e 30
n 25
t
20
a
g 15
e 10
5
0

Health Problem 12
 Mortality in elderly
33
% CVD
10
%
Respiratory diseases
10
% Infections,TB

6% Neoplasm
Accidents, poisoning and
4%
violence
17 deaths by chronic diseases by
% 2015
13
Need for Dedicated Health care for elderly ?

Decrease in physical ability / Economic

inadequacy
Increase vulnerability to diseases
Chronic, disabling and multiple Health
problems
Different approach and management

Degradation in family values

Rising Population

14
Major constraints for geriatric health care

Lack of
specialized
and trained
manpower

No
Geriatrics
dedicated
not yet a
health care
popular
infrastruct
specialty
ure

15
 Major Govt. initiatives

National Policy On Older Persons (NPOP) -1999

Recommendations by working group of planning

commission -2006 for national programme

Maintenance and Welfare of Parents and Senior

Citizens Act – 2007

Announcement of National programme for Health

Care of Elderly during Budget speech (2008-09)

Approval of “National programme for Health Care

of Elderly” by Ministry of Finance - June 2010
16
NATIONAL POLICY ON OLDER PERSONS (1999)

Components
 Support for financial security
 Health Care
 Shelter
 Welfare and other needs of older persons
 Protection against abuse and exploitation
 Opportunities for development of the potential of
older persons
 Improving quality of life

17
NPOP agenda for health care for the elderly

Geriatric ward for elderly at all DH

Treatment facilities for chronic, terminal and
degenerative diseases
Providing Improved medical facilities at
CHCs / PHCs / Mobile Clinics
Inclusion of geriatric care in the syllabus of
medical courses including courses for nurses
Reservation of beds for elderly in public
hospitals
Training of Geriatric Care Givers
Research institutes for chronic elderly
diseases such as Dementia & Alzheimer
7 Aug 2012 18
Maintenance and Welfare of Parents and Senior
Citizens Act - 2007
Article (20) : The State Government shall ensure
 The Government hospital or Govt. funded
hospitals shall provide beds for senior citizens
as far as possible.
 Separate queues be arranged for senior
citizens.
 Facility for treatment of chronic, terminal and
degenerative diseases is expanded for senior
citizens
 Research activities for chronic elderly diseases
and ageing is expanded
 Earmarked facilities for geriatric patients in
every district hospital.
19
Extract of Finance Minister’s Budget Speech 2008-
09

“The other major intervention will be for the elderly. A

National Programme for the Elderly with a Plan outlay of
Rs. 400 crore will be started in 2008-09. Among other
measures, we will establish, during the XIth Plan Period
two institutes of aging eight Regional Centres and a
Department of Geriatric Medical Care in one of the Medical
Colleges/Tertiary level Hospitals in each State.”

20
NATIONAL PROGRAMME FOR HEALTH CARE OF
ELDERLY (NPHCE-2010)

Na
Po t i o n ce
li n n a f
e
t re o or
Ol c y o al i n
a lfa eni .
Pe de n M
e We d S 007
(1 rso r h
T nd a n ,2
99 ns a nt s ct
9) re ens A
a
P iz
Cit

NPHCE 2010 21
 SERVICES FOR ELDERLY ALREADY
IN INDIA
Constitutional and legal provisions.
Maintenance and welfare of parents
and senior and welfare of parents
and senior citizens Bill 2007
Ministry of Social Justice &
Empowerment

22
National policy on older persons policy
on older persons
January, 1999. areas of intervention --
◦ Financial security, healthcare and
nutrition, shelter, education, welfare,
protection of life and property etc. for the
wellbeing of older persons in the country.
National Council for Older Persons
◦ Constituted by the Ministry of Social
Justice and Empowerment to
operationalise the National Policy on Older
Persons
23
The Vision & Objectives of NPHCE
The Vision:
To provide accessible, affordable, and high-
quality long-term, comprehensive and
dedicated care services to an Ageing
population;
Creating a new “architecture” for Ageing;
To build a framework to create an enabling
environment for “a Society for all Ages”;
To promote the concept of Active and Healthy
Ageing;
Convergence of NRHM, AYUSH & all other dept.
24
Objectives
To provide an easy access to
promotional, preventive, curative and
rehabilitative services to the elderly
through community based primary health
care approach
To identify health problems in the elderly
and provide appropriate health
interventions in the community with a
strong referral backup support.
To build capacity of the medical and
paramedical professionals as well as the
care-takers within the family for
providing health care to the elderly. 25
Strategies for NPHCE 2010
District
Hospital -10
bedded
PHC/CHC level - wards,
equipment, 8 RMC - PG
additional courses in
training,
additional human Geriatric
human resources, Medicine,
resources and training
(CHC), IEC,

Community IEC using

level - Core mass media,
domiciliary folk media
visits by Strategi and other
trained health es communicati
care workers. on

26
Supplementary Strategies for NPHCE

Mainstreaming
AYUSH and
convergence Reorienting
Promotion of with medical
public private programmes of
education to
partnerships Ministry of
Social Justice support
in Geriatric geriatric
Health Care. and
Empowerment issues.
in the field of
geriatrics.

27
 EXPECTED OUTCOMES
OF NPHCE
Regional Geriatric Centres (RGC) in
8 Regional Medical Institutions
Post-graduates in Geriatric
Medicine (16) from the 8 regional
medical institutions;
Video Conferencing Units in the 8
Regional Medical Institutions to be
utilized for capacity building and
mentoring; 28
DistrictGeriatric Units
Geriatric Clinics/Rehabilitation
units
Sub-centres
Training of Human Resources

29
Operational Guidelines
Package of Services at different levels
(SC/PHC/CHC/RGC)

30
Package of Services
 The range of services will include
 Health promotion
 Preventive services
 Diagnosis and management of geriatric medical
problems (out and in-patient)
 Day care services
 Rehabilitative services
 Home based care
 Districts will be linked to Regional Geriatric Centers for
providing tertiary level care.
 Integration with existing primary health care delivery system
and vertical at district and above as more specialized health
care are needed for the elderly.
31
 Services at PHC
Weekly geriatric clinic by a trained Medical Officer
Conducting a routine health assessment (eye, BP,
blood sugar & record keeping).
Provision of medicines and proper advice on chronic
ailments
Public awareness on promotional, preventive and
rehabilitative aspects of geriatrics during health and
village sanitation day/camps.
Referral services.

32
ORGANIZATIONAL STRUCTURE

33
 Services at Sub-centre
Health Education related to healthy
ageing
◦ Domiciliary visits to home bound / bedridden
elderly persons .
◦ Arrange for suitable calipers and supportive
devices.
◦ Linkage with other support groups and day
care centers.

34
 Services at Community health centre
FirstReferral Unit (FRU) for the Elderly from
PHCs and below.
Geriatric Clinic for the elderly persons twice a
week.
Rehabilitation Unit for physiotherapy and
counselling
Domiciliary visits by the rehabilitation worker
for bed ridden elderly and counselling of the
family members on their home-based care.
Health promotion and Prevention
Referral of difficult cases to District
Hospital/higher health
35
 Services at District Hospital
Geriatric Clinic for regular dedicated OPD services to
the Elderly with Lab facility & adequate medicine.
Ten-bedded Geriatric Ward with existing specialties

Provide services to referred by the CHCs/PHCs etc.

Conducting camps for in PHCs/CHCs and other sites.

Referral services to tertiary level hospitals

36
Services at Regional Geriatric
Centre
30-bedded Geriatric Ward for in-
patient care and dedicated beds
for the elderly patients in the
various specialties.
Laboratory investigation required
for elderly with a special sample
collection centre in the OPD block.
Tertiary health care to the cases
referred from medical colleges,
district hospitals and below.
37
Activities under NPHCE at various
levels
At Sub Centre level:
Health Education related to healthy ageing,
environmental modifications, nutritional
requirements, life styles and behavioural
changes.
Special attention to home bound / bedridden
elderly persons and provide training to the
family health care providers in looking after
the disabled elderly persons.
Arrange suitable callipers and supportive
devices from the PHC.
Linkage with other support groups and day
care centres etc. operational in the area. 38
Activities at SC
level

Following items will be made available at

the Sub-centre level:
Walking Sticks
Calipers
Infrared Lamp
Shoulder Wheel
Pulley
Walker (ordinary)
No additional contractual staff.

39
At PHC level:
The weekly geriatric clinic
by trained medical officer.
 Coordination with CHC, district hospital, sub
centers, other National Health Programmes/
Departments for medicines, ambulances
 Training of manpower & Separate registration
counter for elderly.
 Public awareness during health and village
sanitation day/camps.
 Provision of medicine to the elderly for their
medical ailments. 40
Following items will be made available at the
PHC:
Nebulizer
Glucometer
Shoulder Wheel
Walker (ordinary)
Cervical traction (manual)
Exercise Bicycle
Lumber Traction
Gait Training Apparatus
Infrared Lamp etc.
41
At RH/CHC level:
◦ First level medical referral centre for medical care
and rehabilitation services
◦ Twice weekly health clinics for the elderly persons
◦ Rehabilitation unit
◦ Domiciliary visits for care of disabled persons by
Multi rehabilitation worker
◦ Referral Services to DH
◦ Training of staff
42
Following items will be  Cervical traction
made available at (intermittent)
the CHC:  Walking for gait
 Nebulizer training equipment
 Glucometer  Walking Sticks /
 ECG Machine Calipers
 Pulse Oximeter  Shoulder Wheel

 Defibrillator  Pulley

 Multi - Channel  Walker (ordinary)

Monitor  Cervical traction

 Shortwave (manual).
Diathermy

43
At District Hospital level
Regular Geriatric OPD with Specialty Care for

Elderly.
Geriatric Ward (10-bedded) for in-patient care

to the Elderly.
Training to the Medical officers and paramedical

staff of CHC’s and PHC’s

Camps for Geriatric Services in PHCs/CHCs and

other sites
Referral services for severe cases to tertiary
44
Following items will be made available at the District
Hospital:
Nebulizer
Glucometer
ECG Machine
Defibrillator
Multi-channel Monitor
Non invasive Ventilator
Shortwave Diathermy
Ultrasound Therapy
Cervical traction (intermittent)
Pelvic traction (intermittent)
Tran electric Nerve stimulator (TENS)
Adjustable Walker.
45
 Regional Geriatrics Centers
Sr
No Regional Institutes States Linked

1 All India Institute of Medical Delhi, Haryana, Uttarakhand,

Sciences, New Delhi Punjab Himachal Pradesh, M.P.

2 Institute of Medical Sciences, Uttar Pradesh, Bihar, Jharkhand,

Banaras Hindu University, Uttar West Bengal
Pradesh
3 Grant Medical College & JJ Hospital, Maharashtra, Goa, Northern
Mumbai, Maharashtra, Districts of
Karnataka,Chattisgarh
4 Sher-e-Kashmir Institute of Medical Jammu & Kashmir
Sciences, Srinagar, Jammu &
Kashmir
5 Govt. Medical College, Kerala, Southern Districts of
Tiruvananthapuram, Kerala, Karnataka & Tamil Nadu

6 Guwahati Medical College, Assam & NE States

Guwahati, Assam
7 Madras Medical College, Chennai, Tamil Nadu, Andhra Pradesh, 46
 At Regional Geriatric Centers level
Provide tertiary level services for
complicated/serious Geriatric Cases.
Post graduate courses in Geriatric Medicine.
Training to the trainers of identified District
hospitals and Medical Colleges.
Developing evidence based treatment
protocols for Geriatric diseases prevalent in
the country.
Developing/and updating Training modules &
guidelines and IEC materials.
Research on specific elderly diseases.
47
 Developing Geriatric Department in Medical college
of each States/UTs
It is proposed to develop 12 additional Regional Geriatric
Centers in selected Medical Colleges of the country
Sr No State Medical College
1 Punjab PGIMER, Chandigarh
2 Uttar Pradesh KGIMS, Lucknow
3 Jharkhand Ranchi Medical College, Ranchi
4 West Bengal Kolkatta Medical College, Kolkata
5 Andhra Pradesh Nizam Institute of Medical Sciences, Hyd.
6 Karnataka Bangalore Medical College, Bangluru
7 Gujarat B.J.Medical College, Ahmadabad
8 Maharashtra Government Medical College, Nagpur
9 Orissa S.C.B.Medical College, Cuttack
10 Tripura Agartala Medical College, Agartala
11 Madhya Pradesh Gandhi Medical College, Bhopal
12 Bihar Patna Medical College,
7 Aug 2012 Patna 48
 Proposed Financial Assistance
during 11th plan
Items RMI DH CHC PHC S. C

construction 2 crore 80 lakh - - -

Equipments 1.7 crore 10 lakh 1 lakh Rs.50000 Rs.32000

Drugs 20 lakh 10 lakh - - -

Training 5 lakh Rs. 70000 1.15 lakh Rs.32000 -

IEC activities - 5 lakh - - -

Research 50 Lakh - - - -

Manpower 88.4 lakh 28 .2 lakh 1.8 lakh - -

recruitment
49
Financial mangement
Financial management groups (FMG) of
Programme Management support units at
state and district level, which are
established under NRHM, will be
responsible of maintenance of accounts,
release of funds, expenditure reports,
utilization certificates and audit
arrangements.

50
 State level
 State will monitor release of
funds and expenditure incurred
under various components of
the programme in the State.
 Submit monthly statement of
expenditure in the prescribed
format to the State Health
Society.
51
 HOW TO ACHIEVE OPTIMUM
ELDERLY CARE?

Active advocacy at various levels of

planning
Need for reorganization of the
facilities and approach
Efforts to be made to revive cultural
values and reinforce the traditional
practice of interdependence among
generations
Surveillance of the ongoing
programmes and evaluate for
effectiveness.
52
7 Aug 2012 53
Thank you!!!