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Mr. Rushikesh B. PawarII Msc (N)

CON.PIMS (DU)

CARE OF ELDERLY

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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.

INTRODUCTION

BY Definition….60-69 70-79 80+

Old Old - Older

Oldest- Old

60-74 75- 84 85+Young Old

Middle old Old-Old

Source: National Policy on Older Person 1999 GOI

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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.

Low- and middle-income countries will experience the most rapid and dramatic demographic change.

Source :WHO 2010

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

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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 .

12/12/2015

Ageing: The Indian Scenario…

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Elderly persons lives in rural area.

Women

Illiterate and dependent.

BPL

Were in vulnerable situation and without

sufficient food. 12/12/2015

Socio-demographic profile of the elderly in India.

75%

48%

66%

73%

66%

Source : Census 2001

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Kerala

11.8%

Himachal

Pradesh

10.1%

Tamil

Nadu

10.0%

Maharashtra 9.2%

Punjab

8.9%

Orissa

8.7%

Andhra

Pradesh

7.7%

States with more than 7% elderly population ( SRS 2010)

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STATEWISE ELDERLY POPULATION IN INDIA, CENSUS 2001.

%

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PRONE FOR

INFECTIONS

PRONE FOR

INJURIES

PRONE FOR PSYCHOLO

GICAL PROBLEMSPRONE

FOR DEGENER

ATIVE DISORDER

S

INCREASED RISK

FOR DISEASE

INCREASED RISK OF

DISABILITY

INCRASED RISK OF DEATH

Health risks of elderly

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Cataract &Visual impairment- 88%

Psychiatric problems- 9%COMMON MORBIDITIES IN ELDERLY IN INDIA

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05

101520253035404550

Prevalence of common health problems in elderlyGOI study-2007

Percentage

Health Problem

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CVD

Respiratory diseases

Infections,TB

NeoplasmAccidents, poisoning and violencedeaths by chronic diseases by 2015

Mortality in elderly33%

10%10%

6%

4%

17%

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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

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Major constraints for geriatric health care

Lack of specialized and

trained manpower

Geriatrics not yet a popular

specialty

No dedicated health care

infrastructure

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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

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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

NATIONAL POLICY ON OLDER PERSONS (1999)

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Geriatric ward for elderly at all DH

Treatment facilities for chronic, terminal and degenerative diseasesProviding Improved medical facilities at CHCs / PHCs / Mobile ClinicsInclusion of geriatric care in the syllabus of medical courses including courses for nursesReservation of beds for elderly in public hospitals

Training of Geriatric Care Givers

Research institutes for chronic elderly diseases such as Dementia & Alzheimer

NPOP agenda for health care for the elderly

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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.

Maintenance and Welfare of Parents and Senior Citizens Act - 2007

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“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.”

Extract of Finance Minister’s Budget Speech 2008-09

NPHCE 2010

The Maintenance and Welfare of Parents and Senior

Citizens Act, 2007.

National Policy on

Older Persons (1999)

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

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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

SERVICES FOR ELDERLY ALREADY IN INDIA

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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

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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.

The Vision & Objectives of NPHCE

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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.

To provide referral services to the elderly patients through district hospitals, regional medical institutions

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Core Strategies

COMMUNITY LEVEL -

domiciliary visits by trained health care

workers.

PHC/CHC level - equipment,

training, additional

human resources (CHC),

IEC,

DISTRICT HOSPITAL –

10 bedded wards, additional human

resources,

8 RMC - PG courses in Geriatric

Medicine, and trainingIEC using mass

media, folk media and other communication

Strategies for NPHCE 2010

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Promotion of public private

partnerships in Geriatric

Health Care.

Mainstreaming AYUSH and convergence

with programmes of

Ministry of Social Justice and

Empowerment in the field of geriatrics.

Reorienting medical

education to support geriatric

issues.

Supplementary Strategies for NPHCE

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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;

EXPECTED OUTCOMES OF NPHCE

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District Geriatric Units Geriatric Clinics/Rehabilitation units Sub-centres Training of Human Resources

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Package of Services at different levels (SC/PHC/CHC/RGC)

Operational Guidelines

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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.

Package of Services

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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.

Services at PHC

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ORGANIZATIONAL STRUCTURENCD- NON COMMUNICABLE DISEASES

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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.

Services at Sub-centre

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First Referral 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

Services at Community health centre

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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

Services at District Hospital

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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.

Services at Regional Geriatric Centre

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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.

Activities under NPHCE at various levels

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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.

Activities at SC level

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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.

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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.

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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

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Following items will be made available at the CHC:

Nebulizer Glucometer ECG Machine Pulse Oximeter Defibrillator Multi - Channel

Monitor Shortwave

Diathermy

Cervical traction

(intermittent) Walking for gait

training equipment Walking Sticks /

Calipers Shoulder Wheel Pulley Walker (ordinary) Cervical traction

(manual).

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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 level

hospitals/ Regional Geriatric Centers

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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.

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Sr No Regional Institutes States Linked

1 All India Institute of Medical Sciences, New Delhi

Delhi, Haryana, Uttarakhand, Punjab Himachal Pradesh, M.P.

2 Institute of Medical Sciences, Banaras Hindu University, Uttar Pradesh

Uttar Pradesh, Bihar, Jharkhand, West Bengal

3 Grant Medical College & JJ Hospital, Mumbai, Maharashtra,

Maharashtra, Goa, Northern Districts of Karnataka,Chattisgarh

4 Sher-e-Kashmir Institute of Medical Sciences, Srinagar, Jammu & Kashmir

Jammu & Kashmir

5 Govt. Medical College, Tiruvananthapuram, Kerala,

Kerala, Southern Districts of Karnataka & Tamil Nadu

6 Guwahati Medical College, Guwahati, Assam

Assam & NE States

7 Madras Medical College, Chennai, TN.

Tamil Nadu, Andhra Pradesh, Orissa

8 PRAVARA RURAL HOSPITAL AND MEDICAL COLLEGE.

LONI MAHARSHTRA ,INDIA

Regional Geriatrics Centers

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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.

At Regional Geriatric Centers level

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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.

State level

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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.

HOW TO ACHIEVE OPTIMUM ELDERLY CARE?

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ROLE OF NURSE IN ELDERLY

HEALER

CAREGIVER

EDUCATOR

Gerontological Nursing Roles

ADVOCATE

INNOVATOR

Nursing plays a significant role in helping individuals stay well, overcome or cope with disease restore function and purpose in life and mobilize internal and external resources.

In this healer role, gerontological nurse recognizes that most human beings value health, are responsible and active participants in their health maintenance and illness management, and desires harmony and wholeness with their environment.

Holoistic approach is essential viewed in context of their biological, emotional, social, cultural and spiritual elements.

HEALER

Conscientious application of Nursing process to care of elders.

Inherit in this role is the active participation of older adults and their significant others and promotion of highest degree of self care in elderly.

Providing care, efficiency and best interest that rob them of their existing independence.

CAREGIVER

Formal and informal opportunities to share knowledge, skills related to care of older adults.

Educating others including normal aging, pathophysiology, geriatric pharmacology and resources.

Essential to this role is effective communication involving listening, interacting, clarifying, coaching, validating and evaluating.

EDUCATOR

Advocacy including aiding older adults in asserting their rights and obtaining required services, facilitating a community or other group’s effort to affect change and achieve benefits for older adults.

ADVOCATE

Assumes an inquisitive style, making conscious decisions and efforts to experiment for an end result to improved gerontological practices.

INNOVATOR

STANDARD I. Assessment: The gerontological nurse collects patient health data.

STANDARD II. Diagnosis: The gerontological nurse analyzes the assessment data in determining diagnoses.

STANDAR III. Outcome identification: The gerontological nurse identifies expected outcomes individualize to the older adult.

STANDARD IV. Planning: develops a plan of cares that prescribes interventions to attain outcomes.

STANDARD V. Implementations: implements the interventions identified in the plan of care.

STANDARD VI. Evaluation: evaluates the older adults progress towards attainment of expected outcomes.

ANA STANDARDS OF GERONTOLOGICAL NURSING PRACTICE (Nursing Care)

STANDARD I. Quality of Care: The gerontological systemically evaluates the quality of care and effectiveness of nursing practice.

STANDARD II. Performance Appraisal: The gerontological nurse evaluates his/her own nursing practice in relation to professional practice standards and relevant statutes and regulations.

STANDAR III. Education: The gerontological nurse acquires and maintains current knowledge in nursing practice.

STANDARD IV. Collegiality: contributes to professional development of peers, colleagues and others.

STANDARD V. Ethics: decisions and actions on behalf of older adults are determined in an ethical manner.

STANDARD VI. Collaboration: collaborates with older adult, the older adults caregiver, and all member of interdisciplinary team to provide comprehensive care.

ANA STANDARDS OF GERONTOLOGICAL NURSING PRACTICE (Quality Care)

STANDARD VII. Research: interprets applies and evaluates research findings to improved gerontological nursing practice.

STANDARD VIII. Resource Utilization: considers the factors related to safety, effectiveness and cost in planning and delivering patient care.

Aging is a natural process common to all living organisms.

Various factors influence the aging process. Unique data and knowledge are used in applying

the nursing process to the older populations. The elderly share similar self-care and human

needs with all other human beings. Gerontological nursing strives to help older

adults achieve optimum levels of physical, psychological, social and spiritual and spiritual health so that the can achieve wholeness.

PRINCIPLES OF GERONTOLOGICAL NURSING PRACTICE

Heredity Nutrition Health status Life experiences Environment Activity Stress produce unique

FACTORS INFLUENCING AGING

PHYSIOLOGIC BALANCE

CONNECTION

GRATIFICATION

COMMON NEEDS

BIBLIOGRAPHY Text book of “preventive and social

medicine” k. park ,21st edition, m/s banarsidas bhanot publisher.page no-812to 814.

“Community health nursing”, ‘principal & practices’,k. k.gulani, published by, neelam kumar,page no-34-36

“Community health nursing”, BT basavanthappa, jayapee brothers medical publisher- page no-19-20.

Cont….. Community health nursing, “concept and

practice”, barbara walton spradly, lippincott 4th edition, page no-70to76.

“Nursing care in the community”,joan m. cookfair,second edition,page no-671 to 678

“Community health nursing”,stenhope, Lancaster trends, page no-172-171

Thank you!!!