Year : 2022 | Volume
: 66 | Issue : 1 | Page : 1--2
The state of elderly in India: Life and challenges in the decade of healthy aging
Ashish Goel1, Amanjot Kaur2,
1 Professor and Head, Departments of Medicine, Dr. B. R. Ambedkar State Institute of Medical Sciences, Chandigarh, India
2 Senior Resident, Departments of Medicine, Dr. B. R. Ambedkar State Institute of Medical Sciences, Chandigarh, India
Professor and Head, Departments of Medicine, Dr. B. R. Ambedkar State Institute of Medical Sciences, Chandigarh
|How to cite this article:|
Goel A, Kaur A. The state of elderly in India: Life and challenges in the decade of healthy aging.Indian J Public Health 2022;66:1-2
|How to cite this URL:|
Goel A, Kaur A. The state of elderly in India: Life and challenges in the decade of healthy aging. Indian J Public Health [serial online] 2022 [cited 2022 May 26 ];66:1-2
Available from: https://www.ijph.in/text.asp?2022/66/1/1/342597
Owing to the success of public health measures over the past few decades and the addition of antibiotics in the medical armamentarium against infectious disease agents, baby boomers of the 20th century are now preparing for the silver tsunami in the 21st century. We are witnessing a remarkable increase in human longevity globally, allowing a greater share to older people in the population.
There are over 138 million older people in India, comprising 10.1% of the national population. With declining fertility rates and improving life expectancy and population, aging is an inevitable truth. The proportion of older people in our country has grown considerably in a relatively short span of time. Indeed, some experts project that by 2051 India will have as many as 301 million older persons, constituting 22.5% of the total population. While the more developed nations became wealthy before they grew old, that will not be true for a developing economy like ours. Aging not only increases the burden of disease but also changes the nature of demands on the health-care systems. Developing societies need to accommodate the needs of an aging population while continuing to address other priority areas of noncommunicable diseases (NCDs), infectious disease control, and maternal and child health. Increasing longevity and accumulation of health deficits over time result in multiple comorbid conditions and add to the complexity of medical care in old age. The traditionally held geriatric giants of immobility, instability, impaired intellect and incontinence still continue to challenge medical care while newer syndromes of frailty, sarcopenia, and anorexia are emerging rapidly. While NCDs have been under the spotlight for the geriatric populations, the COVID-19 pandemic has laid bare the inequity, vulnerability, and fragility of our public health care systems. Not only did frail older adults suffer severe disease often that resulted in poorer outcomes following COVID-19 infection but also faced social isolation, loneliness, and mental health challenges during the pandemic phases. In addition to inequalities in socioeconomic and educational background, the rapidly growing older community often lives in the midst of technological isolation. Migration of youth in the absence of formal long-term care support systems often results in breakdown of informal family-caregiving arrangements and has only compounded the problem.
While the previous century witnessed the growth of the specialty of pediatrics, the current century is poised to see a similar expansion of geriatric health care. As the older population becomes more sizeable, care would become more specialized and focused while need drives the direction of innovation. Indeed, the current decade (2021–2030) adopted as the decade of healthy aging by the World Health Organization envisages longer, healthier, and more fulfilling lives universally. Introduced in 2010 across 713 districts in India, the National Program for the Health care of the Elderly envisages comprehensive, dedicated, easily accessible and affordable health-care services to older persons in India without compromising on quality. The program has a vision to create a new architecture in an enabling environment for an aging society. While strengthening health care delivery for older persons in both rural and urban areas, tertiary care has been upgraded through 19 regional centers and training programs in geriatric medicine. The National Health Systems Resource Center, a technical support institute with the MoHFW provides technical assistance to the states and center with a vision to provide universal health coverage and comprehensive primary health care including the community as an active subject rather than traditionally held passive object in the context of public health systems. Under the National Health Policy of 2017, Ayushman Bharat Health and Wellness centers (AB-HWCs) have been envisioned to provide comprehensive care including geriatric and palliative services. With the launch of AB-HWCs in 2018, the health-care workers supported by community-based platforms focus on health promotion while protecting autonomy and maintaining the dignity of older persons in the community. It is imperative that capacity building and roll out of elderly care packages is ensured all over the country.
Mainstream medical research has always excluded older persons, with unfounded reasons to protect them from harm. Older people have remained under-represented in research programs owing to ageism, comorbidity profile, lack of insurance, physical immobility, and issues in communication. While exclusion seriously limits the generalizability, yet results are nonchalantly extrapolated and applied to the elderly. In the decade of healthy aging, some of these boundaries need to disappear and aging research should get stronger with newer techniques, methods, agents, food fortification, and bolder initiatives including cosmetology as we move toward more independent lives in age-friendly environments.
Advances in information technology will give further impetus to mobile health programs increasing the technology divide. Digital literacy will remain a challenge in the coming days as the older populace learns the art of functional, independent, and healthy aging. Lifelong learning principles, enabling older persons to do what they value, while retaining their autonomy in decision-making to preserve purpose and identity will allow our society to age healthier.
While health policy gears up to the challenge of predicted population aging, the society as a whole is required to foster abilities of older people while delivering transparent, equitably distributed, person-centered, age-responsive, self-sustained, multidisciplinary, and long-term care. The medical fraternity has an important role to play in this transition as leaders of behavior change in the community. An inclusive, multidisciplinary approach involving participation of public health scientists, stakeholders from the domains of clinical care, rehabilitation, palliation, and nutrition among others, would be needed to drive healthy aging in the community and improving the care of older people. A population aging actively in health and independence not only spells more satisfaction but also translates into a reduced burden of disease, thereby reducing the cost of aging and improvement in disability-adjusted life years. Hence, ensuring a more efficient and effective nation.
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