Care of elderly

care of elderly

1. 1 Mr. Rushikesh B. Pawar II Msc (N) CON.PIMS (DU) CARE OF ELDERLY

2. 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 INTRODUCTION

3. 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

4. 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. 4 Source :WHO 2010

5. 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

6. 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 6 Ageing: The Indian Scenario…

7. 12/12/2015 7 Socio-demographic profile of the elderly in India. 75% 48% 66% 73% 66% Source : Census 2001

8. 8 States with more than 7% elderly population ( SRS 2010)

9. 9 STATEWISE ELDERLY POPULATION IN INDIA, CENSUS 2001. %

10. 10 Health risks of elderly

11. 11 COMMON MORBIDITIES IN ELDERLY IN INDIA

12. 12 Prevalence of common health problems in elderly GOI study-2007 Percentage Health Problem

13. 13 Mortality in elderly 33% 10% 10% 6% 4% 17%

14. Need for Dedicated Health care for elderly ? 14

15. Major constraints for geriatric health care 15

16. Major Govt. initiatives 16

17. 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 NATIONAL POLICY ON OLDER PERSONS (1999)

18. 18 NPOP agenda for health care for the elderly

19. 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 Maintenance and Welfare of Parents and Senior Citizens Act - 2007

20. “ 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 Extract of Finance Minister’s Budget Speech 2008-09

21. 21 NATIONAL PROGRAMME FOR HEALTH CARE OF ELDERLY (NPHCE-2010)

22. 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 SERVICES FOR ELDERLY ALREADY IN INDIA

23. 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

24. 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 The Vision & Objectives of NPHCE

25. 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 25

26. 26 Strategies for NPHCE 2010

27. 27 Supplementary Strategies for NPHCE

28. 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 EXPECTED OUTCOMES OF NPHCE

29. District Geriatric Units Geriatric Clinics/Rehabilitation unit s Sub- centres Training of Human Resources 29

30. Package of Services at different levels (SC/PHC/CHC/RGC) 30 Operational Guidelines

31. 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 Package of Services

32. 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 Services at PHC

33. 33 ORGANIZATIONAL STRUCTURE NCD- NON COMMUNICABLE DISEASES

34. 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 Sub-centre

35. 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 35 Services at Community health centre

36. 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 District Hospital

37. 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 Services at Regional Geriatric Centre

38. 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 under NPHCE at various levels

39. 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 Activities at SC level

40. 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

41. 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

42. 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

43. 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). 43

44. 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 44

45. 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

46. 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 46 Regional Geriatrics Centers

47. 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 At Regional Geriatric Centers level

48. 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. 48 State level

49. 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. 49 HOW TO ACHIEVE OPTIMUM ELDERLY CARE ?

50. ROLE OF NURSE IN ELDERLY 50

51. Gerontological Nursing Roles

52. 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

53. 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

54. 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

55. 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

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

57. 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)

58. 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)

59. 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.

60. 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

61. Heredity Nutrition Health status Life experiences Environment Activity Stress produce unique FACTORS INFLUENCING AGING

62. COMMON NEEDS

63. BIBLIOGRAPHY Text book of “preventive and social medicine” k. park ,21 st 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.

64. Cont….. Community health nursing, “concept and practice”, barbara walton spradly , lippincott 4 th 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

65. Thank you!!!