National Programme for Health Care of the Elderly recovered.pptx

National Programme for Health Care of the Elderly

1. National Programme for Health Care of the Elderly (NPHCE): 1

2. Rising Population of Elderly 2011 census in India Elderly Population - 10.38 Crore Percentage of elderly - 8.6% 2050 Projections In India: Elderly Population - 32.43 crore Percentage of elderly - 20.6% Elderly population growth much faster Population growth rate (2001-2011) +18% Elderly population growth rate (2001-2011) +36% 2

3. Burden of Disease in Elderly 40% have some form of disability 20% are suffering from mental health issues . 27% of this population group has multi-morbidities (35 million people). 32% of elderly age 60 and above have hypertension 5.2% were diagnosed with chronic heart disease 2.7% with stroke 3

4. Burden of Disease in Elderly The self-reported prevalence of Diabetes among the elderly age 60 and above is 1%. The prevalence of asthma, bronchitis, and COPD is higher among elderly age 60 and above (5.9%, 1.6% and 2.8% respectively) than in older adults aged 45-59 (3.1%, 0.7%, and 1.6% respectively). 55.3% Elderly people have self reported EYE or Vision Related Conditions . 4

5. National Programme for the Health Care of Elderly The MoHFW had launched the NPHCE during 2010-11 to address various health related problems of elderly people. It is articulation of the International and national commitments of the Government as envisaged under the UN Convention on the Rights of Persons with Disabilities (UNCRPD) National Policy on Older Persons (NPOP) adopted by GOI in 1999 Section 20 of " The Maintenance and Welfare of Parents and Senior Citizens Act 2007 " dealing with provisions for medical care of Senior Citizen. The programme is State oriented and basic thrust of the programme is to provide dedicated health care facilities to the senior citizens 5

6. Objectives: 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 with National Health Mission, AYUSH and other line departments like Ministry of Social Justice and Empowerment. 6

7. Components of the Program: 7

8. LASI ( Longitudinal Ageing Study in India) The LASI is a nationally representative survey of older persons in India. Undertaken through International Institute of Population Sciences (IIPS) Mumbai. LASI wave-1 survey (2017-18) covers all 30 states and 6 Union Territories of India Sample size of 72,250 older adults aged 45 years Including 31464 people above 60 years of age 8

9. LASI collects data on four major subject domains: 1. Disease Burden & Risk Factors 2. Health Care and Health Care Financing 3. Family Social Network and Social Welfare Programmes for the Elderly 4. Economic: Income, Wealth, Expenditure, Employment, Retirement and Pension The final report of LASI wave-I released on 6th January 2021. 9

10. Program Strategies: 10

11. Expected outcomes 11

12. Organizational structure 12

13. Packages of services Subcentre Education related to healthy ageing Domiciliary visits for home bound/bedridden elderly persons Provide training to the family care providers in looking after the disabled elderly persons. Arrange for suitable callipers and supportive devices from the PHC to the elderly disabled persons to make them ambulatory. Linkage with other support groups and day care centres etc. operational in Primary Health Centre area 13

14. Basic Rehabilitation Equipments to be kept at Health & Wellness centre under NPHCE Shoulder Wheel Wall ladder finger Exerciser. Finger Exerciser web Free exercise weight cuff (0.5 kg, 1 kg, 1.5 kg). Shoulder Pulley Walking aid for training - Adjustable Walker, Reciprocal walker Exercise Couch, pillow, towel Floor patterns may be designed having alternate patterns different colour tiles (1 feet X 1 feet) to help in teaching gait pattern/visual feedback for neurological impaired geriatric patients. One wheel chair. Charts for teaching basic exercise Chart for teaching basic positioning/posturing the patient suffering from hemi- neglect Spirometer 14

15. Primary health centre Weekly geriatric clinic run by a trained Medical Officer Maintain record of the Elderly using standard format during their first visit Conducting a routine health assessment 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 for diseases needing further investigation and treatment as per need. 15

16. Basic Rehabilitation Equipment for PHC and UPHC under NPHCE Shoulder Wheel Wall ladder finger Exerciser Finger Exerciser web Shoulder Pulley Walking aid for training - Adjustable Walker, Reciprocal walker Exercise Couch, pillow, towel Floor patterns may be designed having alternate patterns different colour tiles (1 feet X 1 feet) (to help in teaching gait pattern/visual feedback for neurological impaired geriatric patients). One wheel chair. Exercise Charts for teaching Chart for showing positioning, lifting and carrying technique for elderly. Spiro meter Lower & upper extremity cycle/basic ergometer. 16

17. Comprehensive geriatric assessment 17

18. Following are contents required in Comprehensive Geriatric Assessment kit to be available with PHC team Vision- Snellen Chart Hearing- Hand held audio scope Nutrition- Mini-Nutritional Assessment Scale Cognitive - Mini-Mental Status Exam (MMSE), Mini Cog Affective- Geriatric Depression Scale Functional- Index of independence Home Safety Checklist Sphygmomanometer Thermometer Glucometer HbA1C kit Haemoglobin Meter Pulse Oximeter Spirometer Hand held dynamo meter. 18

19. Comprehensive geriatric assessment 19

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21. General Practice 21

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23. Katz Assessment of Independence 23

24. Mini-Nutritional Assessment Scale 24

25. Geriatric depression scale 25

26. CHC 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 Referral of difficult cases to District Hospital/higher Centre 26

27. Equipment Nebulizer Glucometer ECG Machine Pulse Oximeter Defibrillator Shortwave Diathermy Cervical traction Walking for gait training equipment Walking Sticks/Callipers Shoulder Wheel Pulley Walker (ordinary) 27

28. District Hospital Geriatric Clinic for regular dedicated OPD services to the Elderly. Facilities for laboratory investigations for diagnosis Provision of medicines for geriatric medical and health problems Ten-bedded Geriatric Ward for in-patient care of the Elderly 28

29. Existing specialities like General Medicine; Orthopaedics . Ophthalmology: ENT services etc. will provide services needed by elderly patients. Provide services for the elderly patients referred by the CHCS/PHCs etc Conducting camps for Geriatric Services in PHCs/CHCs and other sites Referral services for severe cases to tertiary level hospitals 29

30. Regional Geriatric Centre Geriatric Clinic (Specialized OPD for the Elderly) 30 bedded Geriatric Ward for in patient care Dedicated beds for the elderly patients in the various specialties viz. Surgery, Orthopedics , Psychiatry, Urology. Ophthalmology, Neurology etc. 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 30

31. National Centre for Ageing High level tertiary care with multidisciplinary clinical services involving National Center for Ageing medical and surgical disciplines. OPD care in various clinical disciplines. Special clinics like memory clinic, fall and syncope clinic, frail elderly clinic, aids and appliances clinic, implants and cosmetic clinic. Day care centre for: Investigations, rehabilitation, respite care, dementia care incontinence care 31

32. In patient care for: Intensive care, acute rehabilitation, diagnostic and therapeutic services, long term rehabilitation service. Human resources development in all sub-specialties of Geriatric Medicine Developing evidence based treatment protocols for Geriatric diseases prevalent in the country. Special focus on care for 75+ aged population 32

33. Progress in implementation of Programme : 1) Expansion of primary & secondary Geriatric care services to all districts : 33

34. Progress in implementation of Programme : 2)Tertiary level activities of NPHCE : RGC 19 Regional Geriatric Centres (RGCs) in selected Medical Colleges of 18 States OPD services are being provided through 18 RGCs 250 Bedded Geriatric Care and Rehabilitation Centre is sanctioned at PGI Chandigarh Two National Centre for Ageing (NCA) has also been developed as centre of Excellence for Geriatric Care services. Madras Medical College, Chennai AIIMS, New Delhi 34

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36. RGCs All India Institute of Medical Sciences (AIIMS), New Delhi Institute of Medical Sciences, Banaras Hindu University, Varanasi Uttar Pradesh Grants Medical College & JJ Hospital, Mumbai, Maharashtra. Gauhati Medical College, Guwahati, Assam Government Medical College, Thiruvananthapuram, Kerala Madras Medical College, Chennai, Tamil Nadu Sher-a-Kashmir Institute of Medical Sciences, Srinagar, Jammu & Kashmir KGIMS, Lucknow, Uttar Pradesh Dr. Rajendra Prasad Govt. Medical College, Himachal Pradesh Dr. S.N. Medical College, Jodhpur, Rajasthan Rajendra Institute Medical College, Ranchi, Jharkhand 36 Regional Geriatric Centres Bangalore Medical College, Bengaluru, Karnataka. Nizam Institute of Medical Sciences, Hyderabad, Andhra Pradesh. Kolkata Medical College, Kolkata, West Bengal B. J. Medical College, Ahmadabad, Gujarat. S.C.B. Medical College, Cuttack. Odisha Agartala Medical College, Agartala , Tripura Gandhi Medical College, Bhopal, Madhya Pradesh. Patna Medical College, Patna, Bihar Govt Medical college, nagpur

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39. Progress in implementation of Programme : 3)Workshop (Virtual): To address Comprehensive Geriatric Care Assessment & Delivery through Various National Health Programmes Workshop conducted to understand the various National Health Programmes for delivering Comprehensive Geriatric Care at various level of service delivery followed, was conducted with the expert groups 4.) Performance Review of the Tertiary Care Services : The Review meeting of Tertiary care activities of the National Program for Healthcare of Elderly (NPHCE) was held to review the physical & financial progress of the Regional Geriatric Centers (RGCs) and two National Centers for Ageing (NCAs). 39

40. Progress in implementation of Programme : 5) Activities Conducted by States/UT to commemorate International Day (1 st October) Health Camps for elderly Awareness Programme on Healthy Ageing, NCD Screening etc. Felicitation the elderly person in various States including NGOs & Institutions. Sensitization/workshop for all working staff for implementation of NPHCE programme at District and CHC level. 40

41. Progress in implementation of Programme : 6)Training Modules Three sets of Training modules for Medical Officers, Nurses and Community based workers to deliver Comprehensive Geriatric care has been developed. State level Training of Trainers of Medical Officers for Comprehensive Geriatric Care has been conducted at Chhattisgarh. 41

42. 7) NPHCE Website Website of the NPHCE program has been initiated through Center for Health Informatics (CHI) to provide comprehensive information along with data regarding Geriatric facilities and services available through-out the country. www.nphce.nhp.gov.in . 8) IEC Audio/Video spots on different topics of elder care, print material for posters etc. have been developed. The regional language version of IEC material developed. Progress in implementation of Programme : 42

43. 9) Monitoring and evaluation/audit: At all levels, the Union Ministry of Health and Family Welfare, as well as the Directorate General of Health Services, will continue to monitor and assess the program. Village panchayats work best in monitoring health service delivery . The knowledge gap can also be addressed by enhancing communication between stakeholders. Progress in implementation of Programme : 43

44. Financial management Financial management groups (FMG) of Programme Management support units at state and district level, which are established under NHM Will be responsible of maintenance of accounts, release of funds, expenditure reports, utilization certificates and audit arrangements. State will monitor release of funds and expenditure incurred under various components of the programme in the State. 44

45. Funds Utilization 45

46. Challenges 46

47. Challenges 47

48. Way forward 48

49. References IAPSM'S textbook of community medicine 2 nd edition K. Park's textbook of preventive and social medicine 26 th edition Training module MO national health care program of elderly Training module of CHO national health care program of elderly LASI Wave -1 survey 2017-18 National Programme for Health Care of the Elderly(NPHCE) | National Health Portal Of India https://www.nhp.gov.in/national-programme-for-health-care-of-the-elderly(nphce) Operational guidelines national programme for the health care of the elderly  Annual report of MOHFW 2020-21 49

50. Thank you……… 50