NPHCE.pptx

National Program for Healthcare of the Eldery (NPHCE)

1. National Program for Healthcare of the Elderly (NPHCE) Dr.V.Monisha

2. Elderly Day – 1 st October

3. Elderly Population in India Is it Large ? Yes ! 8% of 1.2 billion – more than 100 million (btw, total population of Australia+NZ+UK = 89 million) Is it Growing ? Yes ! Proportion of elderly in the Indian population is rising, from 5.6% in 1961 to 12.71% in 2026 Is it Healthy ? The Physical, mental and social wellbeing of the elderly is interrupted with problems

4. Health Risks of Elderly

5. Common Morbidities in Elderly

6. Skin Changes Skin becomes less elastic & dry Itching is common Dark yellow or brown colored spots ( Senile lentigines (Liver spots)) Lines and wrinkles appear Nails become thick, tough, and brittle Increased sensitivity to temperature

7. Circulatory System Care High Blood Pressure Diet low in salt Decrease fat intake Exercise as recommended by physician

8. Respiratory Changes Respiratory muscles become weaker Changes may cause the elderly to experience: Dyspnea Breathing increases in rate Increases susceptibility to infections such as a cold or pneumonia

9. Respiratory Care Alternate activity with periods of rest Avoid polluted air May need continuous oxygen therapy Sleep

10. Nervous System Changes Blood flow to brain decreases & there is a progressive loss of brain cells -- Interferes with Thinking - Reacting Interpreting - Remembering Senses of taste, smell, vision, & hearing are diminished Nerve endings less sensitive Decreased ability to respond to pain and other stimuli Decrease in taste& smell frequently affects appetite

11. Changes in Vision Problems reading small print Seeing objects at a distance Decrease in peripheral vision Decrease in night vision Increased sensitivity to glare Cataracts Glaucoma

12. Changes in Hearing Hearing loss Person may speak louder than usual Ask for words to be repeated Not hear high frequency sounds May not hear well in crowded places

13. Digestive System Changes Muscle action becomes slower & peristalsis decreases Teeth are lost Liver function decreases Dysphagia is frequent complaint Slower digestion of food Indigestion Increase flatulence Constipation Decrease sensation of taste Poor appetite, Poor diet Care Good oral hygiene Repair or replace damaged teeth High-fiber high-protein foods Increased fluid intake

14. Urinary Changes Kidneys decrease in size & become less efficient Bladder becomes less efficient May not empty completely Care Increase fluid intake

15. Endocrine System Changes Increased production of some hormones and decreased of others Immune system less effective BMR decreases Intolerance to glucose Lose bone density Care Proper exercise Adequate rest Medical care for illness Balanced diet Healthy lifestyle

16. Reproductive System Decrease of estrogen / progesterone in female Thinning of vaginal wall Decrease vaginal secretions Inflammation of vagina common Weakness in supporting tissue: Uterine prolapse Breasts sag when fat redistributed Decrease in Testosterone Slow production of sperm Response to sexual stimuli slower Testes smaller less firm

17. Psychosocial Changes Some individual cope with psychosocial changes, and others experience extreme frustration and mental distress Fears of a sick person: Death Chronic illness Loss of function Pain Dealing with fears created by an illness: Listening Patience Understanding Provide support

18. Confusion & Disorientation Signs : Talking incoherently Not knowing their name Not recognizing others Wandering aimlessly Lacking awareness of time or place Hallucinating Regressing in behavior Paying less attention to personal hygiene Inability to respond to simple commands or instructions

19. Causes of temporary confusion / disorientation Stress and/or depression Use of alcohol or chemicals Kidney disease Respiratory disease Liver disease Medication Diseases: CVA Arteriosclerosis Atherosclerosis Cause TIA’s ministrokes which result in temporary periods of diminished blood flow to the brain.

20. Dementia Loss of mental ability characterized by a decrease in intellectual ability, loss of memory, impaired judgement , personality change, and disorientation Acute dementia When the symptoms are caused by temporary reason: High fever, dehydration, hypoxia Chronic dementia When symptoms are caused by permanent, irreversible damage to brain cells

21. Alzheimer’s Disease Form of dementia that causes progressive changes in brain cells Early Stages Memory loss Mood & personality changes Depression Poor judgment Confusion regarding time & place Middle Stages Night time restlessness Mood swings increase Personal hygiene ignored Weight fluctuates Paranoia & hallucinations Full time supervision needed

22. Late Changes Total disorientation Incoherent Unable to communicate with words Loses control of bladder & bowel functions Develops seizures Loses weight despite eating a balanced diet Becomes totally dependent Lapses into a coma Dies

23. Care Provide a/an safe and secure environment, follow the same routine, keep activities simple and last for short periods of time. Avoid loud noises, crowded rooms, and excessive commotion. Promote awareness of person, time, and place by providing reality orientation (RO ) Address person by name preferred Avoid: sweetie, baby, honey State your name, correct elderly if calls you by the wrong name Make reference to day, time, place Use clocks, calendars etc.

24. NPHCE

25. Vision To provide accessible, affordable, and high-quality long-term, comprehensive care to the ageing population. To build a framework to create an enabling environment for "a society for old ages“ . To promote the concept of Active and Healthy Ageing . Convergence with National Rural Health Mission, AYUSH and other line departments like Ministry of Social Justice and Empowerment

26. Objectives To provide an easy access to promotive , 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.

27. Organizational Structure

28. Packages of Services @ Subcentre Level Health Education related to healthy ageing Domiciliary visits for attention and care to home bound / bedridden elderly Arrange for suitable callipers and supportive devices from the PHC Linkage with other support groups and day care centres etc. operational in the area

29. Packages of Services @ Primary Health Centre Level Weekly geriatric clinic Maintain record using standard format Routine health assessment of the elderly Provision of medicines and advice on chronic ailments Public awareness on promotional, preventive and rehabilitative aspects of geriatrics during health and village sanitation day/camps Referral for those needing further investigation and treatment to Community Health Centre or the District Hospital

30. Packages of Services @ Community Health Centre Level 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 care facility

31. Packages of Services @ District Level Geriatric Clinic for regular dedicated OPD services Facilities for laboratory investigations and provision of medicines for geriatric health problems. Ten-bedded Geriatric Ward for in-patient care of the Elderly Existing specialities like General Medicine; Orthopaedics, Ophthalmology; ENT services etc. will provide services needed by elderly patients. Provide services for elderly patients referred by the CHCs/PHCs Conducting camps for Geriatric Services in PHCs/CHCs and other sites Referral services for needy/ severe cases to tertiary level hospitals

32. Responsibilities of CHOs Undertake comprehensive geriatric assessment twice a year Providing immediate/primary management of common ailments of elderly and referring to MO at PHC or conducting teleconsultaion services and manage as per MO-PHC instructions. Develop and administer a personalised care plan for each elderly identified in the community in consultation with MO-PHC. Facilitate identification and provide guidance to care givers regarding care given to bed bound elderly.

33. Things to note Develop elderly support groups named “ sanjeevini ” Conduct periodic home visit to bedbound elderly, sick elderly and restricted mobile elderly. Undertake preliminary assessment for the need of assistive devices- support, rehabilitative service for elderly .