implementing active ageing (a who framework policy) in community dwelling elders in india: alec2017

02/05/2023 1

IMPLEMENTING ACTIVE AGEING (A WHO FRAMEWORK POLICY)

IN COMMUNITY DWELLING ELDERS IN INDIA

Dr Alakananda BanerjeeFounder Chairperson: Dharma Foundation of India

Vice President: All India Senior Citizen Organisation(AISCCON)

Arctic Light E-Health Conference 1-2 February 2017

CONTENT

1. Changing world scenario2. Government initiatives for elders in India3. Major constraints for elder healthcare in India4. Active Ageing5. Community Health Model and Active Ageing in India6. Future plans:Can we involve mhealth and

framework of Active Ageing?

05/02/2023 Arctic Light E-Health Conference 1-2 February 2017 2

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 http://www.un.org/en/development/desa/population/publications/manual/projection/index.shtml

Soon, the world will have more older people than children.


http://www.who.int/world-health-day/2012/toolkit/background/en/

CHANGING WORLD SCENARIO

02/05/2023 Arctic Light E-Health Conference 1-2 February 2017

5

CONTENT

1. Healthcare Challenges in India

2. Reforming systems for health :global vision

3. Community health workers in rural India

4. Community health centers and Active Ageing

5. mHealth and Active Ageing

HEALTHCARE CHALLENGES: INDIA


Population1,326,801,576 (July 2016 est.)Density382 people per.sq.km (2011 est.)

In million

India currently has the largest illiterate population.

HEALTHCARE CHALLENGES: INDIA

• High proportion of out-of-pocket expenditure on health

• Weak public health systems.• Unavailability of doctors and

nurses.


INITIATIVES BY GOVERNMENT OF INDIA

COMMON MORBIDITIES OF ELDERLY IN INDIA

Cataract &Visual impairment- 88%

Arthritis & locomotion disorder-40%

CVD &HT – 18%

Neurological problems- 18%

Respiratory problems

including Chronic bronchitis- 16%GIT pro

blems 9%Psychiatric problems- 9%


Ref – ICMR study 2001Delhi & Haryana

SOCIAL PROBLEMS AND ISSUES OF THE ELDERLY IN INDIA

• Disintegration of joint family system: Children take care of parents

• The concept of old-age homes or assisted living is socially largely unacceptable in India

• Isolation, elder abuse

http://planningcommission.nic.in/data/ngo/csw/csw_15.pdf


MAJOR GOVT. INITIATIVES FOR ELDER HEALTHCARE IN INDIA

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


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 training

IEC using mass media, folk

media and other communication


STRATEGIES FOR“NATIONAL PROGRAMME FOR HEALTH CARE OF ELDERLY”

MAJOR CONSTRAINTS FOR GERIATRIC HEALTHCARE IN INDIA

Lack of specialized and trained

manpower(medical doctors/nurses)

Geriatrics not yet a popular specialty in

medical /nursing schools

No dedicated health care

infrastructure


GAPS IN THE AVAILABILITY OF HEALTH PROFESSIONALS IN INDIA


India has a ratio of 0.7 doctors and 1.5 nurses per 1,000 people compared to the WHO's ideal average of 2.5 doctors and nurses per 1,000 people

CAN WE INVOLVE OTHERS INTO THIS FRAMEWORK?

1. AYUSH stream of traditional alternative medicine in India. (Ayurveda Yoga,Unani.Siddha,Homoeopathy)

2. Allied health Professionals. (Physiotherapy/Occupational Therapy etc)

3. Home healthcare4. Elders themselves


1)AYUSH(Traditional Indian Medicine)

• AYUSH : Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy,, is a governmental body in India purposed with developing, education and research

• The Ministry of AYUSH was formed with effect from 9 November 2014


http://ayush.gov.in/MINISTRY OF AYUSH(INDIA)

2)NATIONAL INITIATIVE FOR ALLIED HEALTH SCIENCES

• Allied Health Professionals (AHPs: PT,OT,RT etc) play a critical role and are the support pillars of the healthcare team.

• Realise importance of interdisciplinary health teams including physicians (all medical professionals including specialists)

• Promote, protect, treat and/or manage a person('s) physical, mental, social, emotional, environmental health and holistic well-being.


A STUDY TO AUGMENT THE CAPACITY AND QUALITY OF ALLIED HEALTH PROFESSIONALS IN MINISTRY OF HEALTH AND FAMILY WELFARE GOVERNMENT OF INDIA AND PUBLIC FOUNDATION OF INDIA


18

3)HOME HEALTHCARE IN INDIA: A UPCOMING SERVICE FOR ELDERS

• Better health outcomes and lower medical costs .• It is estimated that for an average individual, 70% of

health care needs can be met in the home environment.

• Home-based health care in India is poised for transformation

“With life expectancy increasing significantly in India, home health care is becoming mandatory.”–Dr Devi Prasad Shetty

4)ELDERS AS SUPERVISORS IN COMMUNITY

• Lifetime experience• May have valuable time• Elder resource as an

important part of the community .


ACTIVE AGEING

Active ageing is the process of optimizing opportunities for health, participation and security in order to enhance quality of life as people age.

It applies to both individuals and population groups.



21

CONCEPT:SELF CARE

• Self-management of diseases may formulate 80% of care of a chronic health condition in elders

Public Health Rep. 2009 Jul-Aug; 124(4): 478–480.PMCID: PMC2693160 Self-Management Programs: One Way to Promote Healthy Aging Steven K. Galson, MD, MPH

• Self-care is a significant health resource of elders with different health status.

Scand J Caring Sci. 2007 Dec;21(4):456-66.Self-care as a health resource of elders: an integrative review of the concept.Høy B1, Wagner L, Hall E

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2693160/

https://www.ncbi.nlm.nih.gov/pubmed/?term=Galson%20SK%5BAuthor%5D&cauthor=true&cauthor_uid=19618783

https://www.ncbi.nlm.nih.gov/pubmed/?term=Galson%20SK%5BAuthor%5D&cauthor=true&cauthor_uid=19618783

https://www.ncbi.nlm.nih.gov/pubmed/18036008



https://www.ncbi.nlm.nih.gov/pubmed/?term=H%C3%B8y%20B%5BAuthor%5D&cauthor=true&cauthor_uid=18036008

https://www.ncbi.nlm.nih.gov/pubmed/?term=H%C3%B8y%20B%5BAuthor%5D&cauthor=true&cauthor_uid=18036008

https://www.ncbi.nlm.nih.gov/pubmed/?term=Wagner%20L%5BAuthor%5D&cauthor=true&cauthor_uid=18036008

https://www.ncbi.nlm.nih.gov/pubmed/?term=Hall%20EO%5BAuthor%5D&cauthor=true&cauthor_uid=18036008

CONCEPT:MUTUAL HELP

• Supporting active ageing is motivated by the superior ambition to substantiate a society for all ages.

• Guiding principles of active ageing explicitly include rights and obligations to others in the community.

• Older people are considered to be obliged to use the opportunities offered by society to realize a self-responsible and jointly responsible for life.

Adv Gerontol 2003;11:7-18.Active ageing: a policy framework. Kalache A, Gatti A


CONCEPT:HEALTH PROMOTION


BENEFITS ARE NOT LIMITED TO INDIVIDUALS: BETTER HEALTH AND INCREASED PARTICIPATION IN SOCIETY MEANS REDUCED HEALTHCARE COSTS AND A GREATER CONTRIBUTION TO SOCIETY AS A

WHOLE

http://apps.who.int/iris/bitstream/10665/67215/1/WHO_NMH_NPH_02.8.pdf

COMMUNITY HEALTH CENTRE AND ACTIVE

AGEING


• Our model builds the health service in collaboration with on going community support providers.

• Concept of self care, mutual care and health promotion is initiated in the elders of the community


1. VNKS, Chattarpur and Manav Rachna University New

Delhi, Faridabad (Study)

2. ACF Sneha Sandhya and Pawani Physiotherapy Centre,

Visakhapatnam, Andhra Pradesh.(Community Initiative)

3. Multi Service Health Centre, New Barrackpore North

24 Paraganas, Kolkata West Bengal (Sustainable model)

4. DVVPC College of Physiotherapy, Vadagaon Gupta,

Ahmednagar, Maharashtra (Study)

5. BHEL, Hardwar, Uttar Pradesh (CSR)

6. PEWS ,College of Physiotherapy Guwahati and

Help age Guwahati ,Assam (Study)

ONGOING COLLABORATIONS IN INDIA

ONGOING INTERNATIONAL COLLABORATION

ANABELA CORREIA MARTINS, PhD PTSenior Lecturer / Physiotherapy Dept.International CoordinatorPrincipal Investigator FALLSENSING www.fallsensing.comPolytechnic Institute of CoimbraESTeSC Coimbra Health SchoolRua 5 de Outubro - S. Martinho do Bispo - Apartado 7006 - 3040-162 Coimbra PORTUGAL


http://www.fallsensing.com/

AIM OF THE PROGRAM

Development and implementation of a community health centre integrating with active aging to empower elderly-dwelling individuals at the community level for chronic disease prevention and control in old age through self-promotion, self-care and mutual help.


AIM OF THE PROGRAM

Through integrated approach, AHP and elders who volunteers to become community supervisors (CS) are trained in basic health promotion, manage many of the chronic conditions and diseases that affect elders and chronic patients in community.


HYPOTHESES

Will the model/program lead to better outcomes and continuity

of care of health of elders in the community?

Arctic Light E-Health Conference 1-2 February 2017 2905/02/2023

METHODOLOGY

1. Elders >60 years ,male or female ,are selected through RWAs and Local Senior Citizen Organisations.

2. They are trained training module delivered by AHP (physiotherapist) based on 7 collaborative health sessions) as CS.

3. These CS support disabled patients/old age homes, patients discharged from hospitals after an acute illness, who stay in the community and neighbourhood to stay independent and healthy.


WHAT DO WE TEACH?TRAINING MODULE FOR CS

1. Communication skills and capacity building, concept of healthy and active ageing.

2. First Aid, Basic life support, Sanitation/hand hygiene.3. Diabetes, Hypertension, Arthritis, Neurodegenerative diseases,

Cancer, Metabolic diseases, CVD, CVA.4. Exercises and Diet Modifications in prevention of non

communicable disease.5. Accidents at home, burns, falls, medication adherence/error,

regarding visits to healthcare providers. Palliative and long term care6. Stress, anxiety in caregivers, social isolation, abuse7. Training on need assessment and toolkit


TRAINING MODULE FOR HS

The CS undergo a simple written exam and VIVA after 4 weeks of end of sessions/training.


INTERVENTION AND OUTCOME MEASURES

• Need assessment toolkit• Training Module• Process guidelines • Monitor frailty ,falls, activity and

participation of elders participating in program

• http://www.who.int/management/ToolkitsforStrengtheningPHCAlbaniaPHC.pdf• http://www.who.int/ageing/publications/AF_PHC_Centretoolkit.pdf• http://phcperformanceinitiative.org/• http://www.mohfw.nic.in/showfile.php?lid=2171


http://www.who.int/management/ToolkitsforStrengtheningPHCAlbaniaPHC.pdf

http://www.who.int/management/ToolkitsforStrengtheningPHCAlbaniaPHC.pdf

http://www.who.int/ageing/publications/AF_PHC_Centretoolkit.pdf

http://www.who.int/ageing/publications/AF_PHC_Centretoolkit.pdf

http://phcperformanceinitiative.org/

http://phcperformanceinitiative.org/

http://www.mohfw.nic.in/showfile.php?lid=2171

http://www.mohfw.nic.in/showfile.php?lid=2171

ROLE OF CS1. Monitoring of vitals(BP,Blood Sugar), understanding

and sharing basic signs and symptoms of medical conditions.

2. Motivation and encouragement to caregivers and promotion of healthy lifestyles under the supervision of a doctor/physiotherapist through group therapies and home visitations.

3. CS provide valuable support in spreading awareness of communicable diseases and preventive measures, in their colonies and low socioeconomic/tribal/rural areas people staying in their vicinity.


ADVANCED TRAINING PROGRAMS Tackling emergencies situations at home


ADVANCED TRAINING PROGRAMS

The AHP and CS teaches and helps others in his neighbourhood and family who need to be taken care of.


1. Service at the community health centre.

2. Hold training programs3. Maintain and store data base of

such patients of the community are stored in the Community Centre and shared with other healthcare providers in times of emergency or acute care.

4. Monitoring health of elders in community.


HOW DOES AHP BRING HELP COMMUNITY ELDERS?

WHAT SERVICES DOES THE AHP AND CS GIVE TO COMMUNITY

Old age home inmates trained as CS, help other inactive inmates to gain mobility strength, promote health and achieve better quality of life.


• Visit and monitor vitals (Blood pressure/blood sugar)of patients needing long term care.

• Counsel caregivers and motivate patient.

• Communicates with AHP/Doctor, visits the patient in presence of AHP

MULTIDISCIPLINARY TEAM

1. Early recognition of problems and timely intervention

2. Admission prevention and facilitates discharge from hospital

3. Provide cost effective rehabilitation in community(home based and centre)

4. Opportunity for developing holistic knowledge and skills within the framework of healthcare providers



EMERGENCY/ ACUTE CARE!! DoctorAHP

Trained Community Supervisor to take care of Small Group through individual home visits, visits old age homes and conducts small group meetings

Elder from small group who needs help in health emergencies call/messages CS with the problem that she/he has.

OUR STAKEHOLDERS

COMMUNITY CENTRE

Doctor

CS

Patient/elder in community

MOBILE PHONE USERS IN INDIA


HUMAN INTERACTION AND TECHNOLOGY


CAN WE INTEGRATE mHEALTH (technology)AND ACTIVE AGEING ?

OBJECTIVES

• Translate Need Assessment and Toolkit Guidelines/Training Module of Community Health Model and Active Ageing into mhealth application.

• Empower to engage people.• Innovation/low cost technology to

involve/improve human interactions.• Reach the common people of India.


OBJECTIVE

Utilize resource of CS (from urban area) to work in neighboring rural and semi rural areas where health facilities are very poor


https://www.nhp.gov.in/miscellaneous/m-health

Mobile based Primary Health Care System for Rural India :M V Ramana Murthy, Mobile Computing and Wireless Networks, CDAC, Electronics city, Bangalore

THANK YOU

CREATING A

HEALTHY

INDIA

[email protected]

www.dharmafoundationofindia.org

05/02/2023 45Arctic Light E-Health Conference 1-2 February 2017

mailto:[email protected]