Care of elderly

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

 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

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

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

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

 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

Elderly persons lives in rural
area.
Women
Illiterate and dependent.
BPL
Were in vulnerable situation
and without sufficient food. 12/12/2015 7
75%
48%
66%
73%
66%
Source : Census
2001

PRONE FOR
INFECTIONS
PRONE FOR
INJURIES
PRONE FOR
PSYCHOLOGIC
AL PROBLEMS
PRONE FOR
DEGENERATI
VE
DISORDERS
INCREASED
RISK FOR
DISEASE
INCREASED
RISK OF
DISABILITY
INCRASED RISK
OF DEATH
10

Cataract &Visual
impairment- 88%
Arthritis &
locomotion disorder-
40%
CVD &HT – 18%
Neurological
problems- 18%
Respiratory
problems
including Chronic
bronchitis- 16%
GIT pro
blems 9%
Psychia
tric
proble
ms- 9%
11

12
P
e
r
c
e
n
t
a
g
e
Health Problem

CVD
Respiratory diseases
Infections,TB
Neoplasm
Accidents, poisoning and
violence
deaths by chronic diseases by
2015
13
33
%
10
%
10
%
6%
4%
17
%

14
Decrease in physical ability / Economic inadequacy
Increase vulnerability to diseases
Chronic, disabling and multiple Health problems
Different approach and management
Degradation in family values
Rising Population

15
Lack of
specialized and
trained manpower
Geriatrics not
yet a popular
specialty
No dedicated
health care
infrastructure

16
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

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

Geriatric ward for elderly at all DH
Treatment facilities for chronic, terminal and
degenerative diseases
Providing Improved medical facilities at CHCs
/ PHCs / Mobile Clinics
Inclusion of geriatric care in the syllabus of
medical courses including courses for nurses
Reservation of beds for elderly in public
hospitals
Training of Geriatric Care Givers
Research institutes for chronic elderly
diseases such as Dementia & Alzheimer 18

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

“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

 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

 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

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

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

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
26
Strategies for NPHCE 2010

Promotion of
public private
partnerships in
Geriatric Health
Care.
Mainstreaming
AYUSH and
convergence with
programmes of
Ministry of Social
Justice and
Empowerment in the
field of geriatrics.
Reorienting
medical education
to support
geriatric issues.
27

 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

 District Geriatric Units
 Geriatric Clinics/Rehabilitation units
 Sub-centres
 Training of Human Resources
29

 Package of Services at different levels
(SC/PHC/CHC/RGC)
30

 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

 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

33
ORGANIZATIONAL STRUCTURE
NCD- NON COMMUNICABLE DISEASES

 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

 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

 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

 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

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

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

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

Following items will be made available at the PHC:
 Nebulizer
 Glucometer
 Shoulder Wheel
 Cervical traction (manual)
 Exercise Bicycle
 Lumber Traction
 Gait Training Apparatus
 Infrared Lamp etc.
41

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

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
 Cervical traction
(manual).
43

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

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

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 46

 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

 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

 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?

 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.

 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.

 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.

 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.

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

 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.

 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.

 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.

 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.

 Heredity
 Nutrition
 Health status
 Life experiences
 Environment
 Activity
 Stress produce unique

PHYSIOLOGIC BALANCE
CONNECTION
GRATIFICATION

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

 Community health nursing, “concept and
practice”, barbara walton spradly, lippincott
4th 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

Care of elderly

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Care of elderly