As India becomes increasingly urbanised and families break up into smaller units, homes for the elderly have sprung up. The care of elderly people is managed by a set of professionals or voluntary organisations interested in geriatric services. The number of such care homes is rising rapidly in urban and semi-urban India. These homes are either paid for, or offer free or subsidised service. Typically, such homes are run by NGOs, religious or voluntary organisations with support from the government, or by local philanthropists. They provide accommodation, timely care, and a sense of security for their residents. However, the quality of service varies as these homes lack regulatory oversight. Many homes lack clearly established standard operating procedures, and their referral paths to health care are informal. There is an urgent need to understand the quality of life at such institutions, including the impact of these homes on the mental health of their residents.
A rapidly growing section
A formal approach to homes for the elderly is an important policy and planning issue for India. The UN World Population Ageing Report notes that India’s ageing population (those aged 60 and above) is projected to increase to nearly 20% by 2050 from about 8% now. By 2050, the percentage of elderly people will increase by 326%, with those aged 80 years and above set to increase by 700%, making them the fastest-growing age group in India. With this future in mind, it is essential that our policy framework and social responses are geared to meet this reality.
A recent set of research papers from Hyderabad focusing on the quality of health in homes for the elderly has some interesting insights. The papers highlight the fact that good intentions and a sense of charity are often inadequate when it comes to addressing the basic health needs of their elderly residents. These papers are outcomes of the Hyderabad Ocular Morbidity in Elderly Study (HOMES) by the L.V. Prasad Eye Institute that was primarily meant to understand the vision needs of elderly residents of such homes. About 30% of the residents who were part of the study (over 1,500 participants from 40 homes) had a vision impairment of some sort, but nearly 90% of this vision impairment could be addressed by simple, relatively low-cost health interventions: issuing better eye glasses or cataract surgery.
The study also found some ‘unseen’ effects of vision impairment: many were prone to depression. In fact, those with both vision and hearing impairment had a rate of depression that was five times higher than those without. Our homes, buildings and social environment are not built keeping the elderly (or people with disabilities) in mind. As people age, and their motor skills weaken, they are at a greater risk of falling down and hurting themselves. Having an impairment increases this risk. Instead of planning for accessible and elderly-friendly structures that allow them to operate safely, we reduce their mobility. People with functional skills are asked to stay away from daily tasks like cooking, sewing, cleaning, or washing up. This reduces their sociability, their sense of independence and well-being — all leading up to mental health issues and depression.
The state of homes for the elderly today offers us some low-hanging fruit we can address easily: build formal pathways for basic health screening between such homes and public health facilities. This can include screenings for blood sugar, blood pressure, periodic vision and hearing screening, and a simple questionnaire to assess mental health. Such interventions are inexpensive (think of all the motorcycle-operated screenings outside public grounds for morning-walkers) and could go a long way in identifying health issues and offering support. The next step would be to build formal pathways to address any health issues that such screenings identify. Many hospitals (public, NGO-run, and private care) can help.
Public policy support
Crucial though will be the need for robust public policy to support homes for the elderly. Health institutions will also need to offer a comprehensive set of packages that are tailored for the elderly — not piecemeal solutions for diabetes, cardiology or cancer, for example. What happens once care is provided? Homes for the elderly must be guided, again by policy, to make their facilities, buildings and social environment elderly- and disabled-friendly. Design, architecture and civic facilities must be thought from the ground up — and these innovations must be available for all residents, not just those living in expensive ones. There are lessons here for society as a whole, but, as they say, let’s take one step at a time.
Tejah Balantrapu is Associate Director, Science, Health Data, and Story-telling , L.V. Prasad Eye Institute; Srinivas Marmamula is Associate Director, Public Health Research and Training, L.V. Prasad Eye Institute