Needs of chronic disease prevention in old age population

Context

• There is a rapid rise in the share of the old i.e. 60 years or more and associated morbidities, especially sharply rising non-communicable diseases (NCDs) and disabilities.
• Though life expectancy is increasing, but also the rate of chronic disease is increasing in older community.

Indian Human Development Survey (IHDP) 2015

• According to the findings of IHDS, the prevalence of high blood pressure among the old almost doubled over the period 2005-12; that of heart disease rose 1.7 times; the prevalence of cancer rose 1.2 times; that of diabetes more than doubled, as also that of asthma; other NCDs rose more rapidly (i.e. by two and a half times).
• Multi-morbidities i.e., co-occurrence of two or more Non-Communicable Disease (NCDs) rose recently for like two and a half times.
• The prevalence of high blood pressure and heart disease rose more than twice while that of high blood pressure and diabetes nearly doubled.

Construction of Wealth Quartiles

• It was constructed to examine whether prevalence of NCDs varied across them and over time.
• The burden of NCDs shifted from the most affluent to the least affluent over this period. In both the first (least wealthy) and fourth (wealthiest) quartiles, the prevalence rose sharply in most cases but in all the rises were faster among the least wealthy.
• The ratio of high blood pressure in the first quartile relative to the fourth rose from 0.36 in 2005 to 0.40 in 2012; that of heart disease rose from 0.31 to 0.38; that of diabetes from 0.23 to 0.34; and that of blood pressure and heart disease rose from 0.11 to 0.58
• NCDs are associated with 93% of deaths among the old. The least wealthy have become more susceptible to this risk.
• According to WHO, 2015, By age 60, the major burdens of disability and death arise from age-related losses in hearing, seeing or moving. Thus co-occurrence of disability and NCDs poses a higher risk of mortality.

Disability, another barrier

• Disability is the umbrella term for impairments, activity limitations and participation restrictions.
• Disabilities in Activities of Daily Living (ADL) show dependence of an individual on others, with need for assistance in daily life.
• In select disabilities, there is a sharp rise with age and over time.
• Difficulty in walking was 1.7 times greater in the age group 70-plus years relative to 60-69 years in 2012. Over the period 2005-2012, overall prevalence rose 6.1 times.
• Difficulty in using toilet facilities was 2.3 times higher among the older group (70-plus years). Overall prevalence was five times higher in 2012.
• Difficulty in dressing was about 2.5 times higher in the older group. Overall prevalence jumped about five times between 2005-12.
• Hearing difficulty was just under twice as high among the older group in 2012, while the overall prevalence rose 4.7 times over this period.
• A combination of NCDs and disabilities that is more likely to be fatal. Heart disease and disabilities (1-4) rose 1.3 times. Blood pressure and disabilities in this range rose 1.2 times, as also diabetes and disabilities. Blood pressure and heart disease and disabilities increased 1.4 times.

State of population of old ages in India

• Although India will be the youngest country in the world by 2020 with a median age of 29 years, the number of elderly people is likely to increase significantly after that, according to the 2014 State of Elderly in India report released by the non-profit organization.
• By 2021, the elderly in the country will number 143 million. Presently, the elderly in divided into three categories: the young old (60-70) the middle-aged old (70-80) and the oldest old (80 plus).
• The increase in life expectancy over the years has resulted in an increase in the population of the elderly. While the overall population of India will grow by 40% between 2006 and 2050, the population of those aged 60 and above will increase by 270%.
• Out of this, the oldest old segment, which is the most vulnerable on account of suffering from disabilities, diseases, terminal illness and dementia, is also the largest growing segment of the elderly population, at a rate of 500%.
• The increasing population of the elderly is “a development concern that warrants priority attention for economic and social policies to become senior citizen-friendly”.

About India Human Development Survey (IHDS)

• The India Human Development Survey (IHDS) is a nationally representative, multi-topic survey of 41,554 households in 1503 villages and 971 urban neighborhoods across India.
• IHDS has been jointly organized by researchers from the University of Maryland and the National Council of Applied Economic Research (NCAER), New Delhi.
• MULTI-MORBIDITIES: the major challenge facing modern health care systems is aging of the population in the context of significant pressure to contain costs. The proportion of people aged 60 years or more in the world population is expected to increase rapidly from 10% in 2000 to 21% in 2050.
• Concurrently, the number of patients with multi-morbidity, i.e., coexistence of several chronic diseases, will increase dramatically. The prevalence of multi-morbidity has been estimated at more than 80% among persons aged older than 85 years.2
• Clinical research has focused predominantly on single disease and episode, often with a focus on mortality as the main endpoint. Thus, one of the most important tasks in clinical medicine today is managing multi-morbidity. This requires an evolution away from the single disease focus that has dominated medicine for centuries.
• The aim of this commentary is to propose clear terminology for the clinical concepts describing different aspects of multi-morbidity and to elucidate the relationship between these clinical concepts and their epidemiologic analogs.

Fate of elders in India

• Senior citizens in India face a plethora of challenges ranging for abandonment, poor physical and mental health care and support, lack of understanding of old age issues, absence of any form of social security, poorly functioning old ages homes and absent care – giver support.
• Disability in India is not taken seriously and is ignored as something that is bound to be acquired with old age; furthermore, several civil society organizations working in the disability sector too leave out senior citizens with acquired disabilities from their list of beneficiaries and intervention plans.
• While culturally and socially, elderly members of the family are treated with great respect in India, there is almost very little to nothing to ensure their welfare in society.
• Cases of elderly neglect, desertion and abuse are rampant across the country, most of which go unreported as a result of poor social and community support systems. The functioning and conditions of old age homes are abysmal too.
• Despite the report of the Standing Committee on Social Justice and Empowerment on the implementation of schemes for the welfare of senior citizens in February, 2014, nothing seems to have progressed or changed.
• Given the present government’s skilling and development agenda, the aging population – which the state is obliged to‘within the limits of its economic capacity and development, make effective provision’ for seems to find no place in the scheme of things, perhaps because they are not perceived productive.
• Given that the Maternity Benefit (Amendment) Bill, 2016 has begun the conversation, perhaps the time now is ripe to lobby for and bring to the forefront issues of senior citizens and ensure that the State fulfils its obligation towards the senior citizens of the country.

Know about National Health Policy

New Policies to look way ahead

• The Central Government is in the process of developing newer plans and schemes to benefit senior citizens.
• In the 2007-08 Budget the Finance Minister has proposed to provide monthly income to seniors and develop new health insurance schemes.

For the benefit of senior citizens, it has been proposed that-

• The National Housing Bank will introduce a ‘reverse mortgage’ scheme under which a senior citizen who owns a house can avail of a monthly stream of income against mortgage of the house. The senior citizen remains the owner and occupies the house throughout his or her lifetime, without repayment or servicing of the loan. Regulations are to be put in place to allow creation of mortgage guarantee companies.
• An exclusive health insurance scheme for senior citizens is to be offered by the National Insurance Company. Three other public sector insurance companies as mentioned in the Medical Insurance section, are to offer a similar product to senior citizens.
• The Maintenance of Parents and Senior Citizens Bill(External website that opens in a new window) of 2007 – This bill has been recently introduced in Parliament. It provides for the maintenance of parents, establishment of old homes, provision of medical care and protection of life and property of senior citizens.

Conclusion

• The curse of old age has become worse. Along with expansion of old age pension and health insurance, and public spending on programmes targeted to the health care of the old, careful attention is urgent to reorient health systems to accommodate the needs of chronic disease.
• A little can be done by Prevention and control by enhancing the skills of health-care providers and equipping health-care facilities to provide services related to health promotion, risk detection, and risk reduction.