GERIATRIC HEALTH CARE

INTRODUCTION

• Age of retirement, often brings physical, cognitive & emotional changes

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Common issues:

Hearing loss, cataracts, osteoarthritis, diabetes, COPD, dementia, depression

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• Limited healing ability, more prone to illness and injury
• Need comprehensive care & support for healthy aging

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HEALTH PROBLEMS OF OLDER ADULTS

MOBILITY ISSUES:

Causes:

• Muscle weakness,
• joint pain,
• neurological decline

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Effects:

• Loss of independence,
• increased risk of falls,
• poor ADLs,
• bed-bound

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SENSORY IMPAIRMENTS:

Hearing:

• Presbycusis,
• tinnitus,
• balance issues

Vision:

• Presbyopia,
• cataracts,
• floaters,
• dry eyes

Taste/Smell/Touch:

• Decreased sensation → impacts safety & enjoyment

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VESTIBULAR PROBLEMS:

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• Dizziness in >30% of elderly → major fall risk

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• Caused by inner ear & balance system dysfunction

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CHRONIC MEDICAL CONDITIONS:

Heart disease, type 2 diabetes, COPD, kidney disease, arthritis, stroke

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• Osteoporosis: Reduced bone density

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• Dementia: Memory loss, confusion, behavioral changes

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• Bronchitis: Smoking & infection-related

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MENTAL HEALTH ISSUES:

Depression, anxiety, dementia, schizophrenia

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Causes:

• Isolation, grief,
• chronic illness,
• sensory loss

Symptoms:

• Mood swings,
• hallucinations,
• restlessness,
• sleep/appetite changes

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NUTRITIONAL CHALLENGES

• Decreased appetite, chewing/swallowing difficulty, reduced taste/smell
• Need fewer calories but more essential nutrients

MANAGEMENT OF COMMON GERIATRIC AILMENTS�

ARTHRITIS

• Osteoarthritis & Rheumatoid Arthritis
• Joint pain, swelling, and mobility issues due to cartilage wear or autoimmune reaction.

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Management

• Pain medication,
• physical therapy,
• weight control,
• assistive devices,
• emotional support.

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INCONTINENCE

• Loss of bladder control
• Types include stress, urge, overflow, and functional incontinence.

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Management

• Medications,
• lifestyle changes,
• bladder training,
• supportive devices,
• environment safety.

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OSTEOPOROSIS

• Decreased bone density leads to higher fracture risk.

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Management

• Calcium & vitamin D,
• weight-bearing exercise,
• fall prevention,
• regular check-ups.

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CARDIOVASCULAR DISEASES

Common Conditions:

• Hypertension,
• CAD,
• heart failure.

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Management

• Control risk factors (BP, cholesterol),
• lifestyle changes,
• cardiac rehab,
• regular monitoring.

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RESPIRATORY DISEASES

Common Conditions:

• COPD,
• pneumonia,
• asthma,
• lung cancer.

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Management:

• Accurate diagnosis
• Medications & interaction checks
• Flu & pneumococcal vaccines
• Oxygen therapy
• Clean air environment
• Good nutrition & exercise

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VISION & HEARING PROBLEMS

Causes:

• Aging,
• disease,
• UV exposure,
• nerve changes.

Common Issues:

• Dry eye, cataracts, macular degeneration, glaucoma, hearing loss.

Management:

• Screening tests (Snellen, whisper test)
• Education on risks & regular exams
• Collaboration with specialists
• Home lighting & color contrast
• Advocacy for accessibility
• Support groups & counselling
• Clear communication, well-lit areas
• Use of assistive devices

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CANCER IN OLDER ADULTS

Risk Factors:

• Genetic mutations,
• weakened immunity with age.

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Management:

• Comprehensive physical & cognitive assessment
• Personalized pain & symptom management
• Nutritional & emotional support
• Open communication & education
• Interdisciplinary care coordination
• Family & caregiver support
• Palliative & end-of-life care
• Survivorship planning & follow-up

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DEMENTIA

Impact:

• Affects memory,
• attention,
• communication,
• reasoning,
• judgment, and
• problem-solving.

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Common Type:

Alzheimer’s disease.

Management:

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• Assessment & personalized care planning.
• Person-centered care with family involvement.
• Address behavioral symptoms (agitation, aggression, anxiety) with non-drug approaches.
• Support with ADLs through environment modification & task simplification.
• Simple language, non-verbal cues, validation, and two-way communication.
• Cognitive stimulation & reminiscence therapy.
• Establish consistent routines.
• Ensure safety: remove hazards, add handrails, improve lighting.
• Nutrition: healthy food, fluids, texture-appropriate meals.
• Promote active lifestyle: daily chores, exercise, gardening.

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COUNSELLING FOR OLDER ADULTS

• Focus on aging, emotional health, independence, and social issues
• Emotional Support: Grief, anxiety, depression management
• Cognitive Support: Memory training, dementia care
• Health Guidance: Chronic illness management, healthy lifestyle
• Social Support: Reduce isolation, promote social activities
• Family Support: Educate caregivers, prevent burnout
• End-of-Life Care: Grief support, advance care planning

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• Supportive Treatment
• Geriatric Assessment (CGA)
• Team Approach: Doctors, nurses, therapists
• Medication & Pain Management
• Fall Prevention: Home safety, balance training
• Nutrition & Exercise
• Cognitive Stimulation & Emotional Care
• Palliative & Advance Care Planning

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ORGANIZATION OF GERIATRIC HEALTH SERVICES

GERIATRIC HEALTH SERVICES AT SUB-CENTER LEVEL

•  Integrated care: Preventive, promotive, curative, rehabilitative & palliative
• Focus on physical, mental, dental, eye & nutritional care

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Key Components of Geriatric Services

• Screening & Assessment
• Hypertension, diabetes, osteoarthritis, cognitive decline
• Use of ADL tools for functional status
• Chronic Disease Management
•  Monitor BP, sugar, arthritis
• Lifestyle modification & medication adherence

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Health Promotion & Support

• Physical Activity & Yoga
• Fall prevention, group/home-based exercises
•  Nutritional Guidance
• Address obesity, deficiencies, lifestyle diseases
• Adult Immunization
• Influenza, pneumococcal vaccines (esp. with co-morbidities)

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Supportive Services

• Medication Management
• Promote adherence & prevent adverse effects 
• Home Visits
• For immobile elders; monitoring & care at home
• Counselling Support
• Address grief, depression, anxiety, loneliness
• Palliative Care
• Symptom relief, psychosocial support, quality of life
• Referral Services
• To PHC/CHC/hospitals for advanced care

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ASHA’S ROLE IN ELDERLY CARE

• Identify and list elderly (bed-bound, mobile, destitute)
• Encourage visits to Health & Wellness Centers
• Provide psychosocial support and counselling
• Conduct home visits & fill assessment checklists
• Monitor medication use, assistive devices, and follow-up
• Notify CHO for risks, abuse, or health conditions
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MPW(FEMALE/MALE) ROLE

• Initial geriatric screening (twice/year)
• Support ASHA in elderly care activities
• Provide basic nursing and counselling at home
• Form elderly & caregiver support groups
• Promote healthy aging (nutrition, rehab, exercise)

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PHC-LEVEL GERIATRIC SERVICES

•  Dedicated geriatric clinic
• Multidisciplinary care team
• Comprehensive geriatric assessment
• Screening for common elderly ailments
• Medication management & rehab services
• Health promotion, end-of-life care

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CHO’S ROLE IN GERIATRIC CARE

•  Comprehensive assessment twice/year
• Primary treatment & tele consultation referrals
• Create personalized care plans
• Conduct home visits for bed-bound elderly
• Support rehab & assistive device assessment
• Health education & nutrition support

MEDICAL OFFICER (PHC) RESPONSIBILITIES

•  Weekly geriatric clinics
• Advanced assessments & disease management
• Provide counselling & physiotherapy
• Conduct quarterly home visits for bed-bound elderly
• Maintain care records & refer to higher centers
• Train caregivers and link with wellness centers

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CHC-LEVEL GERIATRIC SERVICES

•  Doctor-led geriatric clinic (twice/week)
• Multidisciplinary specialist care & tele-consultation
• Lab investigations & counseling (including mental health)
• Physiotherapy & home care support via rehab worker
• Referral to tertiary centers
• Mobile medical units for remote care
• Availability of drugs & basic rehab equipment

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NATIONAL PROGRAMME FOR HEALTHCARE OF THE ELDERLY (NPHCE)�

NATIONAL PROGRAMME FOR HEALTHCARE OF THE ELDERLY (NPHCE)

Launched: 2010 (11th Five-Year Plan)

Aim:

• Accessible,
• affordable,
• specialized care for elderly (60+)

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Key Objectives

•  Provide preventive, promotive, curative & rehabilitative services
• Strengthen referral systems for elderly care
• Train healthcare workers & caregivers
• Integrate with NRHM, AYUSH, Ministry of Social Justice

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Core Strategies

• Community-based care (including home visits)
• Geriatric services at PHC, CHC, DH (10-bed wards)
• Tertiary care at 8 Regional Institutes (PG courses in geriatrics)
• IEC activities for public awareness
• Monitoring, research & evaluation

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Challenges

• Lack of trained geriatric professionals
• Limited rural access 
• Funding & awareness gaps
• Need better integration with existing health systems

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STATE-LEVEL PROGRAMS/SCHEMES FOR�OLDER ADULTS�

The following are key schemes implemented at state levels:

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ROLE OF COMMUNITY HEALTH NURSES IN GERIATRIC CARE�