Add community to the aged care equation

“In 2050, there is a demographic phenomenon ready to happen, which has never happened in recorded history.

Kasturi refers to the population of older people who will exceed the population aged 0-15 for the first time.

“This may prompt who declares 2021-30 as a decade of healthy aging,” he noted in a recent event titled “The “Era of Nursing” at the International Centre in Bangalore.

It is estimated that there are currently about 150 million elderly people (people over 60 years old). Kasthuri noted that this is larger than the total population of the UK and Australia.

It is not only a large number, but also an increasing number, which is estimated to exceed 320 million by 2050. The elderly will account for 20% of India’s population. In other words, by 2050, one in every five Indians will become older.

The changing social and family structure combined with an increase in older populations emphasizes the importance of shifting health care focus to older people and shifting from a disease-centric approach to their overall health.

Looking down at the “people”

Older people often struggle not only with physical illness, but also with social isolation, digital alienation, disorientation, mobility restrictions, interpersonal struggles and loneliness. In 2022, who revealed that one in four older people have experienced social isolation. This can seriously affect its health and lifespan, with the impact on mortality compared to smoking and obesity.

“You and I have been trained to study the body carefully, including individual cells, look at its chemistry and physiology, study pharmacology… no one teaches us to look at this person. In fact, in words, we are told that we do not allow our emotions to be with our work,” Mr. Rajagopal, Pallium of India evernium of Indim event Indies over Indies event Indies event Indies event over Indies event over Indies event. He believes that this approach is often a barrier to incorporating palliative care into health care.

The Bioethics Unit of the Indian Medical Research Council said the responsibility of healthcare providers is to relieve pain, but Rajagopal noted that even basic pain relief – leaving behind other aspects of happiness alone, fewer Indians in need. Most importantly, he believes that existing healthcare practices sometimes add to suffering.

A study by the Indian Public Health Foundation experts published in the British Medical Journal in 2018 shows that about 55 million Indians are trapped in poverty over the year due to health care spending. The study further revealed that about 38 million people fell below the poverty line due to spending on drugs alone.

Rajagopal criticized: “According to World Bank data, India is one of the 12 worst countries in catastrophic health spending. Our healthcare providers are destroying social, mental and physical health for more than 4% of the population in a year.”

There are currently about 150 million elderly people in India (above 60 years old) and by 2050, 1 in every five Indians will become older. |Photo source: Sridharan N.

Many layers

Another way to increase suffering, he noted, is to have a person spend his last day in the ICU.

“I know intensive care can miraculously save lives. But I also know that in the context of incurable diseases, this is the most severe pain to human body, mind and mental pain,” Rajagopal said. “The data shows that two-thirds of the elderly are admitted to the ICU within 48 hours.

“These are some reality that is not easy to talk about or think about. We talk about healthy aging; we are not talking about meaningful things like “age is a number”. But we are not thinking about the end of people’s lives.”

The caregiver’s plight usually doesn’t attract attention. Related are other issues such as social, mental and mental pain, anxiety, depression and social issues including poverty, caste and class, and relationship issues.

Rajagopal noted that we need to address all of these issues, highlighting the need for palliative care and community involvement in the care of older people.

Palliative care

In 2014, the World Health Assembly asked its member states and who strengthen palliative care as part of integrated care. However, Mr Rajagopal noted that even many palliative care organizations themselves often end up doing superficial work that addresses only the symptoms rather than the causes.

“If we look deeper, we will find very huge problems related to emotional problems, social problems, poverty, etc. Interpersonal problems, mental and sexual problems reach the deepest level. To get there, a little training is needed.”

He admitted that palliative care has received more attention in the country recently. In 2017, national health policies view palliative care as an integral part of integrated primary health care. In 2019, the Indian Medical Council added palliative care to the MBBS course. In 2022, the Indian Nursing Council provides a mandatory module of 20 hours for undergraduate nursing courses.

Rajagopal pointed out that while development is promising, it is crucial to fill the implementation gap and fully attract the community.

Community is the key

In 2018, countries participating in the Global Primary Health Care Conference in Astana, Kazakhstan made a commitment to strengthening primary health care to achieve universal health insurance and health for all. Known as the Astana Declaration 2018, one of the important decisions made during the conference was that care must reach where they need it, which highlights the point of accessibility, which remains a major challenge in India.

“This is crucial because we often find that what we need most never arrives at the hospital. To do this, it is important to get people involved in designing and controlling sanitation systems; because health is not only about hospitals, but also about food, agriculture, irrigation, sanitation, transportation, etc,” Rajagopal notes. ”

He draws on anecdotes from Kerala, describing how an elderly man with advanced malignant tumors live in a hut, holding an umbrella whenever the roof leaks.

“What will our healthcare system do for this? Our healthcare social workers come together and help fix it. These people do 100 times more important than what I do prescribe medications. Get involved in the community and they will find solutions.”

Compassionate ability

According to Rajagopal, different parts of the medical equation must include patients, their families, volunteers, and a variety of professionals who can improve their quality of life.

“For many older people, there was a time when they refused to go to the hospital. It was crucial to get to their level, listen to their level and give them care. It was crucial to make this visible to nursing and medical students.”

Rajagopal also stressed the importance of engaging the community in actual decision-making processes.

“They know the local problems and they will find local solutions,” he said, demonstrating this with anecdotes from an elderly woman in Kerala who underwent knee replacement surgery.

“She will never walk. But a volunteer nearby recruits school students every day.

However, he noted that healthcare professionals often hinder volunteers from being outside legal and procedural barriers. He recommends starting with professional acceptance of community engagement, followed by a public awareness program, recruiting and training volunteers, establishing core values ​​and fundamental rules, launching the program, regularly assessing, reviewing and curriculum corrections, as an effective approach to palliative care.

“The very clear message is that we don’t provide charity for patients; it’s their right. Capacity is crucial, and so is compassion. Respect is often as infectious as a smile,” he said.