Urgent Need to Integrate Geriatric Healthcare into Primary Healthcare Services

Currently, geriatric healthcare services are available in tertiary care hospitals. Urban areas have the most facilities. As majority of the elderly population stay in the rural region of India, the need of the hour is to integrate geriatric healthcare into primary healthcare services.

The healthcare challenges faced by elderly in India revolved around communicable and non- communicable diseases. Apart from age-related issues such as loss of sensory functions, they are also susceptible to chronic conditions such as hypertension, coronary heart disease, and cancer. Estimates by the government of India indicate that cardiovascular diseases account for one-third of the mortality among this segment. There are also conditions like Alzheimer’s, all of which limit even their daily activities. This is exacerbated by factors such as breakdown of family support systems and decreased economic independence.

Geriatric; DEMENTIA

Dementia is affecting more than 55 million people globally, according to the World Health Organization. It is currently the seventh leading cause of death and one of the major reasons for disability and dependency among the elderly population.

Commonly associated with ageing, dementia progresses gradually, making it tough for people to recall information and complete tasks they used to manage effortlessly. Imagine it as a fading of mental connections, leading to confusion, alterations in personality, and challenges in even the simplest of activities. As dementia advances, it often requires increasing support and care from loved ones or caregivers.

As per recent scientific studies, living alone in old age deprives the brain of sensory input.  When a person lives alone, they meet fewer people, and their interactions are limited, thereby leading to less conversational language use. Additionally, other experiences such as participating in festivals, going out for social events, and celebrating important days, are significantly reduced. Medically speaking, domains of language, emotions, social adaptability, semantic memory, and procedural memory get severely impacted when we live alone.

In the elderly apart from social isolation or loneliness, there are other risks factors as well, such as increasing age, diabetes, hypertension, hypercholesterolemia, obesity, smoking, vascular diseases, and physical inactivity.

While various studies have established a connection between social isolation and significant health conditions, including dementia, it is important to note that not everyone with fewer social interactions will develop dementia.

Dementia brings a host of challenges for those affected.

Memory loss hits hard, making recent events and names slip away. Confusion adds a layer of disorientation, complicating daily tasks. Trouble concentrating becomes frustrating, while personality shifts and withdrawal from loved ones create emotional hurdles. Feelings of depression and anxiety often loom large, accompanied by the loss of once-familiar skills. Communication becomes an uphill battle, leaving both the person with dementia and their loved ones feeling isolated. Recognising even close faces becomes a struggle, and mobility issues and safety concerns heighten in later stages.


Education: The first step to support is to learn and be aware of the specific type of dementia your loved one has, its progression, and associated behaviours to better understand their needs.

Practicing Empathy and Reassuring Presence: Maintain a calm and reassuring demeanour while interacting with the person. Listen attentively to their concerns and frustrations, acknowledging their emotions and trying to understand their feelings, whether it is anger or fear. Be patient with communication, as it might take time for the person to express himself or herself. Show empathy and validate their feelings.

Empowerment and Respect: Allow the person as much autonomy as possible in their daily life. Respect their personal space and preferences, fostering a sense of control and dignity.

Structured Routine: Establish a structured routine that includes both quiet times and engaging activities. This helps create a sense of predictability and reduces confusion. Maintain regular routines for tasks like bathing, dressing, and eating. Use written lists or calendars to assist with remembering appointments and tasks.

Familiar objects: Keep cherished objects and photographs around the living space to provide comfort and familiarity. Such items can help the person feel more secure and connected.

Medication management: Implement reminders or systems for medication schedules. Ensure medications are taken regularly and as prescribed.

Safety and supervision: Safety is paramount for dementia patients who might be prone to wandering, falls, or other accidents. Create a safe environment by removing hazards and implementing security measures to prevent accidents or fall. Keep a close look so that they do not wander outside the house and might get lost. If possible, keep the local communities informed.

Bathing safety: Use a sturdy shower chair to prevent falls during bathing. Clearly communicate each step of the bathing process, ensuring the person feels respected and informed.

(Dr Naresh Purohit is Epidemiologist and advisor -National Programme for Health Care of the Elderly (NPHCE) . The views expressed here are of the author)


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