Geriatric health:

problems and
solutions
including
community based
rehabilitation

Presenter:
Santoshi Paudel
MPH 2023
CPH and CM
Click icon to add picture
 Geriatrics
The term geriatrics originates from the Greek geron meaning "old man", and iatros
meaning "healer".

Geriatrics: A branch of medicine that deals with the problems and diseases of old age
and the medical care and treatment of aging people.
 Its main aims:
o to promote health
o to prevent and treat diseases
o to prevent the disabilities in older adults.

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 Ageing
• Ageing can be defined as lifelong process of progressive change in biological,
psychological and social structure of a person.

• World Assembly on aging adopted, as its main focus of concern, the population
aged 60 or over as elderly population.

• Population ageing is a shift in the distribution of a country's population towards

older ages and is usually reflected in an increase in the population's mean
and median ages

• Population ageing arises from two possibly-related demographic effects:

 Increasing longevity and
 Declining fertility
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 Ageing: Types
Biological age:
• Measured by Abilities and Performances
Psychological age:
• Measured by mental capacity – intelligence, memory power, cognitive function
etc.
Social age:
• Social age refers to the social habits and roles of the individual relative to his
group or society.

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 Who are Elderly ??

• The chronological age of 65 years above as a 'elderly' or older person.

• The United Nation agreed cutoff is 60+ years to refer to the older population.

• In context of Nepal, people who are 60 years and above. (Senior Citizen Act 2063)

What could be the difference between the term geriatrics and elderly?

Geriatrics refers to the branch of medicine whereas elderly is a demographic term used to

describe a stage of life characterized by older age

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 Healthy Ageing??
• WHO as well as the UN General Assembly- 2021-2030 is the ‘Decade of Healthy
Ageing’ for promotion of healthy elderly.
• WHO defines healthy ageing as “the process of developing and maintaining the
functional ability that enables wellbeing in older age.”
• Healthy ageing, like active ageing, emphasizes the need for action across multiple
sectors and enabling older people to remain a resource to their families, communities
and economies.
• It’s about ensuring that people can continue to live fulfilling lives as they age,
regardless of health conditions.
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 Dimensions of Healthy Ageing?

Healthy lifestyle slows cellular ageing soby:proceed

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Quick Quiz???
International Day of elderly???
• October 1
National Senior Citizen Day??
• Paush 11

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 Global scenario

Number of people age 65 years or

above in million
1800
1603
1600

1400

1200

1000

800 761

600

400
1960
260 2021
200
Source: World Social Report, 2023
2050
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 Global scenario contd…

Percentage of world population over 65 years, 1950-2050

Source: World
Social Report,
2023

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SHIFTING GEOGRAPHY OF ELDERLY

Source: World Social Report, 2023

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Population Ageing- A positive Indicator

• signals our extraordinary collective success in improving living

conditions
• high to low levels of fertility and mortality
• socioeconomic development

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 Population statistics Nepal
Population pyramid 2001 Population pyramid 2021

Source: CBS

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 Population statistics Nepal
Age wise population distribution 2012-2022 Life expectancy at birth, 1950-2100

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Source: www.statista.com/statistics/422727/age-distribution-in-nepal/ 16
Status of Ageing population in Nepal
Over 2.9 million people living in Nepal are aged over
60 which is almost 10.21% of the country's total population.

Nepal's average population growth rate is 0.92% and the

older population growth rate is 3.29% per year

Aging Index increased rapidly from 23.3 in 2011 to 36.7 in

2021.

The proportion of older people is expected to double to 18.6%

in 2050
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Policies and Programs for Senior Citizen in
Nepal

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S.N. Legal Documents Program Description
1. Constitution of Nepal Section 41
Rights of senior citizens: The senior citizens shall have the
right to special protection and social security from the State

2. Senior Citizen Act, Enacted by Government of Nepal to make provisions

2063 and Regulations immediately on the protection and social security of senior
2065 citizens

3. National Health 6.20 In accordance with the concept of health across the
Policy lifecycle, health services around safe motherhood, child health,
adolescence and reproductive health, adult and senior citizen
shall be developed and expanded

6.23.4 Coordination shall be made with concerned agencies to

establish senior citizen care centers with public private
partnership
Free Basic Health care services
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S.N. Legal Documents Program Description
4. Fifteenth Five Year plan 7.8.4 Senior citizens will be protected and a
(2076/077-2080/81) dignified life will be guaranteed.

5. The Social Security Act, Provision of allowance or support to the citizens

2075 (2018) entitled to social security

6. Health Insurance • Elderly (those above 70 years) are considered a

Regulation, 2075 unit with free inclusion in the service.
• Service worth NRs. 1,00,00 for each elderly
members
7. Policy and Program Strengthening of hospital providing geriatric health
2080/81 services; Senior citizens should receive discounts
and benefits in health and other sectors.

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S.N. Legal Documents Program Description
8. Geriatric Health • Geriatric friendly hospital establishment;
Service Operation • Treatment provisions for Parkinson’s, Alzhimer’s disease
Guideline, 2077 under Deprived Citizen Treatment Support Program
• Provision of service under HIP and if the insured amount is
insufficient then hospital should provide health service
under geriatric health service program
• 50% discount on specified health services to citizen above
the age of 60 years

9. Geriatric Health To motivate senior citizens to lead a healthy life and to create
Service Strategy, awareness at the family and community level to increase
2078 health-promoting work.

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S.N. Legal Documents Program Description
10. Social Security Act, Entitled with Social Security Allowance for
2075 (a)Senior citizens,
(b) Indigent,
(c) Incapacitated and helpless persons,
(d) Helpless single women,
(e) Citizens with disabilities,
(f) Children,
(g) Citizens unable to take care themselves.

11. Procedure for Senior As per the Senior Citizens Act 2006, at least two seats are
Citizens in Public reserved for the senior citizens and concession of at least Fifty
Transport-2014 percent on the passenger fare

Age of retirement from services:

Civil services- 60 years
Tribhuwan university-63
For high court- 65;Court of appeal and district court-63
Constitutional agencies-65
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 Programs for elderly
Ministry of • Program to operate establishment of hospital based
geriatric ward, social service unit and OCMC
Health and • Destitute Citizen treatment program (Alzhiemers,
Population parkinson disease)

• Conditional grant to the geriatric home,

organization providing geriatric services
Ministry of • Construction and Operation of Old Age Homes
(section 20 of senior citizen Act)
Women, Children, • Day Celebrations
Senior Citizen • Training to caretakers working on Old Age Homes
• Provision of Senior Citizen Identity Card(section
25 of senior citizen Act)
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 Programs for elderly Contd…

• Senior citizen above 68 years of age receive

Ministry of federal Rs 4,000 each/month
affair and local • Dalit and single women senior citizens
above 60 years of age get Rs 2,000
development each/month

• At least two seats are reserved for the

senior citizens.
Ministry of Physical • Discount of at least Fifty percent on the
Infrastructure and passenger fare.
Transport • Sajha Yatayat provides free bus ride to
elderly and disabled
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Programs for elderly- Local levels
• Distribution of warm clothes, blankets to elderly
• Assistive device distribution
• Home based palliative care services- Bhaktapur Municipality
• Establishment of day care centers, religious groups
• Conduction of screening camp
• Treatment service for Alzhimers- Bhaktapur hospital

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Geriatric Health Service Strategy 2021-2030

The strategy encompasses population-based and service delivery strategies for

healthy ageing and covers prevention, resilience building and primary health care,
living well with long-term health conditions, better support for senior citizens with
high and complex health needs and improving recovery and rehabilitation from acute
episodes.

Vision: “A meaningful, quality and healthy life for all senior citizens”

Goal: To enable senior citizens to lead active and quality lives on the basis of
optimum health protection and effective health service delivery.
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 Strategies
1. Motivate senior citizens for healthy living and enhance awareness at family and community
levels to reinforce health promoting actions. (Objective 1)
2. Strengthen and expand the health protection system for senior citizens. (Objective1)
3. Increase access to, and the affordability and utilization of quality health services and assistive
devices by senior citizens. (Objective 1)
4. Develop a senior citizen-inclusive health system to address the health needs of senior citizens in
an appropriate manner. (Objective 2)
5. Motivate and enhance the professional and technical competence of health personnel to provide
quality geriatric health services effectively and efficiently.
6. Expand and strengthen innovative and implementable social health insurance reform measures
to respond to the needs of senior citizens and their family members. (Objective 2)
7. Mainstream and institutionalize the health concerns of senior citizens into the health system at
all levels. (Objective 3)
8. Strengthen coordination and harmonization across spheres of government andacross sectors for
the effective delivery of geriatric health services. (Objective 3)
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Integrated care for older people (ICOPE) ?
• The identification of older people in the community with priority conditions
associated with declines in intrinsic capacity can be done with the help of the
integrated care for older people (ICOPE) screening tool.
• WHO’s novel concept called Intrinsic Capacity (IC) focuses on assessment of
one’s physical and mental abilities i.e. cognition, mobility, psychological, vitality,
and sensory functions.
Guiding documents:
• Guidelines on Integrated Care for Older People (ICOPE), 2017;
• Handbook: Guidance on person-centred assessment and pathways in primary care,
2019 provide recommendations for community-level interventions and clinical
practice , respectively
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six priority conditions associated with declines in
intrinsic capacity
• The ICOPE approach aims:
support health and care workers to detect
declines in older people’s intrinsic capacity
in community and primary care settings by
conducting person-centred assessments;
and developing personalized care plans
with older people.
Provides an opportunity to empower and
engage older people in their health and
care.
• Assessment and management of each of these
conditions as well as social care needs are
included
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The ICOPE approach: a five-step person-centred
assessment and care pathway

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Problems of elderly

• Problem due to Ageing process

• Psychosocial Problem

• Social and Emotional issue

• Economical issue

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Problem due to Ageing process
Common health conditions:
• Hearing loss

• Cataract

• Refractive errors

• Back and neck pain

• Osteoarthritis

• Chronic Obstructive
Pulmonary Disease
• Diabetes
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Psychological problems: Psychological problems:
• Depression • Elder abuse
• Anxiety • Change in societal roles
• Delirium • Multiple losses
• Dementia • Financial constraints
• Alzhiemers • Agism
• Loneliness
• Social Isolation
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Social and emotional issues: Economical issues:
• Loss of autonomy • Economically poor/financial
• Grief, fear, Loneliness dependence
• Lack of social network • Feeling of helplessness,
worthlessness, joblessness,
• Homelessness, Disappointment
• Financial constrains
• Increased Urbanization and Migration
• Due to Migration of productive
• Increased International migration for citizen workload increases
labor and educational purposes
• Inadequate social security fund
• Decrease in Morality
• Lack of autonomy on financial
• Shift from Joint family to Nuclear decision making at family
family (CBS
• Lack of recognition
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 Problems/Challenges on
Geriatric health in Nepal???

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 Problems/Challenges on Geriatric health
in Nepal
• Lack of adequate geriatrician
• Migration blues contribute to the separation of families, leaving elderly members
without essential care and support systems.
• With the increase in life expectancy associated rise in non-communicable diseases
and injuries
• Lack of adequate program to address specific health needs of elderly
• The societal shift from joint to nuclear family structures results in a lack of
traditional familial support, creating challenges in providing adequate care for
elderly family members.
• Urbanization and In Country Migration (66% live in urban area; 54% live in terai,
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 Problems/Challenges on Geriatric health in Nepal Contd…

• Lack of sufficient support from the state, both in terms of healthcare services and
social assistance.
• Elderly individuals encounter financial insecurity and social neglect, adding to the
difficulties of maintaining a decent quality of life in the absence of comprehensive
support systems.
• Old age homes are not operating according to the standard and are deprived of
proper care, support and basic need for comfortable survival
• Lack of an integrated approach in developing programs targeting geriatrics is
evident.
• Elderly individuals, especially those living in the poorest areas are facing financial
hardship or discrimination, do not have access to health and social care programs

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 Utilization by SSA

Source: A further analysis of MICS 2019 Nepal A further analysis

Prepared of MICS
by: Santoshi Poudel2019 Nepal 40
Highlights:
• Few programs have specifically targeted the health and social care needs of the elderly.
• Allowances for elderly individuals may not adequately cover healthcare expenses, and
the current healthcare practices impose significant costs on both elderly individuals and
their families.
• Role of the state is important to effectively implement existing policies and programs
and further develop and implement additional programs to promote effective
participation of elderly population groups in political, economic, social and health-
related aspects of the community.
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1. Fallow fields, frail bones: absence of younger people results in a higher
workload for the people remaining behind
2. Toothless villages, commuting elders: ear that no one would be left to live
with them except their “toothless companions,” meaning other old people and
small children.
3. Attitudes toward the elderly: Lack of respect, a decreasing sense of
commitment, and loss of authority
4. On uneven terrain: Older people's limited mobility restricts their ability to
access services
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 Management of Problem
1. Family’s Role:
• Respect them and try to adjust with them

• Provide reasonable family support for their day to day activities

• Encourage them to undertake independent activities to enhance their self-

esteem
• Discuss the problems and advise in soft and socially accepted manner

• Convey the message of love and respect through words and action

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 Family role contd..

• make room for open discussion between young and old generation

• Involve and include the elderly people in their talks

• Encourage the elderly people to discuss their problems freely.

• Train the children to develop the habit of listening to the wishes and interest of

the elderly people.

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2. Community Role
• Talk more about problems of elderly people with solutions through different medias
like newspaper, radio, television, plays etc.

• Arouse consciousness among different members of society of their duties towards

elderly people.

• Encourage local communities to initiate programs for the senior citizens on the basis of
felt need.

• Highlight the profiles of notable elderly citizen and acknowledge them focusing on
their achievements and successful stories and skills.
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2. Community Role
• Geriatric experience sharing sessions at educational institutes

• Promotion of local religious groups, learning platforms

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 3. Government Role

• Establish geriatric homes as per the national standard

• Run day care center for elderly in every locality with enough chance to interact with
people with different age groups
• Need to increase access to proper medical care specifically among elderly people in
the rural and remote areas. for this, local community support groups (e.g. mothers’
groups, clubs, religious groups) in collaboration with local health authorities could
organize outreach medical care services.

• Extension of programs to produce geriatrician within a nation

• Implementation and extension of ICOPE program

• Emphasis on moral education in school curriculum

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 3. Government Role

• Increase opportunity for income generating activities at younger age

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 Japan and its graceful Ageing
• Idea of of meiwaku i.e. “being a nuisance,”
is hard-wired from an early age, and society
functions on this guilt-laden philosophy.
• Instead of a fear of dead elderly in Japan
fear of being a burden on society and family
• Make effort to remain independent, both
financially and mentally.
• This fear manifests as a strong incentive to
keep working as a cog in the social wheel
for as long as possible.
• people aged 70 and above are either
working or engaged in volunteer activities,
community activities and hobbies.
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References
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8947834/
• https://www.dotm.gov.np/Files/78d42be1-a374-4bbc-9e4d-f397cf37961e_1.pdf
• https://
www.lawcommission.gov.np/en/wp-content/uploads/2018/10/senior-citizens-act-206
3-2006.pdf
• https://austinpublishinggroup.com/gerontology/fulltext/ggr-v8-id1075.php
• https://
www.lawcommission.gov.np/en/wp-content/uploads/2018/10/senior-citizens-act-206
3-2006.pdf
• https://
www.lawcommission.gov.np/en/wp-content/uploads/2018/09/senior-citizens-rules-2
065-2008.pdf
• https://bioone.org/journals/mountain-research-and-development/volume-37/issue-
4/MRD-JOURNAL-D-17-00034.1/They-Moved-to-City-Areas-Abroad--Views-of-the/
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