Multi Service Health centre for Social, Physical and Mental Health of Older Persons

  1. Rationale:

    The biggest achievement of the last century was greater longevity that has resulted in an increasing aging population worldwide. According to the census 2001, the population of the elderly (age 60 years and above) in India was 75.9 million, i.e. 7.4% of total population. It is projected to be 113 million, i.e. 8.9% of total populations by the year 2016.

    1.1 Older person faces particular difficulties in the following key areas: • Physical and Mental Health;
    • Community Care;
    • Social Care;
    • Housing;
    • Transport;
    • Education and Leisure;
    • Access to Information;
    • Decision-Making.

    1.2 Social issues:
    With fast changing socio-economic scenario, industrialization, rapid urbanization, higher aspirations among the youth and the increasing participation of women in the workforce, roots of traditional joint family system has been eroding very fast. In urban areas of the country traditional joint family system has become thing of past. In such changing situations, majority of older persons, who have passed most part of their life with their joint/extended families are on the verge of isolation or marginalization in old age. At this age, when they need family support most, they have to live on their own. Social marginalization, abuse, financial insecurity, loneliness, isolation and even negligence in old age lead violation of Human Rights of Older Persons. Ironically, in India older generations are not aware of their human rights due to high prevalence of illiteracy and lack of awareness.

    1.3 Health issues:
    Diabetes, hypertension joint pains, respiratory diseases are common health related problems seen in older persons. Healthcare in India constitute government and private sector having primary, secondary and tertiary healthcare facilities. There is hardly any hospital having specialised geriatric facility. The various problems faced by the healthcare industry are shortage of doctors, nurses and infrastructures leading to unavailability of cost effective and accessible healthcare. There is a lot of gap in health emergency situations which is either unavailable or too expensive for the older person.

    1.4 Ageing in Place:
    Old age homes and assisted living facilities may not be solutions for majority of elder population in India. The theory of Ageing in Place is based on the project Age Friendly Initiative of Dharma Foundation of India (DFI) is grounded in sound international research and knowledge based on important principles and guidelines by WHO Active Ageing Policy and Towards Building an Age Friendly City. The project presents the vision of the new partnership involving older people, its aims and approaches, and an outline of practical and cost effective ways to achieve them through innovative changes in the community. Preventive care programs of Community Care Centers managed by elders along with physiotherapists and dieticians may be a solution for making a community age friendly.


    2.1 Workshops on health and social issues:
    The project starts with 27 awareness programs/ workshops (once a week) on prevalent chronic health, social and environmental issues of elders in the community. These workshops are taken by healthcare providers, sociologists, lawyers and lawmakers for continuous education and empowerment of elders on various issues pertaining to their everyday life. Briefs of these lectures are translated in local languages and distributed as booklets to the elderly who attend the workshops.

    2.2 Groups:
    There will be selection of voluntary elder members of this organization who would take the responsibility as a group leader/local supervisor. Small groups of 10-15 elder subjects shall be made. Social interaction will be encouraged in smaller groups where group leader conduct exercises/recreational activities/discussions.

    2.3 Multi Service Health centre for Self Management and Community Wellness Program:

    1. Primary care: Primary care providers are on the frontlines of providing the care people need to avoid getting ill and to intervene early when they’re sick to try and prevent serious complications requiring more acute levels of care. When people can have their ongoing health care needs met close to home, then potential problems can be addressed early and chronic conditions better managed. Keeping people healthy in the first place is better than treating them once they become sick. Healthy people require fewer health care resources and recover more quickly when they do get sick. Primary care is the first line of defence in keeping people healthy. Primary care providers are key partners in achieving and advancing a high quality, sustainable system.

    2. Social Security Program: An inclusive social security program for older persons utilizing tools like value based education, awareness generation, research & advocacy to protect Human Rights of Older Persons

    3. Community Physiotherapist: To help the elders of the area to avail basic health facility the DFI will run a CCC in a small space allocated by Senior Citizen Organisation (SCO). The clinic will be managed by active elder members of the SCO. The services provided include caregiver education on nursing and management of long-term conditions such as diabetes, COPD, heart failure, an urgent care centre, hospital discharge facilitation and rehabilitation, caregiver eduaction,physiotherapy, services are provided in patient’ own homes.A trained (graduate or post graduate physiotherapist) will work for 4 hours in the CCC. There will be basic equipments for physiotherapy pain relief modalities, and mobility aids. Equipments to measure blood pressure, blood glucose, and nebulizers will be available in the clinic. The nutritionist will visit the community elders twice a month to assess nutritional uptake and guide diet taken by elders.. A small fee of Rs 30/-is paid for consulting physiotherapist and the nutritionist. The older persons prefer the services as they can walk to the clinic which is accessible to those staying nearby. Around 10-15 elders can avail this service every day. The Community Therapist shall also do one on one home visits to screen health, social and mental issues and supervise elders who need long term care. The revenue generated shall be utilized by SCO in running the CCC(electricity/maintenance of equipments etc)

    4. Integration of community care and hospital services: Hospitals would play an important role by integrating various preventive and curative health services for older persons in the community. Easy discounts for the senior citizens will be offered by nearby Hospitals (Consultations, Preventive Health Checks, Physiotherapy, Blood tests, Discounts for various surgeries can also be taken into consideration etc).The CCC shall promote such facilities available in the hospital. The CCC connects community elders to the Hospital. On discharging elderly patient’s home from hospital after an acute episode, necessary community support from CCC with a focus to understand the health implications of elderly patients, families are in a better position to judge what's best for them. CCC provides patients with an appropriate level of care in the comfort of their own home. This philosophy would be a shift in thinking where the focus is on discharging elderly patients home after an acute episode in hospital instead of assuming that a long-term-care home is the only option. Technology like mhealth and Point of Care shall help communication between CCC and the hospital and older person in the community.


    Health and social services delivered within a neighbourhood by local people in local establishments, and community-based support and voluntary groups can play an important role in delivering support and care to older persons.The Self-Management and Community Program will not conflict with existing programs or treatment as it is designed to enhance regular treatment and disease-specific education given by clinicians/family physicians in healthcare organization. It may form a cost effective way to introduce prevention of co morbidities, education and information centres in elders.Systems that integrate and coordinate health and welfare programmes will be both more effective and efficient in addressing the type of health care needs of many older persons. Integration is a basic requirement both in and among health and welfare sectors. The community care centre (CCC) is proposed as a means of spreading awareness on the social issues and primary healthcare approach to better address the needs of older adults. The proposed approach provides a framework for integrating health and welfare systems and strengthens older peoples ‘connections to their family and communities regardless of abilities or disabilities”