THE CURRENT STATUS OF THE ELDERLY
India has close to 120 million elderly people with a multitude of physical, psychosocial, economic, and spiritual problems. While the functionally and cognitively fit elders can access the regular healthcare facilities offered by the government, they also need an active aging program to keep them independent. Health Ministry has created geriatric care centers and geriatric clinics in most of the states.

However, these centers may not serve the functionally and cognitively impaired elderly. There is a dire need for mobile units, day-care centers, and hospices, and the need for training of personnel in-home nursing. Routine care clinics are not capable to handle the burden of the geriatric population to address their multi-morbidity and several other age-related factors.

There is a need for a rapid training of health-care professionals of various disciplines in geriatric care. The government must support nongovernmental organizations and other agencies which provide daycare, home care, and palliative care so that these services become affordable to all the elderly.
NIGHTMARES OF THE ELDERLY
Indian elderly confront several social issues such as lack of income security, elder abuse, loneliness, neglect, and poor access to healthcare. India also has a lack of policies on the advanced directive, palliative care, and end-of- life care for the elderly. These elderly people are classified into 3 groups –

Group 1 – Functionally and cognitively fit

Group 2 - Mild Functional Limitations or Mild Cognitive Impairment Group 3 - Severe Functional Limitations or Cognitive Limitations
NATIONAL HEALTHCARE PROGRAM FOR THE ELDERLY IN INDIA
The national policy on elderly people was announced in January 1999 to reaffirm the wellness of older people National Policy on Senior Citizens which is ready from March 30, 2011, is under the implementation stage. The major components of this policy included –

• To establish geriatric departments in all the existing eight Regional Geriatric Centers
• To strengthen healthcare facilities for the elderly at various levels of 100 identified districts in 21 states of the country
• For Regional institutions to provide technical support to geriatric units at district hospitals whereas district hospitals to coordinate and supervise activities at Community Health Centers (CHC), Primary Health Centre (PHC), and sub-centers

WILL THEIR NEEDS EVER BE MET?
The sub-centers and clinics cater to the needs of the elderly who can access healthcare facilities. The majority of Group-1 and a small portion of Group-2 elderly who are fortunate to have the assistance from family members or neighbors can access these facilities. These centers are so crowded with other programs that the elderly do not get enough time to get a complete assessment. Hardly, any rehabilitative facilities such as occupational therapy are available even in district hospitals.
Health Promotional Activities
Thanks to the execution of Non-Communicable Disease (NCD) program, at least in some districts, elderly are getting tested for diabetes and hypertension regularly and getting free medications. NCD clinics are equipped with staff to advise on a healthy diet and exercise. However, vaccination for the elderly is still in its infancy and is an unmet need.
Mobile Units (unmet needs)
Even though some of the Non-Governmental Organizations (NGOs) such as Help Age India have started Mobile Healthcare Units including physiotherapy services, the Health Ministry is yet to provide care through mobile geriatric care units. Kerala Government has set up various palliative care units that have mobile services. However, at the national level, it is an unmet need.
Workforce Development (unmet needs)
National Institute of Social Defence (NISD) is giving training to the employees of the voluntary organizations caring for the elderly. However, the demand for home care personnel is so high that untrained persons are getting into jobs with no time for training. Various NGOs have developed home care facilities in Metros. However, these are too pricey and unaffordable to the common man.
Hospices (unmet needs)
The Group-3 elderly with severe functional and/or cognitive impairment cannot be managed at home unless they hire home nurses or trained home people are available. Currently, hospitalization becomes mandatory as they need palliative care. There is a need for hospices that provide palliative care. Albeit, palliative care homes exist in some places, they accept only cancer patients but not geriatric patients. There is a need to create more hospices that cater to the needs of the elderly. There is a need for separate facilities for dementia care.
Daycare centers (unmet needs)
If we have to keep our elderly full of life and independence, we need an active aging program for the elderly. Day-care centers for active aging may be used for group exercise, to provide at least one wholesome meal, for recreational activities such as adult learning, library, and development of new hobbies, and also for income-generating activities.
WAY FORWARD
Healthcare of the elderly cannot be achieved unless we address total health, such as physical, social, economic, psychological, and spiritual aspects. Unless we address all these issues, geriatric health cannot be ensured. The governmental facilities alone may not be enough to cater to the needs of this huge population.

By 2050, India is going to have 20% of the Geriatric Population. NGOs have to step forward to generate assistance. The government should offer some aid to NGOs so that they provide affordable services. All the private healthcare institutions in confluence with the government should create geriatric healthcare facilities. The national program has to be implemented all over the country on an urgent basis. All the facilities addressing the unmet needs have to be implemented in every village and city across the country.

Jehangir Hospital offers holistic geriatric healthcare through its Geriatric Centre with an integrative, multi-disciplinary program exclusively created for the elderly. The program focuses on cognitive stimulation along with restoring and maintaining the physical function. It has also been proven that group-based psychosocial and physical activity programs help in improved attention and concentration, increased confidence, improved physical strength and ability to perform routine activities, encourages socialization, prevents falls and injuries, and enhances their overall quality of life.