Facing the challenge of an ageing population in India.

Alzheimer's Disease, a report about care of the elderly in India

Ms Hendi LINGIAH

A conference was held from 24th to 28th of March 2008 at the Goa Medical College, Goa, India, on “Improving Quality of Care of the Elderly” with central Theme : Dementia Care. This was in collaboration with the Alzheimer’s Disease and Related Disorders Society of India. The participants were the people involved with the Care of the Elders in Goa: Doctors, Old Age Home directors, Caregivers and elderly themselves. I felt priviledged to have had the opportunity to attend.

All over the world, the elderly population is growing continuously and in the next and it is projected that in the next few decades most of the elderly people would be in the developing countries. With improving living standards come better health and more access to medical services, leading to a decline in mortality rates and higher life expectancy.

To cope with this challenge, the National Institute of Social Defence (NISD), an autonomous body under the Ministry of Social Justice and Empowerment, has launched a National Initiative on Care for Elderly which aim to educate and train persons providing care to the elderly.

The NISD as an advisory body, a Resource and Training Centre of Excellence, runs geriatric care courses every six months in several regions of the country to make caregivers aware of the specific physical and psychological conditions of the elderly. It carries out comprehensive certificated courses provided by specialists in geriatric and gerontology on several themes. The courses cover all aspects of elderly care, problems faced by them medical and psychological ones explaining how to provide proper care in each case, a proper practices. Also and most importantly, the program emphasizes on the importance for all caregivers to be aware of the implications and the multidimensional aspects of the care of the elderly.

The Institute, through orientation workshops, also aims to create awareness among the population, including the elderly and their families, about the facilities available for them; to inform institutions/organizations private or public, of the issue of an ageing population. It then emphasises the necessity to make common efforts between government and non government bodies in implementing proper care services and infrastructures, and ultimately, to develop public health policy for the welfare of the elderly.

My contribution to that training program, at the request of Dr. Amit DIAS of the Dementia Society of Goa, the coordinator and main trainer with his colleagues from the Goa Medical College was to give a talk on my personal experience in France, a presentation of the structure I am currently working in, its aims and organization and my role in it as a psychologist. Featuring how these structures developed mostly by the Municipalities through a social policy, are inserted in the government’s public services policy in France.

Many others speakers, medical practitioners, geriatrists, psychiatrists, physiotherapists and nurses; all currently working with elderly and perfectly trained in dementia gave their contributions during these five days. They covered all aspects of Elderly Care such as: Health Problems in the Elderly, Understanding the Human Brain, Healthy Ageing, Medication, Dental problems, Nutrition, Basic Nursing Care, Physiotherapy, Prevention from fall and Assisting activities of daily living.

The Central Theme, Dementia Care, was approached through the sessions: Understanding Dementia, Aggressive behaviour in Dementia and its management, Patients with Severe Stage Dementia. Short films illustrated the disease’s signs, its effects on the family, the way to manage and the absence of help and understanding the patient and the family members were experiencing. Alternatively with these teaching sessions, the participants could ask questions, discuss situations and get advice from the specialists.

We also had Group Work sessions where I had the opportunity to get to know more of the participants and discuss with them the issues they are facing in India while offering services and care for the elderly. The Group Work sessions were specially designed to address these issues, pointing out the difficulties of working in that field, which the average population and institutions are not yet aware, specific knowledge and care practices with elderly, maintaining the structure, recruiting staff, financial resources especially were also explored.

Representatives of the NGO HelpAge India gave a talk on their action in Goa; explaining how they are supporting the eldely with Old Age Homes and how they are working through the Mobile Medicare Unit. They also mentioned the activities they plan to do in the future as the Helpline, Income Generation Program, Day Recreational Centre for Destitute and Rehabilitation of Retired Sex Workers are developed.

A special point was made about the Home Care Project, a research project launched by the Dementia Society of Goa. It is a home-based interventions project as an alternative to clinic-based interventions which are more orientated toward acute conditions of those affected by Alzheimer’s Disease. The project aims to set up within the Community a Home Care Advisor whose role would be to design individualized protocol for their situation at Home with the sufferer and his family.

Furthermore, the important issue of Elderly Abuse was approached through the Family Elderly Protection Law and its implementation on which specialists in geriatrics and gerontology are working today.

I also visited an Old Age Home, a private one, run by Sisters from a Religious Congregation in Goa. During the visit, I could talk to the residents and the owner who gave his house for this specific use. I shared my experience with the Sister Director. We discussed the functioning of the Home and shared our respective views.

Conclusion :

This training gave me the opportunity to learn more about the aged in India, the issues face in the present political climate. As a psychologist in the field of elderly care, I found this training very rewarding. The varied caregivers and medical practitioners met each other and addressed their issues in the aim of working closely in collaboration.

Such initiative provided a valuable contribution to the education and training of those institutions and families, directly taking care of the Elderly People especially those suffering from Alzheimer’s disease. Moreover, it made the caregivers, juniors and seniors, aware of the opportunities available in working with the elderly; removing their fears through information, training and supervision.

It also created an awareness throughout the population; sensitize more people to the issue of ageing, Alzheimer’s disease and appropriate behaviours. Mostly, it encouraged them to seek help and consult a geriatrist if necessary.

Goa is thus building a network of elderly care professionals throughout the territory, implementing protocols of proper care practices among the caregivers, with the aim of setting up proper care services for elderly in health institutions, at home or in residential settings. These professionals are working today on prevention and education, applying practical interventions, building a professional caregiver’s network. Let’s value this initiative of official bodies and organizations of the country in facing the challenge of a “greying population” in India.

About the author

Hendi Lingiah is a clinical psychologist presently working in France in the field of elderly care in a Communal Center for Social Action promoted by the City’s Municipality. She is involved in Gerontological Coordination organizing interventions for elderly at home, especially those affected with Alzheimer’s disease. Originally from Mauritius, she has been associated with a project of residential setting in India for people suffering from dementia, connected to the newly launched comprehensive website for senior citizens in India silver inninigs.com