Would you take a train to keep your doctor’s appointment? Every three months, 72-year-old Pawan Kumar from Bihar’s Muzaffarpur does just that, helped by his son or daughter. Although he has to use his bladder bag, he doesn’t miss his appointment at the AIIMS National Centre for Ageing, where doctors not only listen to all his woes, they screen his parameters without asking and prescribe a routine that makes him feel “normal.” And that magic word is all the elderly need to keep going. They fear a disease as that would mean using up their resources in the absence of medical insurance.
That’s why the government’s recent decision to expand the Ayushman Bharat health coverage to include everyone over the age of 70 years will go a long way towards keeping the elderly healthy. The Rs 5-lakh cover may be too little for some battling multiple health conditions but it can still lower their medical bills and out-of-pocket spends. Simultaneously, a greying population also indicates a need to invest in holistic care facilities that can provide a safety net.
Kumar has been dealing with recurrent infections for years because of the bladder bag he has to use — a cancer survivor, his urinary bladder was removed 10 years ago for cancer treatment. “I have to take antibiotics for infections but they have side-effects. I feel nauseous, my mouth dries up and my lips shrivel up. Most of the time I do not have any appetite. And eating less also affects my diabetes. I come here every three months to get my medicines adjusted and to make sure that all my parameters are normal,” he says while waiting outside the physiotherapist’s clinic for his mobility exercises.
Geriatric care needs a multi-disciplinary approach of managing the person’s age-related disorders, chronic illnesses, emotional and functional well-being.
WHAT’S GERIATRIC CARE?
Every day, 350 people over the age of 65 years visit various clinics, all conveniently located on the ground floor, at the National Centre for Ageing, which promises holistic care under one roof. Geriatric care needs a multi-disciplinary approach of managing the person’s age-related disorders, chronic illnesses, emotional and functional well-being. “For example, an elderly man is likely to have multiple morbidities, say diabetes, knee pain, forgetfulness or an enlarged prostate. If they go to different specialists for each complaint, their bills go up and they will have a problem of taking too many pills prescribed by each,” says Dr Prashun Chatterjee, professor in the department of geriatric medicine at AIIMS. The role of the geriatrician is to integrate the therapy protocol unless a problem is too big and the patient has to be referred to a specialist, say an endocrinologist or orthopaedician.
In fact, the centre has certain speciality clinics like orthopaedics, oncology and general surgery. “If an elderly person is diagnosed with cancer, the oncologist will check with the geriatrician on the patient’s capacity to tolerate chemotherapy or surgery. If the patient is vulnerable, then the two can work on alternative options,” says Dr Chatterjee.
AN AFFORDABLE SAFE SPACE
Given his long treatment protocol at AIIMS, Kumar knows the ins and outs of processes like getting a bed, seeking a surgery date and completing treatment. “While you have to queue up, this is also the best care one can receive at the most affordable cost. With the new cover, I may be able to get sizeable relief,” says Kumar, who was treated for a pancreatic cyst in 2009 and then bladder cancer in 2011. As of now, he pays for his travel and treatment since he does not have health insurance. “Most patients are from poorer families, do not have insurance policies and end up selling their assets for treatment,” says Dr Chatterjee. A government hospital, therefore, seems an affordable option. Once they sign up, the Ayushman card should help them cut down costs.
SCREENING FOR AGE-RELATED DISTRESS
Seventy-eight-year-old Rama Devi* complains of restlessness, sweating and a sharp back and leg pain at night. While diagnosing what led to her condition, the doctor asks her if she has memory problems too. “Yes, I do tend to forget things, find it difficult to remember where I had kept certain household items or who I was looking for,” she says.
As part of preparations for healthy ageing, all patients over the age of 70 years get screened and tested for cognition, memory, depression, nutrition, mobility, muscle loss, vision and hearing issues. A red stamp on the prescription — which lists both present or absent symptoms — can be encircled by the assessor to provide relevant information quickly to the treating doctor.
“This screening can help us pick up conditions such as dementia and Alzheimer’s early on, when the patients can be given medicines to slow the cognitive decline,” says Dr Chatterjee. The screening module also helps zero in on the patient’s mobility and risk of falls. “It is very common for the elderly to restrict their movement once they have had a fall. But this is counter-intuitive because movement is the key to keeping our bones and muscles healthy. So we figure out the reason for the fall and tackle that. It could be muscle loss for which they can undergo physiotherapy, it could be a problem of vision that we can try and correct, it could be because of a hearing problem,” says Dr Chatterjee.
SUPPORTIVE CARE
Equally important as doctors are the personnel providing supportive care. When 67-year-old Shyam Kumar — who already has advanced dementia — complains of leg pain, loss of balance and a lack of appetite, the attendant arranges slots to meet the physiotherapist, who can help him with the pain, the optometrist, who can check his vision, the cognitive therapist, who can teach him some memory exercises, and the nutritionist, who can help him with the diet.
“The idea is to screen and provide them every kind of therapy at one place,” says Dr Chatterjee, who believes that quality care is all about sensitivity.
(*Name changed to protect privacy)
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