India Poorly Equipped To Deal With140 Million Senior Citizens By 2021


New Delhi:An elderly couple from Mumbai had written to the President’s office on Monday, seeking permission for “active euthanasia”, where a person is killed, usually by administering an overdose of pain-killers.

The couple, IravatiLavate, 79, a retired school principal, and her husband Narayan, 86, a former government employee, have no major health problems and no children.

While present laws in the country do not allow active euthanasia, the couple would have had a hard time even in countries that do because they don’t have any life limiting disease.

If the Indian State refuses to admit their plea for assisted suicide, they will have no other option but to go for palliative care at old age homes.

The World Health Organization defines palliative care as “an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness”.

This is done through the prevention and relief of suffering by means of early identification, meticulous assessment, and the treatment of pain and other associated problems. These collateral conditions are usually, physical, psychosocial and spiritual in nature.

India ranks abysmally low in palliative care, which is not yet integrated into the health care system of the country. In a report commissioned by The Economist last year, India ranked 67th out of the 80 countries on the Quality of Death Index.

The second Saturday of October every year is considered as the World Hospice and Palliative Care Day.

Why is it important for the Government to plan for palliative care?

The population ageing, started in the last century with developed countries, is now encompassing developing countries too. India, by no means, is an exception to this phenomenon.

Over the years, the structure of population has changed and will further change in the time to come. The proportion of older persons in the population will increase.

India is home to one-fifth of the global population. With a crude death rate of 8.2 per 1000, the number of people dying each year in India is more than 9.8 million.

Noncommunicable diseases (NCDs), mainly cardiovascular diseases, respiratory diseases and cancer, account for more than half of these deaths in India.

The total number of people in need of palliative care in the country is estimated to be more than 5.9 million.

According to official population projections, the number of elderly persons will rise to approximately 140 million (approximately 10% of the population) by 2021.

NCDs largely affect middle-age and older populations, the groups growing the fastest. About 64 per 1000 people ages above 60 in rural areas and 55 per 1000 in urban areas suffer from one or more long-term disabilities.

The highest number of patients needing palliative care in the future will come from the terminally ill elderly people. Seven out of every 10 Indians live in rural areas, which are served by about 2% of qualified medical doctors.

Places that offer palliative treatment like old age homes few and far between

There are very few places that accept the elderly in our country in their last days.The first formal palliative care service in India was initiated in 1986 as a hospice in Mumbai.

One such place isBengaluru’s Karunashrayawhich helps dying cancer patients deal with loneliness and inevitability.

“On an average, we get 90 new admissions in a month,” says NageshSimha, a surgeon and palliative care physician who has been serving as the medical director of Karunashraya since it opened in 1995 as a home care centre.

Simha explains that most patients reach Karunashraya only when they have passed the curative stage of cancer. Symptoms often don’t show up in the early stages and poor patients rarely have the means to afford treatment since they are diagnosed late. About 75% of the patients who come here cannot afford further medicine and have no one to care for them.

“Only 1-2% of the Indian population that needs palliative care has access to it,” says Simha. So far, it has touched the lives of over 11,000 patients, of whom almost 8,000 have passed away.

From actor Aamir Khan to cricketer Rahul Dravid, a number of celebrities have contributed liberally to the hospice, but a lot of people from underprivileged backgrounds have also taken pains to contribute in their own little way.

Implications of not having good palliative care

Population ageing has profound social, economic and political implicationsfor a country. The increasing number of older persons put a strain on health careand social care systems in the country.

Old age comes with lot of ailment anddiseases. In case of large number of elderly persons in the population, the countryneeds more and more health and medical services, facilities and resources.

Moreand more number of hospitals, doctors and nurses are required. Government spendingon health care is increased with the increase of average age of population.

With the increasing trend of nuclearfamilies in the society and with fewer children in the family, the care of olderpersons in the families gets increasingly difficult. To fulfil caring needs of agedpersons more and more nursing people with appropriate skills are required.

Kerala Model of Old age care

The government of Kerala took a major step tosupport development of palliative care by declaringpalliative care as part of Primary Healthcare in thestate through an official government policy in 2008.

It has managed to develop anintegrated health service delivery model withcommunity participation in palliative care. Theevolving palliative care system in Kerala tries toaddress the problems of the incurably ill, bedriddenand dying patients irrespective of the diagnosis.

Theprimary healthcare system in Kerala plays a majorrole in these activities. The ‘Quality of Death’ studyby Economist Intelligence Unit states that ‘Amid thelamentably poor access to palliative care acrossIndia, the southern state of Kerala stands out as abeacon of hope.’

Although India ranks at the bottomof the index in overall score, and performs badlyon many indicators, Kerala, if measured on thesame points, would buck the trend. With only3% of India’s population, the tiny state providestwo-thirds of India’s palliative care services.

The main components of Kerala’s program are community mobilization and ownership by thelocal community and involvement of the local self-governmentinstitutions (LSGIs) who incorporate palliative care in the primaryhealthcare system.



Suresh Kumar,Models of delivering palliative and end-of-life carein India, Current Opinion Support Palliative Care 2013, 7:216–222

Elderly In India – 2016, Ministry of Statistics and Programme Implementation (MOSPI)

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