Why is community-based elderly care in J&K much needed?

A tale of two eldersAbdul Aziz 72 from a remote village in Kupwara has diabetes hypertension and severe osteoarthritis of both knees He takes eight different pills every day ndash or rather he tries to Some days he forgets Some days he runs out and cannot afford the 150 km round trip to the district hospital Last winter a minor foot ulcer turned into a diabetic foot infection because no one checked his feet at home He spent three weeks in the hospital lost a toe and his family spent over 50 000 on travel and lost wages ldquo I became a burden rdquo he whispers ldquo My son had to borrow money rdquo Fatima Begum 68 lives alone in an old house in downtown Srinagar since her husband passed away Her blood pressure is poorly controlled but that is not her biggest complaint ldquo I don rsquo t feel like eating I don rsquo t feel like talking I just sit by the window rdquo she told me She has classic depression ndash undiagnosed untreated Her children live in another city and call once a week No health worker has ever visited her home She stopped taking her blood pressure medicine six months ago No one noticed These are not isolated cases They are the faces of a silver tsunami that is silently sweeping across Jammu and Kashmir By 2031 nearly one in six residents will be over 60 years old Our hospitals are filling up with elderly patients suffering from a relentless epidemic of non communicable diseases NCDs diabetes hypertension heart disease chronic lung disease kidney and liver failure crippling osteoarthritis and the silent epidemics of anxiety and depression The latest National Family Health Survey NFHS 6 2023 24 confirms that one in four women and one in five men in J amp K already have elevated blood pressure Diabetes is surging But the numbers only tell part of the story Behind every statistic is a grandfather struggling to walk due to arthritic knees a grandmother forgetting her medicines because of depression a family selling land to pay for repeated hospitalizations These are not conditions that can be fixed with a single hospital visit they require continuous compassionate community based care Yet our health system remains stubbornly hospital centric ndash designed for emergencies not for the daily lifelong management of chronic illnesses and the complex web of vulnerabilities they create The hidden burden Beyond just numbersThe elderly in J amp K face a cascade of interconnected challenges that a hospital centric model simply cannot address The NCD epidemic Hypertension diabetes chronic obstructive pulmonary disease COPD chronic kidney disease CKD chronic liver disease CLD and osteoarthritis are rampant An elderly person often has two or three of these at once each complicating the others Arthritis alone especially osteoarthritis of the knees and hips robs mobility and independence turning a home into a prison Mental health crisis Anxiety and depression are nearly universal among the chronically ill elderly yet they are almost never diagnosed or treated at the community level A depressed senior is less likely to take their diabetes medication more likely to neglect diet and more prone to falls and fractures Immunocompromise Ageing and chronic diseases weaken the immune system The elderly are more vulnerable to infections ndash from seasonal flu to COVID 19 to urinary tract infections that can spiral into sepsis Without regular home based monitoring these infections are detected late leading to avoidable hospital admissions Polypharmacy An elderly patient with diabetes hypertension arthritis and depression may take 10 15 pills a day Managing this at home without a trained health worker rsquo s supervision leads to missed doses dangerous drug interactions and side effects like falls from blood pressure medicines Hospital centric care cannot fix polypharmacy only a community based pharmacist or nurse can The four dependencies Financial dependence Chronic diseases drain savings SEHAT covers hospitalisation but not daily medicines travel or lost wages of family caregivers Physical dependence Arthritis and frailty make climbing stairs cooking and even bathing difficult Hospital visits become torturous journeys Social dependence Many elderly live alone or with overburdened children Isolation worsens depression and leads to neglect of health Emotional ... or Community Health Officer These are trained professionals who lead the primary healthcare team at the HWC going door to door to screen for diseases check blood pressure and blood sugar and make Ayushman cards This proactive community based approach is exactly what we need 3 Tackling the root cause National Programme for Non Communicable Diseases NP NCD The NP NCDCS National Programme for Prevention and Control of Cancer Diabetes Cardiovascular Diseases and Stroke establishes NCD cum Geriatric clinics in district hospitals where opportunistic screening for diabetes hypertension and common cancers is done for all individuals aged 30 and above This program is specifically designed to be delivered through the HWC network integrating screening and management of chronic diseases right at the community level A pilot that points the way Home based care in Hazratbal In Block Hazratbal the Department of Community Medicine at Government Medical College GMC Srinagar in partnership with the Block Medical Office has launched a pioneering domiciliary home based healthcare pilot for the elderly What makes it unique is that it uses MD Community Medicine students to provide doorstep care These young doctors visit elderly citizens in their homes check blood pressure and blood sugar adjust ... is A dedicated ldquo J amp K Healthy Ageing Mission rdquo to coordinate efforts across the Health Social Welfare and Planning departments A formal evaluation and scale up plan for the Hazratbal domiciliary pilot with clear timelines and budgets Training programs for ASHAs and MLHPs in geriatric care ndash including dementia recognition fall prevention palliative care and mental health first aid Public awareness campaigns to destigmatise ageing and encourage families to use community health services before emergencies arise The silver tsunami of an aging population need not be a disaster With a community based strategy that integrates health insurance wellness centres NCD control programmes and social support we can turn this wave into a silver lining ndash one where our elderly live longer healthier and more dignified lives free from the tyranny of polypharmacy protected from infections and liberated from financial physical social and emotional dependence Our elders have given us their best years It is time we give them the care they deserve ndash in their own homes in their own communities The author is Professor and Head Department of Community Medicine Government Medical College Srinagar Views are personal but the science and the research agenda are not nbsp