Organization of Geriatric Health Services in India

1. Introduction to Elderly Care in India

The unprecedented increase in human longevity in the 20th century has resulted in the phenomenon of population aging all over the world. Countries with large populations like India have experienced significant growth in their elderly population. Elderly care has become an essential component of healthcare delivery systems to address the unique health needs of this growing demographic.

Geriatric healthcare services in India showing multiple levels of care from community to tertiary level

In India, elderly care faces unique challenges due to changing family structures, urbanization, and increasing burden of non-communicable diseases. Traditionally, elderly care was primarily provided within family settings, but demographic and social changes necessitate formal healthcare systems specifically designed for the elderly.

The healthcare needs of the elderly are complex and multidimensional, requiring an integrated approach that includes preventive, promotive, curative, and rehabilitative services. To address these needs, India has developed comprehensive geriatric health services and implemented specific programs like the National Programme for Health Care of Elderly (NPHCE).

Key Concept: What is Elderly Care?

Elderly care refers to the specialized care and services provided to older adults to meet their unique medical, physical, social, and psychological needs. It encompasses various aspects including healthcare, nutrition, mobility assistance, cognitive support, and social engagement aimed at maintaining dignity, independence, and quality of life for elderly individuals.

2. Geriatric Population Demographics

India’s elderly population has been steadily increasing over the decades. According to the 2011 census, the elderly population (aged 60 years and above) was 8.14% of the total population, which has significantly grown from 7.7% in 2001.

Year	Projected Elderly Population (millions)	Percentage of Total Population
2021	133.32	~10%
2031	178.59	~12%
2041	236.01	~14%
2051	300.96	~19%

Health Profile of Elderly in India

According to various National Sample Surveys and the Longitudinal Ageing Study in India (LASI), the health profile of elderly Indians shows:

75.68% of elderly people have one or more chronic diseases
53.63% have one chronic disease
20.83% have two chronic diseases
3.01% have three chronic diseases

The disability profile among elderly people in India shows:

40% have one or more disabilities
38.39% have one disability
15.44% have two disabilities
5.88% have three disabilities

Important Note for Nursing Students

Understanding demographic trends is crucial for planning elderly care services. The rapid growth of the elderly population in India indicates the increasing importance of specialized geriatric care in community health nursing practice.

3. Organization of Geriatric Health Services

The organization of elderly care services in India follows a hierarchical structure that aims to provide comprehensive care at different levels of the healthcare system. This organization ensures that elderly patients receive appropriate care based on their needs and the complexity of their health conditions.

Levels of Geriatric Care Services

Level	Key Features	Functions
National Level	National Centers for Ageing (NCAs) Policy formulation and implementation National Resource Centers	Tertiary care centers of excellence Development of evidence-based protocols Research, education, and training National guidelines for geriatric care
State Level	Regional Geriatric Centers (RGCs) State Health Society	State-specific implementation Training of healthcare professionals Monitoring and evaluation Fund management and distribution
District Level	Geriatric clinics and 10-bedded wards District Health Society	Specialized outpatient services District-level coordination Referral services for complex cases Implementation of geriatric services
CHC Level	First referral unit Geriatric clinics twice a week Rehabilitation units	Physiotherapy and counseling Home-based care coordination Health promotion activities Referral to district hospitals
PHC Level	Weekly geriatric clinics Basic health assessments	Provision of medicines for chronic ailments Public awareness activities Referral to CHCs/district hospitals Basic health assessments
Sub-Centre/ Health & Wellness Centre	Health education Domiciliary visits	Basic care for home-bound elderly Provision of supportive devices Linkage with support groups Community outreach

4. National Programme for Health Care of Elderly (NPHCE)

4.1 Background and Rationale

The Ministry of Health & Family Welfare launched the “National Programme for the Health Care of Elderly” (NPHCE) during 2010-11 to address various health-related problems of elderly people. The program was introduced in recognition of the growing elderly population and their unique healthcare needs.

The NPHCE is an articulation of international and national commitments of the Government as envisaged under:

UN Convention on the Rights of Persons with Disabilities (UNCRPD)
National Policy on Older Persons (NPOP) adopted in 1999
Section 20 of “The Maintenance and Welfare of Parents and Senior Citizens Act, 2007”

The NPHCE recognizes that elderly individuals have distinct physical, emotional, social, and economic needs that require specialized healthcare services. The program was designed to be state-oriented with a basic thrust to provide dedicated healthcare facilities to senior citizens (>60 years) at various levels of primary, secondary, and tertiary healthcare.

4.2 Vision and Objectives

The vision of the NPHCE encompasses:

Providing accessible, affordable, and high-quality long-term, comprehensive and dedicated care services to an aging population
Creating a new “architecture” for Aging
Building a framework to create an enabling environment for “a Society for all Ages”
Promoting the concept of Active and Healthy Aging

Specific objectives of NPHCE include:

To provide easy access to promotional, preventive, curative and rehabilitative services through community-based primary healthcare approach
To identify health problems in the elderly and provide appropriate health interventions
To build capacity of the medical and paramedical professionals as well as caregivers within the family
To provide referral services to elderly patients through district hospitals and regional medical institutions
To create convergence with National Rural Health Mission (NRHM), AYUSH, and other line departments

4.3 Implementation Structure

The NPHCE is implemented through a structured framework that ensures effective delivery of services at all levels. The institutional framework for implementation includes:

Level	Implementation Body	Role
National	Ministry of Health & Family Welfare	Overall policy, guidelines, and funding
State	State Health Society (SHS)	State-level implementation, fund management
District	District Health Society (DHS)	District-level implementation, coordination
Facility	Medical Colleges, District Hospitals, CHCs, PHCs, Sub-centers	Service delivery at respective levels

Financial Management Groups (FMG) of Program Management support units at state and district levels are responsible for the maintenance of accounts, release of funds, expenditure reports, utilization certificates, and audit arrangements. The funds are released to States/UTs through the State Health Society to carry out activities at different levels.

4.4 Service Packages at Different Levels

The NPHCE provides different packages of services at various levels of healthcare delivery:

Sub-Centre Level

Health Education related to healthy aging
Domiciliary visits for attention and care to home-bound/bedridden elderly
Training to family caregivers for looking after disabled elderly
Arranging suitable supportive devices from PHC to elderly disabled persons
Linkage with other support groups and day care centers

Primary Health Centre Level

Weekly geriatric clinic run by a trained Medical Officer
Maintaining records of elderly using standard format during first visit
Conducting routine health assessment based on simple clinical examination
Provision of medicines and proper advice on chronic ailments
Public awareness on geriatric health during health camps
Referral for diseases needing further investigation and treatment

Community Health Centre Level

First Referral Unit (FRU) for elderly from PHCs
Geriatric Clinic twice a week
Rehabilitation Unit for physiotherapy and counseling
Domiciliary visits by rehabilitation workers for bed-ridden elderly
Counseling of family members for home-based care
Health promotion and prevention activities
Referral of complex cases to District Hospital

District Hospital Level

Geriatric Clinic for regular dedicated OPD services
Laboratory investigations for diagnosis and provision of medicines
Ten-bedded Geriatric Ward for in-patient care
Services through specialties like General Medicine, Orthopedics, Ophthalmology, ENT, etc.
Services for referred elderly patients from CHCs/PHCs
Conducting camps for Geriatric Services in PHCs/CHCs
Referral services for severe cases to tertiary level hospitals

Regional Geriatric Centre Level

Geriatric Clinic (Specialized OPD)
30-bedded Geriatric Ward for in-patient care
Dedicated beds in various specialties (Surgery, Orthopedics, Psychiatry, etc.)
Laboratory investigations with special sample collection center
Tertiary healthcare for referred cases from district hospitals

National Center for Aging Level

High-level tertiary care with multidisciplinary clinical services
Specialized clinics (memory clinic, fall and syncope clinic, frail elderly clinic, etc.)
Day care centers for investigations, rehabilitation, respite care
Inpatient care including intensive care and rehabilitation
Human resource development in geriatric sub-specialties
Development of evidence-based treatment protocols
Special focus on the care for 75+ aged population

4.5 Progress and Achievements

Since its inception, the NPHCE has made significant progress in expanding elderly care services across India:

Expansion of primary & secondary Geriatric care services to all districts: Initially 100 districts were sanctioned in the 11th plan period, followed by 421 districts in the 12th plan period. By 2019-20, all 713 districts have been sanctioned for geriatric services.
Development of tertiary care services: 19 Regional Geriatric Centres (RGCs) have been established in 18 states, providing specialized services.
Two National Centres for Aging (NCA) have been developed one at Madras Medical College, Chennai and another at AIIMS, New Delhi.

Operational achievements (as of 2020):

Daily Geriatric OPD services in 584 District Hospitals, 3,111 CHCs, and 10,180 PHCs
Inpatient services in 507 District Hospitals and 16 RGCs
Physiotherapy services in 445 District Hospitals, 1,131 CHCs, and 14 RGCs
Laboratory services in 539 District Hospitals, 2,408 CHCs, and 13 RGCs

Service Provision (2019-20)

Service Type	Number of Elderly Served
OPD care services	26.59 million
Indoor admissions	968,244
Physiotherapy care	1.53 million
Laboratory tests	9.07 million
Elderly screened and given health cards	2.11 million
Home care services provided	241,271

Training and Capacity Building:

Three sets of Training modules have been developed for Medical Officers, Nurses, and Community-based workers. State-level Training of Trainers has been conducted in several states, generating approximately 236 State-level Master Trainers and 85 National Master Trainers.

5. Community Health Nursing Role in Elderly Care

Community health nurses play a vital role in the delivery of elderly care services in India. They serve as the frontline healthcare providers who connect elderly individuals with the healthcare system and ensure comprehensive care at the community level.

Key Roles and Responsibilities

Assessment and Screening

Conducting initial screening using preliminary Comprehensive Geriatric Assessment for elderly twice a year
Identifying elderly individuals at risk and with specific health needs in the community
Regular monitoring of vital signs and health parameters
Early recognition of deterioration in health status

Health Education and Promotion

Generating awareness about healthy lifestyle practices for active and healthy aging
Educating elderly and their families about disease management
Promoting adequate nutrition, physical activity, and regular health check-ups
Facilitating environmental modifications for safety

Domiciliary Care

Conducting weekly visits to home-bound/bed-bound elderly
Providing basic nursing care and monitoring health status
Assisting with medication management and adherence
Supporting family caregivers through training and guidance

Community Mobilization

Facilitating formation of Elderly Support Groups (“Sanjeevini”)
Organizing caregiver support groups
Working with community organizations to create supportive environments
Linking elderly with social welfare schemes and benefits

Referral and Follow-up

Referring elderly requiring advanced care to appropriate facilities
Ensuring follow-up care after hospital discharge
Coordinating care between different healthcare system levels
Maintaining continuity of care for chronic conditions

Rehabilitation Support

Delivering passive physiotherapy services under supervision
Supporting the use of assistive devices
Promoting functional independence in activities of daily living
Monitoring progress in rehabilitation

Community Health Nursing Approach to Elderly Care

The community health nursing approach to elderly care in India emphasizes holistic care that addresses physical, psychological, and social dimensions of health. By working at the grassroots level, community health nurses can effectively bridge the gap between elderly individuals and the formal healthcare system, ensuring that care reaches even the most vulnerable elderly populations in remote areas.

6. Geriatric Assessment Tools

Comprehensive assessment is essential for effective elderly care. The following assessment tools are commonly used in geriatric care settings in India:

Activities of Daily Living (ADL) Assessment

Activity	Independent (1 point)	Dependent (0 points)
Bathing	Bathes self completely or needs help with a single part of the body	Needs help with bathing more than one part of the body
Dressing	Gets clothes and puts them on with or without help tying shoes	Needs help with dressing or must be completely dressed
Toileting	Goes to toilet, cleans self without help	Needs help transferring to toilet or cleaning self
Transferring	Moves in and out of bed/chair unassisted	Needs help in moving or requires complete transfer
Continence	Controls urination and bowel movements completely	Partially or totally incontinent
Feeding	Gets food from plate into mouth without help	Needs partial or total help with feeding

Score: 6 = High independence, 0 = Low independence (very dependent)

Geriatric Depression Scale (Short Form)

Are you basically satisfied with your life? (No = 1)
Have you dropped many of your activities and interests? (Yes = 1)
Do you feel that your life is empty? (Yes = 1)
Do you often get bored? (Yes = 1)
Are you in good spirits most of the time? (No = 1)
Are you afraid that something bad is going to happen to you? (Yes = 1)
Do you feel happy most of the time? (No = 1)
Do you often feel helpless? (Yes = 1)
Do you prefer to stay at home rather than going out? (Yes = 1)
Do you feel you have more problems with memory than most? (Yes = 1)
Do you think it is wonderful to be alive now? (No = 1)
Do you feel worthless the way you are now? (Yes = 1)
Do you feel full of energy? (No = 1)
Do you feel your situation is hopeless? (Yes = 1)
Do you think most people are better off than you are? (Yes = 1)

Scoring: Score > 5 points suggests probable depression. Score ≥ 10 points indicates depression.

Risk Assessment for Falls

Question	Yes	No
Have you fallen in the last year?	□	□
Are you taking more than 4 types of medicines?	□	□
Do you have conditions like anxiety, depression, or loss of judgment?	□	□
Have you experienced dizziness when getting up from bed in the last year?	□	□

Interpretation: Positive responses to >2 questions indicate high risk for falls and require referral.

Mini-Mental State Examination (MMSE)

A 30-point questionnaire used to measure cognitive impairment, assessing:

Orientation to time and place (10 points)
Registration of three objects (3 points)
Attention and calculation (5 points)
Recall of three objects (3 points)
Language abilities (8 points)
Visual construction (1 point)

Interpretation:

Score < 24 suggests cognitive impairment for those with education above 8th class
Score < 21 suggests cognitive impairment for those with education below 8th class

Practical Note for Nursing Students:

Assessment tools should be used as part of a comprehensive geriatric assessment and not in isolation. Cultural adaptations may be necessary for the Indian context. Always consider the literacy level, language preferences, and cultural background of elderly individuals when conducting assessments.

7. Useful Mnemonics for Geriatric Care

Mnemonics are valuable memory aids for nursing students dealing with complex geriatric conditions. Here are some helpful mnemonics for elderly care practice:

FRAIL – Comprehensive Geriatric Assessment

Falls/Functional decline
Reactions (medication)
Altered mental status
Illnesses (multiple)
Living situation (social support)

DEHYDRATION – Simple Screen for Dehydration in Elderly

Drugs, e.g., diuretics
End of life
High fever
Yellow urine turns dark
Dizziness (orthostasis)
Reduced oral intake
Axilla dry
Tachycardia
Incontinence (fear of)
Oral problems/sippers
Neurological impairment (confusion)
Sunken eyes

DEMENTIA – Potential Reversible Causes

Drugs
Eyes, ears (sensory deficits)
Metabolic (e.g., thyroid, calcium)
Emotion (i.e., depression)
Normal pressure hydrocephalus
Tumor (or other space-occupying lesion)
Infection (e.g., neurosyphilis)
Anemia (i.e., B12 deficiency)

SIG E CAPS – Signs and Symptoms of Depression

Sleep problems
Interest (lack of) (Anhedonia)
Guilt/”Worthlessness”
Energy (lack of)
Concentration problems
Appetite problems
Psychomotor retardation
Suicide ideations

5Ms of Geriatrics

Mobility (promoting function and preventing falls)
Mind (cognitive health and mental wellbeing)
Medications (optimizing medication use)
Multicomplexity (addressing multiple comorbidities)
Matters Most (aligning care with individual’s goals)

While mnemonics are helpful memory aids, they should be used in conjunction with comprehensive assessment and clinical judgment. Always refer to standard protocols and guidelines when making clinical decisions in elderly care.

8. Challenges and Future Directions

Despite the progress made in elderly care services in India, several challenges remain:

Human Resource Challenges

Shortage of trained geriatricians and geriatric nurses
Limited training opportunities in geriatrics for healthcare professionals
High workload on existing healthcare workers
Lack of specialized skills for managing complex geriatric conditions

Infrastructure and Resource Constraints

Insufficient geriatric beds in secondary and tertiary care facilities
Limited availability of rehabilitation services
Inadequate equipment and assistive devices
Uneven distribution of resources across regions

Integration and Coordination Issues

Fragmented care delivery across different levels
Limited coordination between healthcare and social welfare services
Weak referral systems
Inadequate follow-up mechanisms

Accessibility and Awareness

Limited access to services in rural and remote areas
Low awareness about available services among elderly
Stigma associated with seeking mental health care
Financial barriers to accessing care

Future Directions

To address these challenges and strengthen elderly care services in India, several future directions are proposed:

Enhanced Training and Capacity Building

Expanding training programs in geriatrics for all healthcare professionals, including dedicated courses for community health nurses.

Strengthening Primary Care

Increasing the focus on geriatric services at primary care level through Health and Wellness Centres.

Technology Integration

Leveraging telehealth and digital health solutions to expand reach of geriatric services.

Community Participation

Promoting greater community involvement in elderly care through support groups and volunteer networks.

Research and Evidence Generation

Encouraging more research on elderly health issues specific to the Indian context.

Policy Integration

Better coordination between health and social care policies for comprehensive elderly care.

Public-Private Partnerships

Exploring collaborations with private sector to expand service availability.

Focus on Preventive Care

Emphasizing preventive and promotive health measures for healthy aging.

9. Best Practices in Geriatric Care

Several best practices have emerged in the field of elderly care that can be adopted by community health nurses in India:

Mobile Elderly Classification System

Categorizing elderly individuals based on their mobility status helps in prioritizing care:

Mobile Elderly: Independent in movement and activities of daily living
Restricted Mobility Elderly: Requiring personal assistance or mobility devices
Bed-bound/Home-bound Elderly: Requiring continuous care and assistance

This classification guides the type and intensity of care needed, enabling efficient resource allocation and personalized care planning.

Elderly Support Groups (Sanjeevini)

Formation of support groups for elderly individuals has shown positive outcomes:

Providing emotional and social support
Sharing experiences and coping strategies
Promoting peer education on health matters
Encouraging adoption of assistive devices and healthy behaviors
Creating a sense of community and belonging

Caregiver Training and Support

Empowering family caregivers through training and support:

Basic nursing skills for care of bedridden patients
Wound care and pressure ulcer prevention
Safe transfer techniques and assistance with activities of daily living
Medication management
Psychological support for caregivers to prevent burnout

Environmental Modification

Creating safer home environments for elderly:

Removing trip hazards and installing grab bars
Improving lighting, especially in pathways and stairs
Making bathrooms elder-friendly with non-slip surfaces
Arranging furniture to allow easier movement
Ensuring essential items are within reach

Intergenerational Bonding Programs

Promoting interactions between elderly and younger generations:

Youth volunteers assisting elderly with daily activities
Knowledge and skill transfer programs
Collaborative community activities
Digital literacy training by younger volunteers
Storytelling and cultural heritage preservation

“Month of the Elderly” Campaign

Organized around International Day for Older Persons (October 1):

Concentrated efforts for identifying and screening elderly
Health camps and awareness activities
Distribution of assistive devices
Social events celebrating contributions of elderly
Connecting elderly with available welfare schemes

Community Health Nursing Innovation

Some regions in India have implemented innovative approaches like mobile geriatric clinics, telehealth consultations for remote elderly, and training community volunteers as “elderly friends” who make regular visits to check on isolated elderly individuals. These practices can be adapted and scaled according to local contexts and resources.

10. References

Ministry of Health and Family Welfare. (2011). National Program for Health Care of the Elderly (NPHCE): Operational Guidelines. New Delhi: Director General of Health Services, MOHFW, Government of India.
Central Statistics Office. (2011). Situation Analysis of the Elderly in India. New Delhi: Central Statistics Office Ministry of Statistics and Programme Implementation, Government of India.
Ministry of Health and Family Welfare. (2021). Detailed Brief of NPHCE. Retrieved from https://mohfw.gov.in/sites/default/files/Detailed%20Breif%20of%20NPHCE.pdf
National Health Systems Resource Centre. (2021). Operational Guidelines for Elderly Care at Health and Wellness Centre. Retrieved from https://nhsrcindia.org/sites/default/files/2021-06/Operational%20Guidelines%20for%20Elderly%20Care%20at%20HWC.pdf
Verma, R., & Khanna, P. (2013). National Program of Health-Care for the Elderly in India: A Hope for Healthy Ageing. International Journal of Preventive Medicine, 4(10), 1103-1107.
Agarwal, A., Lubet, A., Mitgang, E., Mohanty, S., & Bloom, D. E. (2016). Population Aging in India: Facts, Issues, and Options. IZA Discussion Papers, No. 10162.
Longitudinal Ageing Study in India (LASI) Wave-1 Report. (2021). Retrieved from https://www.iipsindia.ac.in/content/lasi-publications
World Health Organization. (2015). World report on ageing and health. Geneva: World Health Organization.
Sheikh, J.L., & Yesavage, J.A. (1986). Geriatric Depression Scale (GDS): Recent evidence and development of a shorter version. Clinical Gerontology, 5(1-2), 165-173.
Thomas, D.R., et al. (2008). Simple screen for dehydration. Journal of the American Medical Directors Association.
Flaherty, J.H. (1998). Commonly prescribed and over-the-counter medications: Causes of confusion. Clinics in Geriatric Medicine, 14(1), 101-127.
Inouye, S.K., et al. (1999). A multicomponent intervention to prevent delirium in hospitalized older patients. New England Journal of Medicine, 340(9), 669-676.

2025 Comprehensive Geriatric Care Notes for Nursing Students

Prepared for educational purposes only