Summary
• Increasing geriatric populations will need healthcare delivery with a focus on chronic and co-morbid disease management
• New models of care delivery will require new technological innovations that cater to this requirement
• Remote patient monitoring and Home Healthcare are poised to capitalize on this opportunity
• Hospitals need to invest in these modalities of care delivery to stay competitive and relevant in the future
Consider this. Senior citizens (60+ years) accounted for about 8.4 per cent of the population in 2011, and are expected to rise to 19 per cent of the population by 2050 [1]. The decadal growth of the geriatric population from 2001-2011 was a whopping 35.5 per cent vis-a-vis the general population growth of 17.7 per cent [2]. These statistics become more compelling when taken in context with changing value systems and social norms. Where there were once joint families, there is now urbanisation, urban migration, and the rise of nuclear families.
The Elderly population poses unique challenges to care delivery
Geriatrics as a medical sub-speciality is a relatively new field in India. In fact, geriatric care is absent in the medical curriculum in India both for training doctors as well as nurses and paramedical staff.
The issue is compounded by unique requirements of geriatric care owing to their low physiological reserves and co-morbidities. Unlike adult populations, management of the elderly must consider the falling physiological reserves which require drug dose modifications and alternative treatment regimens. Further, the elderly often have multiple co-morbidities which need a multidisciplinary approach and a comprehensive care plan. This results in prolonged management and multiple hospital visits. The elderly can rarely afford multiple hospital visits due to economic, social and physical constraints. Meanwhile, rising cost of care delivery, inadequate insurance coverage and the requirement of comprehensive care plans for the elderly results in worsening of an already bad economic situation. The rising elderly population in India is therefore reminiscent of a ticking time bomb.
Elderly care represents a new opportunity for newer modalities of delivery
Elderly care requires innovative modalities of care delivery. “It is a challenge for governments, NGOs, and health care providers to provide universal health coverage for the elderly across all dimensions - preventive, curative and rehabilitative. Technological advances are imperative for us to negotiate the difficulties of providing affordable and accessible care to elders,” says Dr. Medha Rao, a geriatric expert and Dean of M.S.Ramaiah Medical College, Bangalore.
The lowest hanging fruit here is to provide home care and home monitoring for elderly patients upon discharge from the hospital. This will reduce the requirement for multiple hospital visits. Also, care delivery in home care settings will ensure adherence to treatment plans and reduce the burden of dependency on the family. This represents a key opportunity for home healthcare companies. There are now home healthcare companies and hospitals that can provide high acuity care in the home. In fact, ICU@home is now a reality. Multiple companies offer high-end medical equipment including ventilators at home along with skilled nursing staff to manage these patients.
With technological advancements, we are now able to provide remote patient monitoring in the comfort of the home. When patient vitals data can be communicated to the treating physician at the touch of a button, it allows doctors to treat and manage more patients. In resource-limited settings, such as the Indian healthcare system where doctors are a precious resource, remote patient monitoring technology offers enormous benefits. Stasis, for example, has a unique patient monitoring solution that can be deployed in the home setting, with no infrastructure requirements, and instantly connects doctors to their patient through a smartphone app. The pre-interpreted colour display at the bedside ensures patients and families do not need to interpret the vital parameters and are instantly aware of the patient's condition. Data is made available remotely to doctors either through the app, or a central monitoring station desktop through the web interface. To top it all, data trends are continuously being analysed by the Stasis AI to predict patient deterioration and alert doctors before worsening of the patient's condition. In home healthcare settings, where doctors are not available on-site, this can save lives!
The surmountable challenges of delivering better care to the elderly
There are, however, challenges that need to be overcome to ensure seamless integration of care into the home. Home healthcare is still a labour intensive process and struggles with skilled manpower shortages. The burden of liability also needs to be defined in the absence of a clear escalation matrix. Technology deployed in the home needs to be user-friendly and easy to use even by non-medical personnel as family members are frequently the caregivers. In the absence of hospital infrastructure, tech solutions for the home need to be plug and play. Further, affordability and access to home healthcare services are still restricted to large urban cities. When 71 per cent of the elderly in India reside in rural areas, this represents a considerable challenge for service delivery companies.
Dr. Medha Rao believes that ”The future of geriatric care will largely be within the comfort of the home. Assisted devices and technology for the elders will deliver care that is affordable and easy to use in home healthcare settings”.
While the promise of home healthcare and technology for the home is clear, “Technology with softer 'human touch' is the need of the hour” according to Dr. Medha Rao.
[1] http://vikaspedia.in/social-welfare/senior-citizens-welfare/senior-citizens-status-in-india
