Eldercare in India currently is in 3 formats.
Hospital care which deals with the acutely unwell, assisted living facilities that deal with non-urgent long-term care and homecare which is service provision oriented i.e blood collection, physiotherapy, medical doctor visits etc.
The unmet need is a fourth way which is that of wellness supervision.
WHO defines wellness as ‘the optimal state of health of individuals and groups’.
As one grows older identification of this optimal state becomes more challenging.
Visits to medical professionals are often prompted by illness or symptoms of a problem.
Instead of this reactive approach imagine a world where we could regularly assess a situation and therefore make early identification of illness a reality.
In the current scenario the hospitalization rates in the elderly are high. The reasons are often related to NCDs (non-communicable diseases like Diabetes hypertension cerebrovascular disease). In Most instances complications from NCD’s can be screened for and prevented to reduce the rate of hospitalizations.
In a paper from 2021 from JNU New Delhi assessed hospitalization rates in the elderly (age >60) Amongst the 42000 patients assessed 11000 were hospitalized. Amongst these 52 percent were hospitalized for non-communicable diseases i.e. Diabetes cardiovascular disease cerebrovascular disease)
Needless to say, we cannot ignore the exorbitant cost of hospitalization and the cascade of problems it brings.
We propose a system where regular wellness visits with well-directed objective assessments of individuals are done.
A system where prevention of disease and attaining optimal state of wellness is the priority.
We hope to introduce a subscription-based service offering wellness supervision primarily for parents whose children are abroad. This can however be used by anyone who wishes holistic medical care focusing on prevention not just treatment.
The first need is to establish an integrated health record for the parent. In majority cases other than the patient and the pharmacy no one knows what medication the patient is actually on. Neither do they have a proper record of what medical problems the patient suffers from. This electronic medical record will be the first step towards documentation and clarity where the current illness and medications are listed. The current family physician is also listed as he will be the first point of contact for medical problems.
Similar to the way hospital medicine picks up changes in the clinical state of a patient, these visits will give us early warning signs of impeding medical issues.ie diabetics or bp problems falls risk
Along with the examination there a preventive medication review.
A significant problem in India is that there is no prescription collation. Different doctors will give individual prescriptions and it is then up to the patient to look for polypharmacy or drug interactions. This is a real challenge especially for the elderly. We propose regular prescription reviews by qualified pharmacists and doctors to solve this problem.
Throughout this process the patients stick to their regular physicians and specialists, but as a part of this service they will have the opportunity to pick up early warning signs of disease that usually go unnoticed. Along with this it’s an opportunity for an additional check to avoid drug related errors and interactions.
Once problems are identified communication is established between the next of kin patient and doctor to take things further. This level of coordinated and unified care is the key to better patient management.
The ultimate aim of this is to pick up illness early to prevent complications of illness to screen for illness and to proactively avoid unnecessary hospital admissions and escalating medical complications, therefore allowing the elderly to age in their homes longer and stronger.
Dr Meetali Bidaye
MBBS MRCP(Lon), MRCP Nephrology (Lon)
Founder Nivarak Eldercare