advisory committee 14 Gerontology.pdfAbstracts 193 love, care and older age call for counseling and advocacy for their rights, dignity and awareness generation services are beginning

Abstracts

Social Gerontology

• Satisfied with Retired Life: Role of

Psychological Immunity and Social

Networks

Anubhuti Dubey*

Professor, Department of Psychology, DDU Go-

rakhpur University, Gorakhpur (U.P.), India.

Email: [email protected]

Retirement from work is a major transition in

life. It can be a roller coaster as the person has to

make changes in his/her existing pattern of life

which he/she was living for decades. The present

endeavor tried to examine the contribution of

personal resources (measured as psychological

immunity having three subsystems i.e. Monitoring-

approaching; Creating-executing; and Self-

regulation) and social resources (measured as social

networks) in living a satisfied life after retirement

from work. The sample comprised of a total of 150

male participants (mean Age= 65.23 years) retired

from their government jobs after working for an

average of three decades. The data was collected

using Psychological Immune System Inventory,

Satisfaction with Life Scale and Social Networks

scale. To find out the contribution of psychological

immunity and social networks in satisfaction with

life the stepwise multiple regression analysis was

performed. The findings revealed that two

subsystems of psychological immune system,

namely, monitoring-approaching and self-

regulation predicted 21.7% variance in overall life

satisfaction. Moreover, monitoring-approaching

subsystem positively predicted (27% variance) the

present satisfaction with life and both self-

regulation and creating-executing subsystems

predicted 49.7% variance in future satisfaction with

life. None of the seven social networks emerged as

significant predictors of life satisfaction. However,

the acknowledgement of social networks like

offspring and son/daughter-in-laws significantly

and positively contributed in psychological

immunity. These findings suggest two thing- (i) the

psychological immunity is important in life

satisfaction after retirement (ii) the presence of

social networks directly contribute in enhancement

of psychological immunity and then leads to

satisfaction with life. The findings are discussed in

the light of contributors to successful ageing.

Keywords: Psychological immunity, life

satisfaction, social networks, retirement, successful

ageing

• The study on the role of Geriatric social

workers for aged.

Chandrakanta Diyali

Ageing is not to be mistaken as an event but;

this is a series of gradual processes that commences

with life and goes on throughout the life cycle. It is

depiction of the closing period in the lifespan. As

per the data of World Population Prospects, 2017;

the number of older persons those aged 60 years or

over is expected to be more than double by 2050 and

to more than triple by 2100, rising from 962 million

globally in 2017 to 2.1 billion in 2050 and 3.1 billion

in 2100. Globally, this demographic age group (60

or over) is growing at the rate of about 3 per cent

per year in comparison to the younger age group,

due to high birth rate and lower death rate the

reason highlighted is advancement in the required

services like medical care. Till very recent times the

cultural values and traditional practices had been

ensuring the highest respect and honor given to

this golden population, since the inception of

human race but due to the reckless un thoughtful

and rash drive towards globalization, urbanization

and consumerism and its ill effect of mass -

migration and resultant preference to the nuclear

family system and the ever new wave of anew

definition of ‘empowered women’ in much to

showcasing way, has led to each women search for

her individual identity outside of her traditional

role of a home maker /loyal care taker for the whole

family and consequent seeking of the Independence,

even from their close ones in the family system, has

made the older population get lost in a perplexed

situation of not being attended to, taken care of and

unheard by the younger women in the family (may

it be daughter in law or sister in law) as that was

the age old practices. Now, the older members are

treated as burden and a big liability. Therefore, the

Abstracts 193

love, care and older age call for counseling and

advocacy for their rights, dignity and awareness

generation services are beginning to be provided by

outside of the family system i.e.by the professionals

who undertake professional training in highly

systematically developed academic curriculum and

field work practices in the various agencies or open

communities These are the skillful and knowledge

based Professional Social Workers known as

geriatric social workers. Therefore, this paper has

been developed to highlight the pivotal and growing

role of professional social workers working with

older people in many and varied agencies and the

open communities like in acute hospital or

rehabilitation services, public residential facilities,

Local Authorities, community units, primary care

settings or psychiatry care, adult learning disability

services and a small number in community Care

Centers where there are defined teams and

supervision structures.These professional brings a

range of specialised skills and methods of interve-

ntion in affecting positive change and problem

resolution for the most loveable n honored senior

citizens .A Social Worker has a very good networ-

king with the communities and services available

that can be a great help in the restoration,

protection and rehabilitation of our senior citizens

for problem solution.

• Cognitive Function and Quality of Life

Elderly in Integrated Community Elderly

Post at Bandung, Indonesia

Dinni Agustin1, Atik Kridawati1, Niknik

Nursifa1, Darnialis Darwis1, Tri Budi W.

Rahardjo1

1Public Health Graduate Program, Univeristas

Respati Indonesia, Jalan Bambu Apus I No.3

Cipayung, Jakarta Timur, Indonesia 13890 E-

mail: [email protected]

The enhancement of expectancy for life will be

followed by physical, biological, mental and socio-

economic problems in the elderly will be affect to

quality of life. The purpose of this research is

analyze the relationship cognitive function with

quality of life elderly and compare differences of

QOL based on age, sex and length of education.

Quantitative research method with cross sectional

design. The sample of this research were 53 elderly

members of the Integrated Community Elderly Post

and collection data by interview. The instrument

used to measure cognitive function by Mini Mental

State Examination (MMSE). Quality of life use the

WHOQOL-OLD module-manual 2006 instrument.

Analysis used linear regression, chi square and

multiple linear regression. The results of mean and

standard deviation for quality of life (60.4 ± 12.7;

min 43 max 80), cognitive function (18.68 ± 3.91;

min 11 max 26), Age (68.11 ± 6.02; min 60 max 81),

length of education (3.94 ± 4.82; min 0 max 16),

gender (female = 50.9%; male = 49.1%). Cognitive

function was significantly associated with quality of

life elderly (r = 0.413; R2= 0.171; b = 1.344; p =

0.002). Quality of life will increase 1.344 times if

the cognitive function increase one MMSE score.

Age, sex and length of education were not

significantly related to the quality of life elderly (p>

0.05). The conclusion is cognitive function will

improve the quality of life elderly.

Key words: cognitive function, quality of life,

elderly

• ‘STAC-ing the Old Age’ - a socio-cognitive

perspective

Harjot Kaur

Assistant Professor, Department of Psychology,

DAV University Jalandhar-Punjab. E-mail:

[email protected]

The current research aims to predict the novel

mechanism of ‘cognitive aging’ highlighting the

relevance of cognitive reserve and various psycho-

social factors which can act as scaffolds to buffer

the biological processes of cognitive decline in

Elderly-Scaffolding theory of Aging and Cognition

(STAC-Park and Lorenz, 2009). The executive

functions of working memory and production and

inhibition of response demarcate the index of perf-

ormance on everyday tasks. The role of emotions

and the social support significantly predict the

everyday cognitive performance in older adults

(Winblad, 2004). The sample of 75 in the age range

of 58-75 years were tested individually upon

validated psychological tools- positive -negative

affect scale (Watson et al. 1988) and social support -

network scale (Lubben, 1988) to predict executive

functioning upon WAIS-Backward digit span

(Wechslar, 2003) and Stroop color and word test

(Golden and Freshwater, 2002). The obtained data

are analyzed using the suitable statistical analysis

and the results are discussed in light of empirical

evidences available.

Keywords: cognitive aging, executive

functions, emotions, social support

• The promotion of long-term care

insurance and dementia measure for

elderly in Japan

Hidetaka Ota, MD, PhD

Professor, Director of Center, Advanced

Research Center for Geriatric and Gerontology,

Akita University, Japan

194 Journal of The Indian Academy of Geriatrics, Vol. 14, Supplement, 2018

We are facing with Super-Aged Society now.

In near future, especially 2025, baby boomer

generation becomes over 75 years in Japan.

Estimated number of old-old population is about 20

million at 2025 and the percentage of old-old

population will increase more and more due to

falling birthrate. In fact, Super Aging Society has

already advanced in the distinct except the big city

such as Tokyo, Osaka. Aging rate in Japan is most

rapid in Akita. Maybe, similar situations are

expected in most of European countries and Asian

countries within 25 years. In this time, I will

explain about outline of Long-Term Care Insurance

System of Japan to care elderly person and describe

present condition and future prediction of this

System. Moreover, I will focus on dementia issue

becoming the big problem in Japan and explain the

performed dementia measure now.

• Time Bank: An idea whose Time has come

Indira Jai Prakash

Future of Gerontological services will depend

on innovative ideas and practical strategies that

will help older people live with dignity in a setting

where family care giving is dwindling, and formal

care is expensive. Time banking is probably an idea

that is worth promoting in India. A Time bank is a

community of people who have agreed to trade each

other their time or services. In a Time, Bank, time

itself is currency and no one person’s time is less or

more valuable than another person’s time. This is

an idea that was promoted in different forms in the

19th century by Rowen, Grey, later by Proudhan,

and in more recent decades by Edgar Cahn. His

books ‘Time Dollar’ and ‘No-Throw-Away-People’

have crystallized the philosophy of Time banking.

Cahn believes that market economy ‘objectifies’

people and discards those who have no marketable

value – such as old, poor, disabled etc. Even helping

professions in the market system will not engage or

elicit the basic skills, energy and simple decency

that people have. Five Core Values of Time Banking

are: 1) Asset- Everyone has something of value to

share with someone else; 2) Redefining work- there

are some forms of work that money will not easily

pay for like building strong families, advancing

social justice which time credits reward and

recognize. 3) Social Networks- Helping each other

we reweave communities of support, and build

trust. 4) Reciprocity- Helping is a two-way street

that empowers everyone involved. And 5) Respect-

respect all human beings, where they are at that

moment, not where we hope them to be sometime in

future. Time credits or Service credits are being

accumulated by seniors while active so that they

could use them in exchange for service when they

need. This system promotes social inclusion, and

builds community capacity. Reports show that it

has helped seniors access services they would

otherwise have to do without- such as home repair,

funeral services, care during emergency etc.

Already time banks have been established in 34

countries and it is time this idea is popularized in

India. This may be one of the answers to the crisis

in caring due to social and economic reasons as well

as poor health care system. It is also a system that

empowers elderly and bestows dignity on them.

• The difference of health care utilization

and one-year mortality between home

care patients and nursing home residents

Chia-Ming Li1, Yi-Hsuan Lee1, Yu-Hsin Chen2,

Kuen-Cheh Yang1,2, Kuo-Chin Huang1

1. Family Medicine Department, National

Taiwan University Hospital Beihu Branch

2. Community and Geriatric Medicine

Research Center, National Taiwan University

Hospital Beihu Branch

Background: Taiwan’s population is aging

rapidly. Taiwan has met the criteria for an “aged

society” in 2018, with more than 14 percent of the

population aged 65 years of age or older. The rapid

growth of the elderly population results in a great

need for long-term care services and a heavy

burden on families and the whole society. Taiwan’s

government launched the new “10-year long-term

care 2.0 plan” in 2016 to establish a comprehensive

community care service system that promoted

“aging in place”. Home based, instead of

institutional based long-term care services were

encouraged. However, the difference of the health

care utilization and mortality of the patients

between the two services were not fully

investigated. National Health Insurance program

in Taiwan reimburses skilled nursing services for

patients living in home or institutions who have

limited activities of daily living, receive palliative

care for terminal illness or are dependent on

ventilators. The policy gives us a chance to compare

the clinical impact on the patients living in home

and institutions.

Objects: The aim of the study was to

investigate the difference of health care utilization

and one- year mortality between patients receiving

home care and nursing home care.

Methods: This was a retrospective cohort

study. 678 home care patients and 84 nursing home

residents receiving skilled nursing services from

2015 to 2017 at National Taiwan University

Abstracts 195

Hospital, Bei-Hu Branch were enrolled. We applied

Cox regression and Poisson regression models for

data analysis.

Results: In comparison with nursing home

residents, patients living at home significantly had

higher educational level, were more in married

status, with religion, higher ratio to sign do not

resuscitation (DNR) directives, had more pressure

ulcer and higher utilization of outpatient clinic,

emergency room services, hospitalization with

longer hospital length of stay (LOS). The ratio of

nasogastric (NG) tube use is lower for home care

cases. Patients who had higher Charlson Comor-

bidity Index (CCI), not used NG tube and signed

DNR directives were independently associated with

1-year mortality.

Conclusion: In comparison with nursing

home residents, patients receiving our nursing care

at home had higher utilization of outpatient clinic,

emergency room services, hospitalization and

longer hospital LOS. The place they lived was not

related to patients’ one-year mortality.

• Future-ready: Training the next

generation of healthcare professionals

Wee-Shiong Lim,1,2

1Department of Geriatric Medicine. Tan Tock

Seng Hospital. Singapore

2Institute of Geriatrics and Active Aging, Tan

Tock Seng Hospital. Singapore

Synopsis: As we think about the future of

professional education, what capabilities will be

needed most that human professionals of the future

can bring? Meeting the challenges posed by frailty,

population aging, and technological advances in an

increasingly inter-connected world will require a

systemic reform of healthcare delivery that is

integrated, patient-centric, team-based, health-

centered, and technology-enabled. Similarly,

approaches that have worked in the past to train

physicians are no longer as relevant today as

demographics, disease patterns, practice

behaviours, and technological advances demand an

urgent reform of medical education at all levels to

forge a future-ready and frailty-ready workforce.

This presentation will outline an evidence-

based conceptual framework of the attributes of

Professional for Tomorrow’s Healthcare (PTH). The

PTH model is modified from the Barber Equation

and comprises 5 domains: PTH=E(K1+K2+F+L).

‘K1’ refers to core geriatrics knowledge and skills

required to fulfil one’s designated role. ‘K2’ refers to

cross-cutting knowledge and skills including

systems-thinking, teamwork, and inter professional

collaboration. ‘F’ refers to future-oriented adaptive

expertise which is necessary for excellence and

innovation in an ever-changing healthcare context.

The PTH equation is dynamic, in that some aspects

of “future knowledge” (F) may become “everyday

practice” (K1 or K2) over time. ‘L’ reframes leader-

ship as a collective social process not dependent on

formal roles, whereby one becomes a change agent

within one’s sphere of influence at the individual,

team and systems levels. As the cornerstone of

healthcare, ‘E’ (ethics and ethos) serves as the final

multiplier of the equation.

This presentation will also touch upon about

how we can prepare healthcare professionals for the

imminent arrival of artificial intelligence (AI), deep

learning and forms of automation such as robotics,

which are about to transform healthcare and

education. Rather than an automation revolution

whereby AI would ultimately replace humans, we

should instead strive towards a knowledge

revolution of “augmented human intelligence” in

which humans co-labour effectively and use AI

intentionally to augment capability and improve

outcomes. A crucial dynamic will be the develop-

ment of critical wise judgement, drawing upon

capacities that are uniquely human such as

empathy, intuition, and caring. In the area of

diagnosis and cognition, it will be important to

move learners beyond rote learning and excessive

memorization to develop meta-cognition and

analytical skills. In the area of technical skills, we

should explore how to enhance the human-machine

interface among learners through learning with and

about automated systems and promoting situa-

tional awareness of machine function and failure.

Lastly, rather than being supplanted or replaced by

AI or related technological advances, caring,

empathy and human presence are going to be more

germane than ever before as the foundational

cornerstone in the future of healthcare.

• Asian Perspectives on Elder Abuse:

Concerns and Responses

Dr. Mala Kapur Shankardass

Associate Professor, Department of Sociology,

Maitreyi College, South Campus, University of

Delhi, India.

Asia Representative, International Network for

Prevention of Elder Abuse (INPEA) E-mail:

[email protected]

Elder abuse is a growing problem in the Asian

region. It is seen in many forms, ranging from

physical, emotional and psychological abuse, to

financial exploitation and neglect. It largely


remains a hidden problem, mostly unreported and

occurs in institutions or other formal settings, or in

the older person’s own home.

Based on research through primary and

secondary sources this paper reviews the concerns

related to elder abuse in select Asian countries and

identifies the responses to deal with the abuse,

mistreatment and neglect of older people in these

societies. Many countries are looking at solutions to

deal with the problem of elder abuse and some of

these relate to policy and legislative responses. The

paper also takes into account the risk factors as

identified in different country situations from an

Asian perspective and suggests national level

interventions.

The paper concludes by putting the research

on elder abuse in the Asian region in a comparative

perspective with that of studies from Europe and

America and holistically treats the subject from a

rights based approach.

• Quality of life in elderly and its

association with marital status and living

arrangements

Nikhil Gaur, Ankur Aggarwal, Rahul Sharma,

Amitesh Aggarwal, Ashish Goel

Introduction; Quality of Life (QOL) is as

important in old age as at other times during

human life. As India is largely a patriarchy, living

arrangements for older persons are dependent on

sons. Over the last few decades, joint family

systems are breaking up owing to increased

migration. Older people, sometimes widowed are

required to live in nuclear arrangements or old age

homes. It is intuitive that both marital status and

living arrangements can impact QOL. The current

work explores their association with QOL.

Methods:100 older subjects (>60 years),

attending the senior Citizen Clinic held in our

hospital every Sunday between 2014 and 2016 were

included after they consented to participate, after

approval by the Institutional Ethical Committee for

Human Research. Patients with acute infectious

conditions were excluded. The present work is a

retrospective analysis of previously collected data

interrogating the dataset for possible associations

between marital status and living arrangements of

older people visiting our hospital for chronic non-

communicable comorbid conditions. To evaluate

this relationship, we compared the mean scores

between different categories of marital status and

living arrangements using analysis of variance.

Results: The age of the subjects ranged from

60 to 84 years. The 100 subjects comprised of 53

(53%) males. The BMI ranged from 15.6 to 32.76

kg/m2. Classifying by marital status, 67 of the

subjects were married, one was single while 32

were divorced. 57 lived with their spouse and

children, 32 with their children only, 7 with their

spouse only, and 4 lived alone. The mean QOL score

was found to be significantly more among the

currently married compared to those who were

widowed, in the three domains of Physical health,

Psychological and Environment (p<0.05 in all three

comparisons) and also higher in the Social

relationships domain though not statistically

significant (p=0.08). In studying the relationship of

QOL with living arrangement, a pattern was

observed in all the four domains of the QOL, though

the differences were not statistically significant.

The mean QOL score (in all four domains) was

highest for the elderly living with spouse and

children

Conclusion: We found that marital status

and Living arrangements impact Quality of Life.

Subjects who are married and live with spouse and

children have significantly better QOL.

• Health and social concerns of elderly men

– A systematic review

Parbhat gautam, Roy, PG; Bharadwaj, R

Introduction : Elderly population, (defined

as age ≥60 years) nearly comprised of 70 million

people in 2011 in India. This number is expected to

increase further in the coming years. Even though

males have a greater share in the total population,

women tend to outlive men which reflects in sex

ratio of 0.9 for people aged over 65. The spectrum of

diseases and social concerns of elderly men is

different from those seen in elderly women and

younger population. The present work reviews the

health and social concerns in older men.

Materials and Methods: A literature search

on PubMed database using keywords “(Health OR

social) AND (concerns OR issues OR challenges OR

problems) AND (elderly OR older OR senior OR

geriatric) AND (males OR men)” in October

revealed total of 24432 articles. Filtering only

clinical trials, RCTs or observational studies

identified 2533 matches. Further, filtering to

publications appearing in previous ten years, in

English, on male subjects, older than 65 years and

with keywords appearing in title or abstract, we

narrowed to 21 articles. These were reviewed to list

the health or social concerns and 21 health and five

social issues were identified. The present work

discusses these issues at greater length.

Abstracts 197

Observations: The health issues we identi-

fied for our review included stroke, cardiovascular

disease, chronic airway disease, incontinence of

urine, diabetes, hypertension, hearing or visual

impairment, anaemia, asthenia, unintentional

weight loss, constipation, arthritis, impotence,

addictions, falls, cancers, cognitive impairment,

rigidity, insomnia and depression. Social issues

which we included are malnutrition, loneliness,

economic dependence and living wills and advanced

directives.

Conclusions: In view of a rapidly ageing

population, understanding concerns of elderly men

assumes greater importance. Addressing these

issues would not only make for a graceful and

healthy ageing in our population but also go a long

way in development of health standards in our

society.

• Growing Burden of Non-Communicable

Diseases in India

Pratima Yadav1, Vani S. Kulkarni2,

Institute for Human Development Delhi

(India)1, Lecturer in Sociology, Department of

Sociology, University of Pennsylvania, USA &

Raghav Gaiha, (Hon.) Professorial Research

Fellow, Global Development Institute,

University of Manchester, England, & Visiting

Scholar, Population Studies Centre, University

of Pennsylvania, USA 2.

The present study provides detailed evidence

on NCDs and their covariates. This is particularly

relevant in the present Indian context, as the

elderly population years is growing three

times faster than the population as a whole. It is

projected that the percentage of elderly people will

more than double between 2010-2050. Alongside,

old age morbidity (NCDs and their multi-

morbidities) has risen significantly during 2004-

2014. Using National Sample Survey data for 2004

and 2014, and ordered probit models, the

underlying covariates are uncovered. There is a

marked shift of NCDs and multi-morbidities from

the younger to the old population. Some of the

covariates associated with lower prevalence of

NCDs and their multi-morbidities include women,

education, physical activity, drinking water through

tube wells and hand pumps, Scheduled Castes/

Scheduled Tribes (the lowest rung of socio-economic

hierarchy), while those associated with higher

prevalence’s include urbanisation, widowed and

divorced/separated, and being affluent. Above all,

there is a (residual) positive time effect confirming

higher prevalence’s of NCDs and their multi-

morbidities. On current evidence, given the

increases in life expectancy, it is uncertain whether

the additional years have translated into healthier

and longer lives or longer years of morbidity. The

policy challenge, however, is daunting, requiring

greater funding for health care, reorientation of the

health care system to serve the old better and

tackle the growing burden of NCDs and their multi-

morbidities, expansion of pension and health

insurance, and behavioral changes (e.g., curbing of

alcohol consumption, smoking and lifestyle

changes) necessary for healthy living.

Key Words: Old, NCDs, Multi-morbidities,

Urbanization, Gender, Affluence, India

JEL Codes: I120, I310, H510

Acknowledgments: We owe a deep debt of

gratitude to Jere Behrman and Irma Elo for

supporting this study and for valuable constructive

advice. We appreciate the advice received from T.

N. Srinivasan, K. L. Krishna, Katsushi Imai and

Raj Bhatia. All errors are the responsibility of the

authors.

• Future Vision for Geriatric Mental Health

in India

Dr. S.C. Tiwari, Professor and Head (Retd.),

Department of Geriatric Mental Health, King

George’s Medical University, Lucknow, U.P,

India, 226003

With advancement in medical sciences, there

has been considerable decrease in mortality from

infectious diseases resulting in enormous increase

in average lifespan. The average life-span in India

which was 32.45 years (Male) & 31.66 years

(Females) in year 1951 has now increased to 67.3

years (Male) & 69.6 years (Females) in the year

2016. This has resulted in rapid increase in

geriatric population. In year 1951 there were 20

million (5.3%) senior citizens in the country which

gradually increased to 77 million (7.4%) the year

2001. According to 2016 data of ministry for

statistics and program implementation this number

was 103.9 million (8.5%) and it is projected that by

2026, there will be 173 million (12.4%) geriatric

population in the country. On the other hand, the

nation has not prepared itself for this rising

challenge. Leave aside geriatric mental health

issues it is not even prepared for other needs of the

elderly.

It is not wise to think geriatric population

same as adult population. This is because of many

reasons. First, the mental health morbidity in

geriatric population is higher than that of adult

population. As many as 30% of elderly people suffer


from some kind of mental illness. An ICMR funded

epidemiological study conducted in northern India

found the prevalence of geriatric mental illnesses to

be 43.32%. According to another study, average

prevalence of mental health problems in the rural

and urban communities indicate that 20.5% of the

older adults are suffering from one or the other

problems (urban 17.3%, Rural 23.6%)

Second, elderly population has some

additional health needs. Delirium, Dementia,

Frailty and Loneliness are some of the issues which

are predominantly found in elderly population.

Third, elderly differ from adults in terms of

body physiology, psychology and availability of

resources. Last but not the least they have multiple

needs such as healthcare, psychosocial, financial,

residential, legal, entertainment, and safety and

security needs.

Keeping in mind the above mentioned

reasons, it is obvious that mental health professio-

nals catering to the needs of adult population will

not be appropriately and adequately competent to

care for the mental health of the elderly. Thus, it

becomes very necessary to have a separate

“geriatric Mental Health” branch in medical

sciences. Currently, India has acute shortage of

geriatric mental health professionals. Against the

requirement of roughly 4000 geriatric psychiatrists,

only 10-20 odd psychiatrists who have specialized

training in geriatric mental health are available.

Department of Geriatric Mental Health (DGMH),

King George’s Medical University (KGMU) has 3

while NIMHANS Bangalore has 2 D.M seats in

Geriatric Mental health. Additionally, DGMH,

KGMU has 2 seats for 1-year fellowship in Geriatric

mental health. Clearly, training 5-7 Geriatric

Psychiatrists yearly in this large country is not at

all sufficient.

There is a present and future need to develop

Geriatric Mental Health services in India. Till such

a time we do not have enough infrastructure and

specialist manpower to manage psychogeriatric

patients, a model to integrate geriatric Health and

Geriatric Mental health services for near future is

required.

Conclusion: Future of Geriatric Mental

Health looks very bright provided psychiatrists and

students of psychiatry show interest in this subject

and the Government gives its full support in the

cause.

• Geriatric mental health services in India

– Current scenario

Shruti Srivastava,

Professor (Psychiatry), Department of

Psychiatry, University College of Medical

Sciences & Guru Teg Bahadur Hospital,

Dilshad Garden, Delhi-110095. E-mail:

[email protected]

Introduction: Currently, roughly 6% of the

population belongs to elderly age group. It is

projected that India” s elderly population will be

more than 340 million by the year 2050.Geriatric

mental health services in India hardly covers the

existing population of the country. Government of

India plans to deal health care in an integrated

approach as the elderly population is on the rise in

the country.

Methodology: Literature search was carried

out using key words “Elderly, India” and further

advanced search using Geriatric mental disorders.

Various studies found that Anxiety disorders are

the commonest, followed by Depression that is

associated with significant mortality from low and

middle income countries. Cognitive disorders are

reported less frequently in this age group. Elder

abuse commonest is the psychological abuse,

followed by financial abuse then by physical abuse.

There are very few research studies that have

focused on elderly mental disorders. The setting up

of Special clinics for senior citizens/ Elderly

population on Sundays is one of the initial steps to

facilitate this vulnerable section of the society some

attention. Resident welfare associations also

undertake various health care camps to ensure

regular checkups so that the services are provided

at the door steps. Ayushman Bharat, an insurance

policy launched by Prime Minister Narender Modi

is to enable health coverage expenditure in major

hospitals will be a boon to the society. The pension

benefits provided to senior citizens, and other

recreational offers like planning Pilgrim visits by

Delhi government are some unique initiatives.

Indian laws demand maintenance of elderly parents

by their children as one of their rights.

Results and Conclusions: In order to bridge

this wide gap between the existing services and

enormous rise in elderly population, there is a need

to take steps to strengthen the already existing

infrastructure, early identification and prompt

interventions, research, resource & budget alloca-

tion, political motivation and inter-sectorial coordi-

nation with the mental health professionals, Non-

Governmental Organizations, policy makers. Integ-

ration of Mental Health services with primary

health set ups already existing in the resource poor

country may seem to be an appropriate step in this

direction. Tele/video conferencing of elderly patients

may be some of the innovative steps in this area.

Abstracts 199

• Knowledge and Attitude of Patients,

Relatives, Nurses and Doctors Regarding

End of Life Care Issues

Subha

Introduction: India is a multicultural society

with strong family ties. Often the elderly members

of a family rely upon their children to make

decisions for them. However, many elders in the

family have not talked about the death and dying of

their loved ones. The reluctance to make end-of-life

decisions for elders seems to be originating from the

pain of imminent loss and helplessness associated

with their decision.

Many physicians and elderly are unfamiliar

with the concept of end-of-life, and are uncomf-

ortable with decision making and providing end-of-

life care. This education is. Crucial for physicians

and family members to understand the pros and

cons of their options to make appropriate decisions.

This practical knowledge will prepare the relatives

and next-of-kin to minimize emotional decisions

and avoiding prolonging of life unnecessarily.

Aim: We plan to assess the knowledge and

attitude of patients, relatives, nurses and doctors

regarding end of life care issues with a focus on do

not resuscitate (DNR), advanced directives, law &

euthanasia to determine if the healthcare workers

and patients in our society are ready for discussion

and legislation on these subjects.

Materials and Methods: A multicenter,

qualitative and explorative, analytic cohort study

will be conducted at AIIMS Delhi, UCMS Delhi,

Institute of Medical sciences BHU, Dr S N Medical

College Jodhpur, SMS College Jaipur, Jaslok

Hospital Mumbai and JLN Medical College Jaipur.

The study will include geriatric population,

relatives of patients, physicians and nurses caring

for these patients. The survey will consist of a

questionnaire and will comprise of scenarios for the

participants. The doctors and nurses will be

evaluated for the same and open/ semi structured

interview, if required.

• Assessment of cognitive status of

Institutionalized Seniors in India

Swati Madan 1, Shanthi Johnson 2

1 All India Institute of Medical Sciences, New

Delhi

2 University of Alberta, Calgary

Introduction: Cognitive decline in senior

population is no longer regarded as a consequence

of the aging process. Nevertheless, seniors are at an

elevated risk of developing cognitive deficits with

advancing age. Hence, alterations in cognitive

function often call for prompt action. In older

individuals, cognitive functioning is likely to decline

during transition from the community settings to

old age homes.

Materials and Methods: The Mini Mental

State Examination (MMSE) was used to assess the

cognitive status of senior women residing in old age

homes of Delhi NCR region. The maximum score

obtained on the MMSE is 30. A score of 23 or less

suggests the presence of cognitive impairment.

Completion of the MMSE takes approximately 5-10

minutes and is therefore regarded as a pragmatic

tool which can be utilized for cognitive assessment

in seniors. The researcher of this study recruited

eighty-five older women after screening two

hundred and twelve institutionalized seniors. After

obtaining informed consent, the researcher started

recruiting subjects randomly from the six old age

homes in Delhi NCR. The MMSE was administered

to the subjects and scores were recorded by the

research investigator.

Results: The subjects of this study had a

lower level of education as compared to their

counterparts in the developed countries. Almost

51% of the subjects had barely studied upto the

tenth grade and had found it difficult to complete

high school education. The mean MMSE score was

found to be 21.7 (5.3). It was observed that on the

basis of MMSE cognitive status classification, 4.7%

seniors had severe cognitive deficits (score ranging

between 0 and 9), 16.5% seniors had moderate

cognitive impairment (score ranging between 10

and 19), 49.4% seniors had mild cognitive

impairment (scores ranging between 20 and 24),

and 29.4% seniors had no cognitive deficits (scores

ranging between 25 and 30).

Conclusion: The MMSE is useful for

assessment of cognitive status in seniors who are

educated and at least high school graduates. The

low educational level of the women contributed tow-

ards poor performance on MMSE. It is recomme-

nded to use other tools in combination of MMSE to

carry out a comprehensive cognitive status assess-

ment of seniors living in old age homes in India.

• Nutritional and fall risk in older women

in long-term care facilities in India

Swati Madan1, Shanthi Johnson2


Delhi

2 University of Alberta, Calgary, Canada


Introduction: Older persons living in long-

term care facilities are at a high risk of under-

nutrition and have a heightened risk of

experiencing falls. Multiple factors predispose older

individuals to a compromised nutritional status and

fall events. These factors include poly-pharmacy,

social isolation, poor dietary intake due to anorexia,

and sarcopenia. The objectives of the present study

were to assess nutritional and fall risk of older

women (aged 60 years and over) and to study the

correlation between these in women living in LTC

facilities of New Delhi.

Material and Methods: Background profile,

MNA, DFRI, and FES-I questionnaires were used

to gather data on nutritional and fall history.

Results: The mean age of participants was

74.21(±5.52) years. A majority were widowed with

poor educational and income level. Findings

revealed that 54% of the older women were at a

high nutritional risk. Fall risk was observed in 58%

of the study participants and a majority of

participants reported high fear of falling. MNA

scores had a significant negative correlation with

Downton Fall Risk Index scores (R= -.419, p<.001).

Conclusion: Timely nutritional and fall

prevention interventions can help in management

of nutritional risk and falls in LTC facilities, and

can significantly improve the quality of life of

institutionalized older individuals, who are a

neglected group in India.

Key words: nutritional risk, fall risk, fall,

older women, long-term care facilities

• Depression in Homes for the Aged in New

Delhi

Swati Madan1, Shanthi Johnson2


Delhi

2 University of Alberta, Calgary

Introduction: Mental health disorders,

particularly, depression have been underestimated,

sequestered, and neglected in older individuals

living in care homes in India. Some studies have

reported that 40% of care home residents have

depressive symptoms. It is more frequent in

widowed or divorced older women who live without

their children and have little social support. The

present study was undertaken with the objective of

assessing the level of depression in older women

(aged 60 years and over) living in homes for the

aged in Delhi.

Materials and Methods: Eighty-five women

residing in six long-term care facilities were

enrolled for the study. Sample size estimation was

carried out using the G Power software using level

of significance as 0.05, and effect size as 0.80.

Ethics approval was obtained from the directors of

these facilities. Women aged > 60 years living in six

homes for the aged in Delhi and NCR area, without

any serious chronic or terminal illness, who

provided informed consent by carefully reading the

letters of consent, and were willing to complete the

Geriatric Depression Scale questionnaire were

included in the study. The researcher assured the

participants that confidentiality and anonymity will

be strictly maintained. The Geriatric Depression

Scale is a 30 item questionnaire, with a simple

Yes/No format that is used extensively in health

care settings to assess the depressive symptoms,

and level of depression present in older adults

living in the community, assisted living facilities,

and long-term care facilities.

Results: Using the GDS Classification scale,

it was found that severe depression was

experienced by 47% women, and it was also

observed that 42.4% women were moderately

depressed. Being a widow, lower educational status,

poor socio-economic background, and social

isolation were significant predictors of depression in

older women residing in homes for the aged in

Delhi/NCR area.

Conclusion: Depression is highly prevalent

in homes for the aged in India, but is unfortunately

neglected and under-treated due to ignorance of

health authorities and lacunae prevailing in the

health care delivery systems. If left untreated for

extended periods of time, severe depression can

lead to high rates of suicide amongst the

institutionalized older adults.

Keywords: depression, homes for the aged,

older women

• Health and Social Delivery Services by

Young Generation: A Case Study in

Yogyakarta and Bandung, Indonesia

Tri Budi W. Rahardjo, Dinni Agustin, Cicilia

Windyaningsih

Cente for Family and Ageing Studies (CeFAS)

Universitas Respati Indonesia

Indonesia’s older population is growing at an

unprecedented rate throughout the period of 1990 -

2020, as well as experiencing an increase in life

expectancy from 66.7 years to 70.5 years. The

number of older persons in Indonesia is expected to

increase to 28.8 million (11% of the total

population) in 2020, and 80 million (28.68%) in

2050. The longer the life of a person, the more the

Abstracts 201

person is prone to experience physical, mental,

spiritual, economic and social problems. Based on

RISKESDAS (Basic Health Research 2013), the

diseases found amongst the older persons in

Indonesia include hypertension, osteoarthritis,

dental-oral problems, chronic obstructive

pulmonary disease (COPD) and diabetes mellitus

(DM) (MoH of the Republic of Indonesia, 2014). The

emergence of various diseases and disorders can

lead to functional disabilities in older persons, with

more severe conditions requiring the help of others,

hence the need for long-term care (LTC). Disability

as measured by the ability to perform activities of

everyday life or Activity of Daily Living (ADL)

affects approximately 51%, with increase in age. To

cope with this situation health and social delivery

for older persons as in integrated services has been

conducting by young generation in Yogyakarta and

Bandung. Young generation in Yogyakarta

established Indonesia Ramah Lansia (Age Friendly

Indonesia Foundation) in 2017, has been mobilizing

the community and local sectors to promote

community development in providing health and

social delivery in the form of community care

services including health promotion, early detection

of degenerative diseases including dementia,

dementia care, lifelong learning for middle age and

older persons, long term care for older persons

through home care , and training on long term care

for care giver. This program is a bottom up system

model. On the other hand, Bandung Cinta Lansia

(Bandung loves older persons) is a top down

program, has been establishing by Bandung City

Mayor, mobilizing all community structurally,

particularly young generation in providing healthy,

productive ageing and long term care for older

persons at home. It is called Sahabat Lansia

(Friends of Older Persons) program.

Key words: Older persons, health and social

delivery model, young generation.

advisory committee 14 Gerontology.pdfAbstracts 193 love, care and older age call for counseling and advocacy for their rights, dignity and awareness generation services are beginning

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