TOWARDS BUILDING AN AGE FRIENDLY COMMUNITYCollaborative initiative of

WHO-SEARO and

Dharma Foundation of India

Dr Alakananda BanerjeePresident

Dharma Foundation of India

Contents

• Population Ageing India: • Health issues of elder women • About hypertension and joint pain in elder

women • Towards Building an age friendly community• Self Management and Community Wellness

INTRODUCTION Population Ageing India

•The ageing of population is on the increase world over in recent times.

•According to the census 2001, the population of the elderly (age 60 years and above) in India was 75.9 million, i.e. 7.4% of total population.

•It is projected to be 113 million, i.e. 8.9% of total population by the year 2016.

Health issues of elder women in India• Various studies in India proved that the population of female

elderly persons especially in rural areas appears to be larger than their male because of their higher life expectancy.

• The elderly are vulnerable to non-communicable diseases (NCDs) which are clearly a major morbidity in this age group. NCDs are responsible for 53% of deaths and 44% of disability in India.

• Compared to men, the health status of women is found to be poor. Main health concerns in elder women in India is hypertension, musculoskeletal disorders, diabetes, obesity, metabolic syndrome etc.

• Hypertension is one of the most important treatable causes of mortality and morbidity in the elderly population.

• It was found that 40.8% of females are suffering from hypertension in India. Patients with hypertension may experience adverse effects on well-being and health-related quality of life which can be associated with headache, dizziness, and tiredness.

• Hypertension is the key disease which leads to cardiovascular diseases.

• It has also been proved that more than half of the elderly females (67.3%) represented various physical problems from which joints pain is the commonest one.

• Joint pains in forms of arthritis, fibromyalgia, and osteoporosis are common in elderly.

Towards building an Age Friendly City

The eight essential features taken into consideration which make a city age friendly are

1. Outdoor spaces and buildings 2. Transportation 3. Housing 4. Social participation 5. Civic participation and employment 6. Respect and social inclusion 7. Communication and information 8. Community and health service

Towards Building an Age Friendly City• The concept of Towards Building an Age Friendly City

emphasizes an active role of the elder.

• The WHO framework on Active Ageing also forms the basis for success of an Age Friendly City.

• Active Ageing is the process of optimizing opportunities for health, participation and security in order to enhance quality of life as people age.

• In an age-friendly city policies, services, settings and structures support and enable people to age actively by recognizing the wide range of capacities and resources among older people

DFI Programs towards

Building Community and Health Service

Chattarpur Extension, New Delhi and members of local Senior Citizen Organisation ,Varishtha Nagrik Kendra Sansthan (VNKS)

Area profile of Chattarpur Extension• The roads to the housing areas are broken and during rains the roads are flooded

making it absolutely inaccessible for people to manoeuvre or walk.

• The distance to the main street (which has public transport facilities like taxi, autos, and buses) is almost 1km -2km from the houses which add to the woes of elders as there is no transport facility from the houses to the main street.

• The pharmacy, grocery, bakery shops are situated on the main street .

• Most of the elders get health benefits from state and central government health schemes.

• The government hospitals are situated 7 kms from Chattarpur Extension.

Establishment of Community Care Centre To help the elders of the area to avail basic health facility the DFI runs a Wellness Clinic in a small space allocated by the VNKS office.

•The clinic is run by active elder members of VNKS.

• A trained (graduate or post graduate physiotherapist) Community Physiotherapist works for 4 hours in the Wellness Clinic. There are basic equipments for physiotherapy pain relief modalities, walkers, gait training sticks

• Equipments to measure blood pressure, blood glucose, and nebulizers are available in the clinic. (Donated by the DFI).

• The Community Physiotherapist is a known face in the neighbourhood. Rs 20/-is paid by elders for each consultation. The elders prefer her services as they can walk to the clinic which is accessible to the elders staying nearby.

Collaboration initiative of WHO SEARO-DFI

Self Management and Community Wellness Program

For Older Women

Self-Management and Community Based Wellness Program

• This program is a multi-dimensional intervention, a combination of learning to self manage their health concern with community initiatives through group programs that engages subjects with in a series of classes in which they are helped to develop critical knowledge, skills and motivation to move forward in their recovery and achieve their personal goals.

• Proper nutrition and lack of exercises plays a major role in an individual's overall health; psychological and physical health status.

• Nonmedical interventions like these can assist elders in coping with and adapting to illnesses as proven through various studies provide better functional outcomes and are more cost effective than conservative care, surgery or more invasive procedures.

• The Self-Management Program consisted of home visits by the Community Physiotherapist and Dietician to educate participants on home exercise and diet modifications for prevention and improving joint pains and hypertension

• The Community Wellness Program consists of participation in workshop and group exercises, in the Wellness Clinic. Group exercises of 4-5 subjects were done in a subject's home.

Subjects covered included 1) Techniques to deal with problems such as fatigue, pain 2) Appropriate exercise for maintaining and improving strength, flexibility,

and endurance, 3) Appropriate use of medications, 4) Communicating effectively with family, friends, and health professionals, 5) Nutrition6) Dynamic relaxation group therapy.

Methodology

• The venue chosen was Chattarpur Extension and Chattarpur Village in South Delhi where a local senior citizen organization named Varishtha Nagrik Kendra Sansthan (VNKS) was adopted for this project.

• The elder women members and spouse of elder men members of VNKS aged 60 or more and having complaint of hypertension or joint pain or both were screened.

• The Patron of the VNKS provided us with a list of all the members of VNKS.

• None of the 250 members were females.

• Active male members of VNKS were explained regarding the project .

Methodology

• The Community Physiotherapist visited houses of members and recruited their wives.

• They were explained thoroughly about the study and its objectives.

• The elder women enthusiastically also helped more women with similar problems in the locality participate in the project..

• A sample of 81 elder women eventually participated.• A dietician was enrolled to consult all the recruited subjects

about their diet plans and modifications.• Demographic and medical profile of subjects was documented

during the initial visit.

Outcome measures:

• Brief Pain Inventory (BPI) • WHOQOL (WHO quality of life) • Blood Pressure of subjects was measured • Mini Nutritional Assessment • Knowledge seeking behaviour towards dietary changes. • Project Feedback Form

Interventions

The subjects were recommended all the exercises and relaxation therapy according to their requirements and needs. The interventions was based on the following

• Relaxation and breathing exercises • Mobility Exercises • Aerobic exercise • Joint protection techniques • Practical changes at home for better and safe mobility • Managing pain • Diet Modification • Knowledge seeking behaviour

Follow up

• Follow up of recruited subjects were done once in every week.

Booklets

Booklets in local Hindi language were printed and distributed to subjects

Community Wellness through workshop on Dynamic Relaxation Group Therapy:

The Dynamic Relaxation Group Therapy is a process which focused on muscle relaxation, smooth breathing pattern and better blood circulation, Improvement in sitting and standing postures (through seven simple alterations) of the subjects were taught, followed by the rotational exercises of each and every joint.

Small Group Exercise Therapy

• Small groups of elder women met for exercises in their homes.

• Preferably one home was chosen for houses on the same street.

• Exercises were supervised by the Community Physiotherapist.

Caregiver Education

• During follow ups caregivers of elderly, like son, daughter, daughter in law, husband were counselled to motivate the subject to keep up with exercises and diet modifications

Results and Discussion:

• The present study included 81 elderly women with the mean age of 62 years belonging to low socio-economic status with an average annual income of Rs 75000. 85% of subject's were uneducated.

• The data was analyzed on the basis of pre and post-intervention results.

• Changes in areas of health status (disability, social/role limitations, pain and physical discomfort, energy/fatigue, psychological well-being/distress, health distress, self-rated general health, knowledge seeking behavior) blood pressure and compliance to diet modifications.

• 47 participants had joint pains, 33 participants had both joint pains and hypertension, and one participant had only hypertension.

WHO Quality of Life (QOL) Pre and post-intervention results on quality of life

BRIEF PAIN INVENTORY (BPI)

Pre and post intervention results in pain and other areas

BLOOD PRESSURE Showing pre and post-intervention results of Blood Pressure Measurements

Result of Intervention of Diet Modification:

Feedback on Self Management and Community Wellness Programs

• 95% of the participants strongly agreed about the well laid out objectives, proper time and place, good presentation and demonstration of the exercises during the project, books and hand-outs quality.

• 5% were simply agreed. • Encourages participation of subjects having similar problems.• Mutual support and success build the participants' confidence

in their ability to manage their health.• Within the end of eight week repeated weekly follow ups

helped 82% of participants to perform exercises.

Conclusion

• As mentioned in the Global Age Friendly City: A Guide, health and social services delivered within a city by local people in local establishments, and community-based support and voluntary groups may play an important role in delivering support and care to elderly.

• The model of The Self-Management and Community Wellness Program will not conflict with existing programs or treatment as it is designed to enhance regular treatment and disease-specific education given by clinicians/family physicians in healthcare organization.

• It may form a cost effective way to introduce prevention of co morbidities in elders This model may also help integrate various services of healthcare in a city.

• The program was especially helpful for women as it gave them the skills to coordinate all the things needed to manage their health and participate in house work, which can help them keep active in their lives.

• Social interaction and sharing of problems helped participants take more interest in continuation of exercises.

• Small groups improved comradeship amongst participants. Small group discussion regarding their health issue improved confidence about self managing health problems.

References:

1.Todays Research on Aging ; http://www.prb.org/pdf12/TodaysResearchAging25.pdf2. Aging in Asia: http://www.ncbi.nlm.nih.gov/books/NBK92618/pdf/Bookshelf_NBK92618.pdf3. Towards building an age friendly world: http://www.who.int/ageing/age-friendly-world/en/

Acknowledgements

WHO-SEARO: Dr Kunal Bagchi,Regional Adviser for Nutrition and Food Safety, WHO Regional Office for South-East Asia

Project coordinator: Ms. Sakshi jain Dietician: Ms. Akriti gupta Project advisor: Mr Debadeep BandyopadhyayClinical advisor: Dr Vinod Kumar Rai Workshop on dynamic relaxation therapy: Dr Subhasis Banerjee (Synphne Singapore) Project in charge: Dr. Alakananda Banerjee

Thank You