|Year : 2018 | Volume
| Issue : 1 | Page : 4-5
Need for a geriatric subspecialty with a focus on geriatric training for UG and PG
Om Prakash Singh
Department of Psychiatry, NRS Medical College, Kolkata, West Bengal, India
|Date of Web Publication||8-May-2018|
Om Prakash Singh
Department of Psychiatry, NRS Medical College, Kolkata, West Bengal
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Singh OP. Need for a geriatric subspecialty with a focus on geriatric training for UG and PG. Ann Indian Psychiatry 2018;2:4-5
|How to cite this URL:|
Singh OP. Need for a geriatric subspecialty with a focus on geriatric training for UG and PG. Ann Indian Psychiatry [serial online] 2018 [cited 2018 May 22];2:4-5. Available from: http://www.anip.co.in/text.asp?2018/2/1/4/232040
Geriatric population is rising in absolute numbers and percentage all over the world due to increase in life expectancy and decrease in birth rate. There is clear evidence of an epidemiological transition resulting in a sharp increase in the incidence of noncommunicable chronic diseases worldwide. Historical, socioeconomic, biological, and political factors will all play an important role in determining the impact of this transition. Health of the elderly requires huge resources which may be lacking in developing countries as developed countries have become rich before they became old whereas developing countries are becoming old before they become rich leading to a resource gap.
Developed countries define geriatric population as the people above 65 years of age, and developing countries like India define elderly persons as people above 60 years of age. According to population census in 2011, there are nearly 104 million elderly persons (aged 60 years or above) in India; 53 million female and 51 million male. Both the share and size of elderly population are increasing over time. From 5.6% in 1961, the proportion has increased to 8.6% in 2011. For males, it was marginally lower at 8.2%, while for females it was 9.0%. With regard to rural and urban areas, 71% of elderly population resides in rural areas while 29% is in urban areas.
Health needs of the elderly significantly differ from the adult population due to change in physiology, comorbidity leading to polypharmacy, multiple disabilities such as hearing and visual impairment, and locomotor disability makes the delivery of health care a challenging task. Due to cognitive impairment and disabilities, it requires special skill to seek informed consent, explain plan of treatment, and ensure adherence. The elderly require someone to accompany them to health facilities and the majority living in rural areas where health facilities are far away are not in a position to avail benefit of health services provided. With increasing nuclearization of families and increasing dependency ratio, there is now dearth of caregivers.
Recognizing these needs, the Indian Government came out with an ambitious program to provide health-care services to the elderly population. The National Programme for Health Care of the Elderly (NPHCE) in 11th 5-year plan with goals of providing health-care services to whole of elderly population. The basic objective of the NPHCE program is to provide separate, specialized, and comprehensive health care to the senior citizens at various level of state health-care delivery system including outreach services. Free specialized health-care facilities exclusively for elderly people through the state health delivery system, namely, district hospitals with geriatric clinic (outpatients department [OPD]) and 10-bedded geriatric ward; bi-weekly geriatric clinic at community health centers (CHCs); weekly geriatric clinic at public health centers; domiciliary visits to elderly persons by ANM/Male health workers posted under subcenters and provision of callipers and supportive devices to make them ambulatory and providing referral treatment at the regional geriatric centers with 30-bedded Department of Geriatrics. This obviously requires doctors trained in geriatric care who will manage at least CHC and Primary Health Centres at district level.
| Workforce Development|| |
Where is the workforce to provide this service?
The Medical Council of India has introduced MD-geriatric medicine to meet the needs of geriatric workforce. However, only five colleges have introduced MD-Geriatrics and have a total of 24 seats of which 15 are in AIIMS, New Delhi. This clearly demonstrates the need of teaching UGs and PGs of other departments to bridge the workforce deficit. The medical education in India inexplicably has limited teaching curriculum for UGs and PGs from different departments for geriatrics. Our teaching is based on compartmentalized system and subjects whereas for elderly requirement is a comprehensive and integrated teaching of geriatric problem. The study by Subramanyam and her group published in this journal clearly brings out that though students are aware of need of geriatric population, but at the same time, attitude questionnaire study reveals negative attitude among interns which indicates lack of sensitization in their undergraduate training. They also found that among General Medicine and Psychiatry PG specialties, those who had specialized geriatric training had better scores. A 2008 survey of undergraduate teaching in geriatric medicine  collected responses from 17/31 UK medical schools and demonstrated shortcomings in the teaching of pressure ulcers, elder abuse, and bio- and social gerontology. There was also widespread failure to adequately assess learning outcomes related to aging. The overall picture is one of consummate mismatch between the proportion of the medical workload made up by the diagnosis and management of frail older people and the amount of undergraduate teaching devoted to it.
Introduction of geriatric teaching at UG and PG level remains the only viable solution to bridge this gap. For this purpose, different societies are trying to formulate a core competencies level required for UG students. The British Geriatric Society has developed such a curriculum also the American Association of Medical colleges have developed a module of core competencies required for UG students for geriatric care.,
| Conclusion|| |
In India, introduction of geriatric teaching in UG and PG curriculum is earnestly required but there are challenges ahead. Our teaching method is not integrative having a fixed period of exposure to different disciplines. In overcrowded curricula, there is a huge jostling going on for the introduction of subjects. Place for geriatric training has to be found in the existing system without demand for extra time by innovative change in teaching system and exposure to geriatric patients early in their career. Although the MCI has defined core competencies required for trainees of MD-geriatric, there is no document available for UG teaching and teaching of PGs of other subjects. Defining and developing such a document is the need of the hour.
| References|| |
Bergman H, Karunananthan S, Robledo LM, Brodsky J, Chan P, Cheung M, et al.
Understanding and meeting the needs of the older population: A global challenge. Can Geriatr J 2013;16:61-5.
Elderly in India 2016. Government of India, Ministry of Statistics and Programme Implementation. Central Statistics Office. Available from: http://www.mospi.gov.in
. [Last accessed on 2018 Mar 31].
NPHCE, Ministry of Health and Family Welfare. Available from: http://www.mohfw.gov.in
. [Last accessed on 2018 Mar 31].
Subramanyam AA, Palsetia DD, Agarwal SR, Kamath RM. Should undergraduates be introduced to geriatric training? A pilot study on knowledge, attitude, and perception in medical interns and postgraduate residents from a tertiary care hospital. Ann Indian Psychiatry. 2018;2:33-40.
Gordon AL, Blundell AG, Gladman JR, Masud T. Are we teaching our students what they need to know about ageing? Results from the UK national survey of undergraduate teaching in ageing and geriatric medicine. Age Ageing 2010;39:385-8.
Oakley R, Pattinson J, Goldberg S, Daunt L, Samra R, Masud T, et al.
Equipping tomorrow's doctors for the patients of today. Age Ageing 2014;43:442-7.
Forrester-Paton C, Forrester-Paton J, Gordon AL, Mitchell HK, Bracewell N, Mjojo J, et al.
Undergraduate teaching in geriatric medicine: Mapping the British geriatrics society undergraduate curriculum to tomorrow's doctors 2009. Age Ageing 2014;43:436-9.