**2. Geriatric problems in India**

#### **2.1 Health problems of elderly**

In India, the elderly people suffer from dual medical problems, i.e. both communicable as well as non-communicable diseases. It is estimated that one out of two elderly in India suffers from at least one chronic disease like diabetes mellitus, dyslipidemia, hypertension, COPD, thyroid disorders, heart diseases which requires life-long medication. This is further complicated by impairment of special sensory functions like vision and hearing. A decline in immunity as well as age-related physiologic changes leads to an increased burden of communicable diseases or infectious diseases like influenza, pneumonia, tuberculosis (TB) in the elderly population. Most common disabilities among the aged were locomotor and visual, almost half of the elderly disabled population was reported to be suffering from these two types of disabilities (2011 census). Cardiovascular disorders account for one third of elderly mortality followed by respiratory disorders mortality (10%) and infections including TB (10%). It has been reported that a geriatric individual takes an average of six prescription drugs concurrently and often suffers from adverse drug reactions [1, 3, 5, 6].

#### *Importance of Geriatric Health Care in India during Covid 19 Pandemic DOI: http://dx.doi.org/10.5772/intechopen.95500*

A key clinical issue in geriatric mental health is the heterogeneity in clinical presentations that confounds diagnosis and treatment of these problems. Patients usually deny the presence of mental health problems and are reluctant to seek help. Geriatric patients have multiple co-morbidities including psychological problems like depression. Few factors contributing to geriatric depression are female sex, widowed status, nuclear families, and stressful life events. Research indicates comparatively higher prevalence of geriatric depression in India, with a median prevalence rate of 21.9%. Symptoms of geriatric depression affect behavioral, physical, and cognitive domains of an individual, while many elderly do not seek help as a stereotype myth prevails that geriatric depression is normal in old age. Dementia is the most common neuropsychiatric illness besides depression as the major contributor to disability in people above 60 years of age, accounting for one quarter of all disability adjusted life years (DALY). It has been shown in different studies that, many environmental factors as well as caregiver approach towards elderly population with dementia are responsible for development of various psychiatric behaviors in elderly like agitation, irritability, restlessness, emotional distress and sleep disturbance. There is urgent need of sufficient number of dementia care homes, rehabilitation centers along with dementia daycare centers to manage the huge number of dementia patients in India [7–12].

## **2.2 Socioeconomic challenges for the elderly**

Elderly or geriatric populations have different socioeconomic problems in their life in the forms of loss of spouse, economic insecurity, social isolation, not getting pension timely etc. Elderly people in India not only work to support themselves but also make economic contributions to their households. Nearly 66% of those over 60 years of age are currently married, 32% are widowed and nearly 3% are separated or divorced (2011 Census). The proportion of those who have lost their spouse is much higher among women compared to men with 48% of older women and only 15% of the older men being widowed. Since women are more likely to be dependent on men for financial security, women face more adversities due to loss of spouse compared to men. Living arrangements among the elderly was not a problem in India till a few years ago because elderly people were given special respect and care in their family. Majority of the elderly are still living with their children in India, about one fifth either live alone or only with the spouse and hence have to manage their material and physical needs on their own. Financial dependency also increases with age. Around 50% of the elderly have some type of personal income after their retirement in the form of social security measures like pension scheme, provident fund, life insurance policies, post office deposits, savings bank interests and non service people of rural as well as urban India get some amount of incentives as part of different national health programs, schemes for elderly population; which will be discussed in subsequent sections. This income earned by the elderly is not sufficient sometimes to fulfill their basic needs and wishes to buy some gifts for their grandchildren on some special occasions. Most of the time, they are seen dependent financially on their offspring. Almost three fourth of the elderly are either fully or partially dependent on others like relatives, friends and neighbors and such dependency is more for elderly women than men. Overall, it appears that elderly still depend greatly on their earnings to support themselves and their family. Presently, lower class and middle class families are facing a great challenge to take care of elderly population due to reduction in economic activities following sudden Covid19 pandemic and subsequent lock-down [1, 6].
