**3. Covid-19 pandemic situation in India and globally**

Corona virus outbreak was first reported in Wuhan city, Hubei province of China at the end of December 2019. Then Italy was affected by this infectious disease followed by multiple countries due to continuous movement of people across the globe by international air travel. The World Health Organization (WHO) declared this Covid outbreak to be a Public Health Emergency of International Concern (PHEIC) on 30th January, 2020. It was declared a pandemic subsequently on 11th March, 2020 when it affected more than hundred (113) countries world-wide [13].

Globally, there have been near about 3 crores (28918900) confirmed cases of COVID-19, with more than 9 lakh (922,252) deaths, reported by WHO with case fatality rate of 3.18% as on, 14 September 2020. Presently, the United States of Americas is at number one position in terms of number of Covid 19 cases, having more than one fifth of total confirmed cases (22.2%) of Covid 19 followed by South-East Asia (18.9%), European region (16.7%), Eastern Mediterranean region (7.3%), African region (3.9%) and Western Pacific (1.9%), being the least affected region globally as on 14th September, 2020. There were more than 1.8 million new cases of COVID-19, with over forty thousand (40,600) deaths reported in the second week of September, 2020.The African Region also showed a decline in Covid 19 cases this week and was the only region to report a decline in deaths due to Covid 19. The European region has reported the third highest number of new cases in this week, accounting for about 16% of global cases and 25% of the deaths, with the second-highest cumulative number of Covid 19 cases per million populations (5,172 cases per million populations). In the South-East Asia Region, three countries namely; India, Indonesia and Bangladesh continue to report the highest number of Covid-19 cases, with the Maldives accounting for the highest number of cumulative cases (16,746 per million populations) in the second week of September, 2020. This region suffered 22% of all new deaths but retains low cumulative deaths in terms of population (46 per million populations). Myanmar is continuing to show increasing number of cases with mortality of less than 1 per million populations. Presently India has the highest number of Covid 19 cases (88.4%) in South-East Asia Region as on 14th September 2020. Indonesia has the highest case fatality rate (4.02%) followed by Thailand (1.67%), India (1.65%), Bangladesh (1.39%), Nepal (0.63%), Myanmar (0.57%), Srilanka (0.37%) and Maldives (0.34%) in South-East Asia Region. Currently, two countries from this region, Bhutan and Timor-Leste have not reported any death due to Covid 19. India has a very good recovery rate of more than 78% till now which is better than many countries compared to huge number of populations affected by Covid 19 [14].

### **4. Geriatric health care service -need and present scenario in India**

Many programmes targeting geriatric population came to act in our country in last few decades but still we do not have the sufficient number of geriatric health clinics, geriatric physicians and caregivers to take care of our elderly. It's high time to look forward in a positive way to deal with these problems of deficiency during this challenging time of Covid 19 pandemic. Geriatrics is relatively a new branch in India with most practicing young physicians having limited knowledge of the clinical and functional implications of aging. India's old, their caregivers and healthcare providers admit ill health as part of senility. Geriatric care is not only concerned with the physiological phenomenon, but also with the medical health problems and specific diseases of an elderly [5].

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

Increasing elderly population in India together with enhanced awareness on health issues is expected to put considerable pressure on the health care system in general and geriatric care in particular. The United Nations Population Fund (UNFPA) conducted a survey across seven states (Himachal Pradesh, Kerala, Maharashtra, Odisha, Punjab, Tamil Nadu and West Bengal) in India in 2011 to build a knowledge base on the socio-economic and health implications of aging and the ability of the elderly to access and use various welfare initiatives of the government. The survey showed that about 7.6% of the elderly in India (approximately 7.9 million persons) had difficulty in accomplishing activities of daily living (ADLs) and were in need of assistance. In general, elderly women have greater difficulty in performing ADLs than elderly men [1].

Aging of population affects economic development of society as economic productivity is usually carried out by youths and adults - the productive forces. Aging problems vary across different geographical regions depending on demographic diversity, socioeconomic status, cultural and traditional practices. India is a country of demographic heterogeneity and geographical diversity, still one thing is common among its population i.e.; love and respect for each other especially for their elderly population. The family provides social and economic support to individuals at various stages of life. Family transition from joint to nuclear structure affected not only the status of elderly but also the family's capability to care for elderly. Family structure changes were brought out by increased mobility for job opportunity, urbanization, capitalism, division of labor and industrialization. Community based voluntary support and viable formal support systems for elderly with chronic diseases and disabilities might address this issue. Creating provisions for elderly housing, domiciliary care systems, communication technologies might bridge the gap between young and old generations. Demographic factors like very old, women, those living alone and unmarried are more likely to enter long term care institutions. Predictors of social placement of an elderly to an institution are mainly social selection and allocation processes in health delivery systems (theoretical perspective) and risk factors that delay nursing home placement (policy perspective). Important reasons for entry into institutions are unavailability and unwillingness of family members to take care of geriatric population as well as availability of caretaker in private as well as government institution. Conditions viz., living arrangement, perception that institutions are good alternatives and persons involved in decision making in family influence institutionalization of elderly. Institutionalized elderly are heterogeneous in terms of demographic characteristics, physical and mental conditions, service utilization patterns, prognosis and life expectancy. Few factors facilitating entry of elderly people in institution are status of elderly within the family, social issues, existence of nursing home, heterogeneity of nursing homes, behavioral ethnography of nursing home life and resident outcomes and attitude and behavior of nursing home personnel [15].

Over the years, government has launched various schemes with the intention of providing health, care, and independence of the elderly around the country. In the domain of public systems, there are two overarching initiatives that are large in coverage, more comprehensive or integrated in design and backed by financial and administrative resources. These are National programme for Health Care for Elderly (NPHCE) and Integrated Programme for Older Persons (IPOP). They facilitate and create an environment for different kinds of elder services. NPHCE is meant to be implemented in convergence with the National Health Mission, Ministry of AYUSH (Ayurveda, Yoga, Unani, Siddhi and Homeopathy) and the Ministry of Social Justice and Empowerment (MOSJE). The Government of India launched National Policy on Older Persons (NPOP) in 1999 with the primary goal of overall wellbeing of the elderly, ensuring them a legitimate position in the society.

The same Year 1999 was observed as the International year for older persons by the United Nations general assembly. The MOSJE has started the Integrated Programme for Older Persons (IPOP) since 1992, with the aim of improving the quality of life of elderly people by providing basic amenities like food, shelter, medical care and entertainment opportunities. The IPOP provides financial assistance (up to 90%) to Panchayati Raj Institution (PRIs) or local bodies, NGOs, educational institutions, charitable hospitals or nursing homes etc. for initiation of different facilities for elderly like old age homes, mobile medical units for older persons living in rural and isolated areas, day care centers, physiotherapy clinics, provision of disability aids, running help lines and counseling centers and sensitization of school and college students to aging issues [1, 16].
