Caregiving for Aging Populations with Multiple Co-Morbidities
Tagged: Medicine & Healthcare
1.1Problem Statement
Nations worldwide are currently fighting with the crest of the ageing wave as their older populations rapidly expand. Rapid In addition to creating a stunning demographic shift, the recent spike in the elderly population has put the world's healthcare delivery system at risk . As much as 55% to 98% of older persons with MCC have two or more chronic illnesses, an actual prevalence rate . Older adults with MCC frequently struggle to care for themselves and manage their chronic diseases . The problem and importance of providing older people with MCC with effective healthcare are increasing globally . The Madrid International Plan of Action on Aging (2002) advocated three critical activities for older adults: development, supportive surroundings, and enhanced healthcare systems (Organization, 2016). By viewing senior adults as "resources" rather than "beneficiaries," the scenario has notably challenged the world's governments to provide a complete health system to their elderly populations in a sustainable manner.
The national policy for older people in India was established in 1999 to promote the health and welfare of the country's elderly population. The nation faces the most significant medical challenge of co-morbidity due to the rising number of seniors, which necessitates a radical shift in policymakers' mindsets inspired by affluent countries .
1.2 The rationale of the study
Ageing is normal when a person is 65 years old or older chronologically. Ageing as a phenomenon poses a unique challenge for all facets of society due to a wide range of problems, including malnutrition, inaccurate diagnoses, physic-emotional issues, financial limitations, and most significantly, the health care system. Population ageing is a worldwide phenomenon experienced by almost all the countries in the world and reflects social, economic and health achievements . The significantly predicted population ageing rate and the related co-morbid conditions are the main reasons ageing affects a nation's policy framework. In emerging countries, there is a significant increase in the senior population. By the year 2050, it is predicted that 79% of people who are 60 or older will reside in developing countries .
1.2.1 Indian Scenario
India, the second-largest country in the world in terms of the total population and the number of people aged 60 or over, has a sizable senior population . Age-related social, economic, educational, and health status differences are significant. The rapid population change in India coincides with an increase in illness burden and, consequently, a rise in the need for health care. However, the public health infrastructure is insufficient to handle a rapidly ageing population's growing health burden because no social security systems apply to the entire population. Due to a considerable rise in older people suffering from chronic diseases, including diabetes, hypertension, and lung ailments, the extent of disparities in India's healthcare system is rapidly expanding. This has indeed proven to be a crucial component in a public and private businesses. Limited housing, a lack of a national policy, and expensive business strategies are currently hurting the delivery of adult health care. Although there are nationalised programmes like the National Family Benefit Scheme (NFBS), the Indira Gandhi National Old Age Pension Scheme (IGNOAPS), and the Indira Gandhi National Widow Pension Scheme (IGNWPS), a focused strategy for health delivery is still lacking .
1.3 Scope
The suggested doctoral thesis thus attempted to critically examine the health delivery system in the Indian urban population with specific attention on the co-morbidities, having recognised that social welfare and health care of the greying population in emerging nations has not been formed. The study project's geographical focus will be on urban centres with plenty of room for sample and model development. However, the supervisor's approval is required before choosing the location and co-morbid conditions.
1.4 Objectives
The delivery of health care to elderly persons with co-morbidities in India from an urban perspective is addressed in the theoretical and conceptual framework of the doctoral thesis.
1.A review of the healthcare systems for elderly care in Asia and India.
2. To determine the situation of health care spending and utilisation among older adults in India
3.To investigate the perspectives of friends and relatives who look after community seniors with MCC.
1.5 Methodology
The given objectives have been carefully framed into the research approach, which is concisely described below.
1.5.1Primary Data collection
The primary data collection would be conceptually designed based on the technical picture of the healthcare system and co-morbid condition obtained through the secondary data to ensure retrieval of pertinent information.
The research area's broad demographic information will be gathered through national databases. In-person structured interviews or digitised patient data from hospitals will be used for a purposeful sample. Age, sex, location, socioeconomic class (Carstairs score), and co-morbid health disorders are among the many strata that will be included in the dataset. Case-by-case data on co-morbidity will be gathered. The study focuses on diabetes, hypertension, and lung problems; each co-morbidity will be classified as a physical or mental health disorder. Data sets related to hospital stays, individual admissions, overnight expenses, current medical policy, home care, and psychological, financial, and non-health aspects will be studied from a quantitative and a qualitative perspective.
1.5.2 Secondary Data Collection
The data related to sociodemographic characteristics, frequency of various co-morbidities, associated risk factors, and history of hospitalisations among the older population, a series of literature reviews in primary bibliographic, clinical research networks, biorepositories, and health databases will be conducted. Hospital patient data sets will be obtained to conduct research.
1.5.3 Quantitative & Qualitative analysis
The mean differences in co-morbidities among men, women, age, sex, and deprivation deciles will be analysed using a t-test. Propensity score matching, a tool that works well for non-experimental causal research, will be used for quantitative data analysis . Each adult with one or more chronic health conditions will have their care quality assessed by a Delphi panel test . It will make it possible to learn about the common co-morbidities in the research field and their underlying linkages. Adults with co-morbidities will have their health care continuity indexed using the Bice Continuity of Care (COC) index . In addition, we will be able to understand how the delivery of healthcare functions in real-time owing to the COC score.
The relationship between the prolonged health care provided to patients with co-morbidity will be established using a marginal logistical model (Proc GenMOD) . To investigate the causal connection between ageing and co-morbid disorders, an inter-phenomenological analysis (IPA) of the primary and secondary data will be conducted along with a comparative case study. A crucial tool for ageing research, IPA is a qualitative methodological technique . It is based on phenomenology, hermeneutics, and ideography, three fundamental philosophical ideas. The tool's main objective is to comprehend perceptions in an academic setting. From a conceptual standpoint, it connects a person's perception to a phenomenon or theory.
A comparative cross-sectional study will be done with the data sets to generalise the idea of active ageing in India's urban population and comprehend how the policy environment functions in real-time. In addition, there will be a clear outline of the variables that most significantly affect the quality of life of older persons with co-morbid conditions. A cross-sectional methodology is the best quantitative approach to close the knowledge gaps between the ageing population and policymakers and explain causal attribution in a particular demographic group.
1.6 Review of healthcare systems and business models
Indian laws and conceptual frameworks address the medical and social needs of the elderly, and a substantial part of these policies has established a role for civil society. Several elements, including health care delivery and an integrated community for adults in rural and urban populations, are addressed in detail in the national policy for senior citizens, 2011, which was released. In the current paper, several pertinent national policies will be critically examined. For the study's goal, good practices used by eminent national centres, including the International Longevity Centre in Pune, the Nightingales Medical Trust in Bangalore, the Vidarbha Project of Help Age India, and others, will be documented. The current policies, programmes, and areas of adult health care with co-morbidity will be reviewed critically in this part, along with their scopes and gaps .
A critical analysis of the creative business models for aged care will be conducted to comprehend what health services are most needed by older people. "In-home care services," "Products for Easier Home upkeep," "Concierge services," "Health care service at home," "Dementia villages," and "Handyman services for the elderly" are the leading models of developed nations like the United Kingdom, Europe, and Australia .
This proposed study was to provide a detailed discussion of some business models, including the Group Home Model, Health Smart Homes for Aging, Australia & Canada, Whittingham Aged Care Model, Combined Aged and Disability Service Model, and Naturally Occurring Retirement Community.
1.7 Ethical Considerations
The entire research project would be conducted within the constraints of India's ethical and regulatory frameworks. For example, the university's research guidelines forbid the acquisition of personal identifiers and specify that informed consent processes, survey data confidentiality, and other necessary ethical norms must be rigorously implemented.
References
1. Fabbri, E., Zoli, M., Gonzalez-Freire, M., Salive, M.E., Studenski, S.A. & Ferrucci, L. (2015). Aging and multimorbidity: new tasks, priorities, and frontiers for integrated gerontological and clinical research. Journal of the American Medical Directors Association. [Online]. 16 (8). pp. 640–647. Available from: https://www.sciencedirect.com/science/article/pii/S1525861015002273.
2.Afshar S, Roderick PJ, Kowal P, et al. Multimorbidity and the inequalities of global ageing: a cross-sectional study of 28 countries using the World Health Surveys. BMC Public Health 2015; 15: 776.
3.Ploeg J, Canesi M, Fraser K, et al. Experiences of community-dwelling older adults living with multiple chronic conditions: a qualitative study. BMJ Open. 2019; 9(3):e023345.
4.Grembowski D, Schaefer J, Johnson KE, Fischer H, Moore SL, Tai-Seale M, et al. A conceptual model of the role of complexity in the care of patients with multiple chronic conditions. Med Care. 2014;52:S7–14.
5.Paul, N.S.S. & Asirvatham, M. (2016). Geriatric health policy in India: The need for scaling-up implementation. Journal of family medicine and primary care. [Online]. 5 (2). pp. 242.
Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5084541/.
6. https://doi.org/10.1016/j.ahr.2021.100012
7.United Nations (2019). Population Ageing and Development, 2019: Datasheet. United Nations, Department of Economic and Social Affairs, Population Division, The 2019 Revision
8.United Nations World Population Prospects, The 2017 Revision: Datasheet. United Nations. Department of Economic and Social Affairs; 2017. Population Division.
9. Bharati, K. & Singh, C. (2013). Ageing in India: need for a comprehensive policy. IIM Bangalore Research Paper. [Online]. (421). Available from: https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2310455.
10.Hillen, J.B., Vitry, A. & Caughey, G.E. (2017). Disease burden, comorbidity and geriatric syndromes in the Australian aged care population. Australasian journal on ageing. [Online]. 36 (2). pp. E14–E19. Available from: https://onlinelibrary.wiley.com/doi/abs/10.1111/ajag.12411.
11. Petrosyan, Y., Barnsley, J.M., Kuluski, K., Liu, B. & Wodchis, W.P. (2018). Quality indicators for ambulatory care for older adults with diabetes and comorbid conditions: A Delphi study. PloS one. [Online]. 13 (12). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6292587/.
12. Bice, T.W. & Boxerman, S.B. (1977). A quantitative measure of continuity of care. Medical care. [Online]. 15 (4). pp. 347–349. Available from: https://www.jstor.org/stable/3763789.
13. Fitzmaurice, G.M., Laird, N.M. & Ware, J.H. (2012). Applied longitudinal analysis. [Online]. John Wiley & Sons. Available from: https://books.google.com/books?hl=en&lr=&id=0exUN1yFBHEC&oi=fnd&pg=PR17&dq=Applied+longitudinal+analysis+&ots=BdqWSXtL0D&sig=3I6lf86vBbRL1wDCM_2izuz7BWs.
14.Petrosyan, Y., Barnsley, J.M., Kuluski, K., Liu, B. & Wodchis, W.P. (2018). Quality indicators for ambulatory care for older adults with diabetes and comorbid conditions: A Delphi study. PloS one. [Online]. 13 (12). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6292587/.
15. Pietkiewicz, I. & Smith, J.A. (2014). A practical guide to using interpretative phenomenological analysis in qualitative research psychology. Psychological journal. [Online]. 20 (1). pp. 7–14.
16. Nicole Crampton (2019). Examples of Elder Care Business Ideas. [Online]. 2019. Entrepreneur. Available from: https://www.entrepreneur.com/article/334861. [Accessed: 13 May 2020].
