COPE

Care for Older PEople

PROJECT AT A GLANCE

Funders: Public Health Foundation of India and Wellcome Trust UK

Duration: 2011 to 2013

PhD student: A T Jotheeswaran 

PhD supervisors: Prof Martin Prince and
Dr Vikram Patel

Assistant coordinator: Shezmin Jasani

Project secretary: Robert  Teles

Collaborators: 
Dr Amit Dias, Goa Medical College, Goa
Institute of Psychiatry, KCL, UK
Dr John Beard, WHO - Department of Ageing and Life Course

Background:

India and China alone are projected to have 270 million elderly citizens by the year 2020. The main public health issue for the older population is the increasing occurrence of chronic diseases (CDs), already accounting for 80% of the global burden of disease. CDs linked to ageing – heart disease, stroke, cancer and dementia – are beginning to be recognized as a public health priority for the region .  While cancer and heart disease contribute mainly to mortality, much of the burden of other CDs (stroke, dementia and mental disorders) arises from years lived with disability  . CDs among older people, and their long-term care needs are under-prioritized with respect to research, policy and practice in India. There is very limited data from India and other LAMIC regarding the prevalence of CDs among older people, their burden, and the effectiveness of existing measures for prevention, treatment and control. Most existing data e.g. the Chennai Urban Rural Epidemiology Study (CURES) comes from young and middle aged samples, which cannot be generalized to older people for the following reasons:  

  • Comorbidity between physical, mental and cognitive disorders is much more common
  • Older people have a higher prevalence of significant long-term disability and dependency
  • Older people often have deficient social protection (no income, no pension, family not always available to support and provide care) leading to significant disadvantage

    
Older people have specific needs that are often forgotten in the development of national policies, such as the National Rural Health Mission policy. Primary care services fail to meet the needs of older persons with CDs particularly because a) they are clinic-based with no outreach and b) because they focus on the detection and treatment of acute health conditions, with little capacity to provide long term support and care to older people and their families. Dependency,  a key public health outcome to which dementia makes an important contribution, may be a more appropriate target at primary care level. Packages of care could be constructed that address relevant impairments (mobility, behaviour, cognitive, nutrition, hydration, continence) horizontally across underlying health conditions (dementia, stroke, heart disease, Parkinson’s disease, arthritis). More research is needed at Phase 1 and Phase 2 levels to construct evidence-based packages of care that could then be evaluated in the public healthcare system in India. The effective dissemination of such research work can raise awareness and inform evidence-based policymaking and service development for older people with dementia and other disabling CDs in India.

Over all aim:
To develop a multi-component (complex) intervention package for use by non-specialist health workers targeting frail dependent older people and their carers, and carry out initial evaluation, as preparatory work for a definitive randomised controlled trial.