Geriatric Care in an Ageing Metropolis: A Physician’s Perspective from Kolkata

Geriatric Care in India: Navigating Health in a Greying Metropolis

Kolkata represents one of India’s most rapidly ageing urban populations, with elderly individuals constituting almost 11 percent of the population. From a physician’s perspective, geriatric cases in Kolkata, India, are characterised by high multi-morbidity, loneliness and social isolation, under-utilisation of preventive care, and gaps in organised, long-term and palliative care services.

Our city has been defined as a greying metropolis reflecting the migration of younger populace to greener pastures elsewhere. Unlike many other Indian cities, Kolkata exhibits a higher proportion of elderly residents, with some estimates saying that 1 in 9 individuals is aged above 60.

Clinical Burden: Multi-morbidity and Atypical Presentations

From a physician’s standpoint, the elderly population in Kolkata presents with a high volume of NCD or non-communicable diseases like diabetes. hypertension, chronic airway diseases, osteoarthritis, and cardiovascular diseases. Neurological morbidity is particularly notable with significant prevalent rates of Stroke, Dementia, and Parkinsonism.

Migration of younger family members to other cities or countries further exacerbates this issue, leaving elderly individuals with limited support and resources. Loneliness, particularly amongst elderly males and widowhood among females are prominent concerns which lead to higher mortality.

Additionally:

1) Many elderly individuals lack medical insurance especially in lower socioeconomic groups.

2) Preventive health seeking behaviour is poor even among financially stable groups.

From a physician’s perspective, this leads to delayed presentation at clinics leading to poor follow-ups and fragmented care.

The Challenges of Polypharmacy and Medication Management:

Buying medicines off the shelf from various unregulated pharmacies or “para dokan” leads to antibiotic resistance and is the bane of our existence as physicians. This is making a lot of antibiotics redundant and we have to choose higher antibiotics leading to increased cost of treatment. Multiple consultations across specialities often lead to overlapping prescriptions.

This leads to adverse drug reactions and poor adherence. In Kolkata, where healthcare is often accessed through a mix of public hospitals, private clinics and informal providers, continuity of care is frequently compromised.

What are the Gaps in Preventive and Primary Care ?

Preventive care remains under-utilised in the elderly population.

1. Vaccination uptake is low for e.g. Pneumococcal, Influenza, Shingles etc.
2. Screening for visual impairment osteoporosis and hearing loss is inconsistent.
3. Awareness is lacking regarding geriatric-friendly homes
   • without sharp edges
   • rubberised floor tiles
   • ample support in way of handles in bathrooms and stairways
   • ramps where necessary.

What are the Palliative and Long-term Care Needs?

Emerging data from Kolkata suggests substantial gaps in palliative care, particularly in low income groups. These can be enumerated as:

• Psychological Distress
• Social Isolation
• Lack of caregiver support
• Communication gaps with healthcare providers.
• Institutional long-term facilities remain limited and home-based care is largely unregulated and inconsistent.

What are the System-based Challenges in Geriatric Care in India ?

• Despite community-based elderly support programs systemic gaps remain.
• Elder care facilities are booming and are the need of the hour but obviously catering to those who can pay for it. Many times, mid-level executives have to sacrifice lucrative careers in other cities because they can’t afford to run two households leading to further economic woes and lesser quality of care for the elderly.
• Shortage of trained geriatricians and structured geriatric OPDs.
• Lack of integrated home care services and inadequate coordination between primary, secondary and tertiary care.

Kolkata’s ageing population therefore presents not only a clinical challenge but a public health imperative.

The Way Forward: A Physician’s Role| A Continuum-Based Model

Addressing geriatric health in Kolkata requires continuum-based models rather than episodic care.

• Adopting Comprehensive Geriatric Assessment CGA – integrating medical functional, cognitive and social evaluation into routine practice.
• Rationalizing pharmacotherapy and preventing over prescription.
• Strengthening preventive care such as vaccinations and routine screening.
• Incorporating Mental Health Screening and early detection of depression, dementia and tendency to self-harm
• Facilitating Palliative Care Discussions – encouraging early conversations around goals of care and end-of-life planning.
• Coordinating Care: Collaborating with physiotherapists, nutritionists and social workers.

Conclusion:

Kolkata stands at the forefront of defining India’s ageing population. For physicians, this represents both a challenge and an opportunity – to redefine care models that prioritise not just longevity, but functional independence, dignity and quality of life. A city that once epitomised cultural values must now evolve to ensure that its elderly population is not merely ageing, but ageing with dignity.

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