The world's population aged 60 and over is 600 million, and WHO forecast it to reach 2 billion by 2050. It reflects improving global health but it poses special challenges for 21st century health care providers. Due to low mortality and increased life expectancy world's population is ageing and this is unfortunate that there is less health care available for the elderly especially in developing countries.

Geriatric health care is not mere diagnosis and treatment of ailments; it also focuses attention on risk factors - physical, social, rehabitational, psychological and environmental.

Though everyone knows that one day he/ she will get old, no one knows when the aging process really starts. For the sake of convenience, the UN has given the cut-off age of 60 for a person to be considered elderly. The elderly population of the world is not homogeneous because individuals' age at different speed and the deterioration rate is also different. So there can be difference between chronological age and biological age.

There are 3 groups of aged individuals:

Young old (60-75 years), Old old  (75-85 years), and very old individuals (75-85 years). Total number of elderly people globally is anticipated to be doubled during 1996-2016 from 62.3 million to 112.9 million.

The number of elderly people in developing countries is almost 3-4 times of that of developed countries. Similarly, the numbers of people over 85 years and centenarians are also increasing steadily and women outlive men by an average 6.8 years. Seventy three percent of the deaths in the elderly are related to heart diseases, smoking and cancers. Twenty percent of the doctors' visit, 30 percent of hospital days and 50% of bedridden days are ascribed to elderly patients.

Common Health problems in elderly:

The health problems of aged people are usually multiple which are compounded by underreporting and apathetic attitude of the relatives towards health problems of the elderly. Any system of the body can be affected by any disease in an aged person due to changes in the physical and chemical barriers of the body. Changes in immune system, malnutrition, multiple drug use, psychological stress, a callous attitude towards one's own health are examples. Hospitals as well as epidemiological studies have shown that maximum cases of geriatric health problems pertain to mental morbidity followed by physical disability. Ophthalmic problems, degenerative diseases of joints, vascular, dermatological and urogenital problems are the common ailments which affect the senior citizens.

Health care needs of Aged people:

The physiology and pathology of an elderly person are entirely different from those of a young person. Hence the health care needs are also individualized because each one has different age related changes. The aging process brings with it the discomforts related to age as well as the need for psychological acceptance. The passing of life, psychological dependency and proximity to death loom large in the elderly. Due to various physical and physiological processes of ageing, the elderly become highly vulnerable to accident, disease and other psychological problems. Heart disease, cancer, and stroke have become the leading "killers" among older adults, while deaths due to infection have decreased. Adults surviving into late life suffer from high rates of chronic illness; 80 percent have at least one and 50 percent have at least two chronic conditions 

Geriatric Health Care

Most preventative health care and early disease screening takes place in Primary Health Care (PHC) centers within health systems. These centers play a critical role in the health of older people worldwide at the local level.

WHO has developed a set of age-friendly primary health care principles that are part of the Perth Framework for Age-Friendly Community-Based Primary Health Care and were finalized during a meeting on age care which took place in Perth, Australia, 2002.

WHO developed a project entitled "Integrated Health Care Systems Response to Rapid Populations Ageing in Developing Countries - INTRA" in 2001. INTRA focus on assessing the role and preparedness of the Primary Health Care (PHC) sector to respond to population ageing, and to make recommendations aimed at improving the delivery of the PHC services to better serve older persons.

Through a series of empirical- based research INTRA, developed in three stages, investigates the nature and practice of primary health care services provision from three different perspectives - PHC users and non users, health care providers and policy makers.

The World Health Organization recently commenced a program designed to foster ''age-friendly'' environments that encourage ''active ageing by optimizing opportunities for health, participation and security in order to enhance quality of life as people age''. WHO strongly advocates that all future medical doctors need to be well trained in an interdisciplinary care of older persons, since most future doctors will see increasing numbers of older persons in daily practice.

Various universities have incorporated geriatric training programs into undergraduate medical curriculum and improved the knowledge, skills, positive attitude, and interest in caring for older patients

Needs and Challenges

In spite of initiatives by Health agencies, Geriatric health Care still remains ignored. Though the numbers of hospitals providing specialized health care to elderly have increased but still they are handful. Geriatric care is capital intensive and at the same time it does not yield much profit. Also in developing countries there is little interest shown by medical staff because geriatric care requires long hours of commitment, and also the doctors are not specialized in geriatric care. So there is still need to spread awareness about Health problems, health facilities and also rehabilitation programs for elderly. Health promotion and cost effective interventions are needed to provide health care to senior citizens.

We have the resources; but we lack the will and right attitude to adequately care for the adults. Let us move ahead in caring for those who have cared for us.