Caring for the Elderly

Mrs Channamasetti Sattemma, 78 years old, lives in Korukollu, a small and remote village in West Godavari district, Andhra Pradesh, in southern India. She came to the attention of the L V Prasad Eye Institute’s community health worker because of her severe vision loss; she depended on her grandchildren for all her daily activities. Sattemma was immediately escorted to our Ln Peruri Venkateshwarlu & Kashiratnamma Eye Centre (a secondary care facility) in Akividu, about 20 kilometres from Korukollu. She had advanced cataract in both eyes and was deeply anxious because of her disability.

Sattemma underwent cataract surgery in her right eye first, and a month later, in her left eye. On the day of surgery for her left eye, she climbed the stairs to the centre on her own, refusing assistance. Today, Sattemma is our best ambassador, tireless in spreading the message of eye health. Many older adults from her community have visited the centre since her sight was restored. I heard about Sattemma’s transformation from Ramakrishna, the centre administrator at Akividu, who is just as delighted with the outcome.

Sattemma is coming to terms with a general decline in her physical function, even cognition. Vision loss can only make all these signs of ageing worse—older people with impaired vision have difficulty walking, a higher risk of falls, debilitating fractures, and as a consequence, greater social isolation. There is growing evidence that links sensory loss to dementia and other cognitive impairments among the elderly. Sattemma regained her confidence and her enthusiasm for life as soon as her vision was restored. She is now in a better place to address all the other physiological changes in her body.

Around the world, Sattemma’s age cohort is expanding. The human population is growing older, with a consequent increase in the proportion of elderly adults. Three years ago, the number of adults in the world who are over 60 years of age, outnumbered the number of children under the age of five. According to the UN World Population Ageing Report, India’s elderly population is on the rise as well, expected to surge from 8% in 2021 to a substantial 20% by 2050—or over 300 million individuals. This significant demographic transformation demands our attention.

The LVPEI response

Today, India’s older adults are experiencing big changes in their lives. Multigenerational households have disintegrated, and the number of care homes for the elderly is exploding. The Hyderabad Ocular Morbidity in Elderly Study (HOMES) by LVPEI’s Srinivas Marmamula is one of the largest eye health studies on the older Indian adult who lives in a care home. It gives us an insight into the prevalence of vision loss in these care homes. We are also afforded a deeper understanding of the interplay of sensory loss with what Sheila West of the Dana Center for Preventive Ophthalmology calls ‘internecine’ impairments, like depression, dementia, and other effects of ageing.

LVPEI has also set about creating a dedicated comprehensive eye care service for “Elderly Eye Care” at our care facilities. Each of these centres is designed with a focus on the unique needs of older adults. Along with their eye care needs, these centres also evaluate other risks and health issues of ageing and provide necessary counselling and education. The first such centre for the elderly was started at our GMR Varalakshmi campus in Visakhapatnam with the generous support of Aurobindo Pharma Limited. Subsequently, two more centres were inaugurated, one at the Kallam Anji Reddy campus in Hyderabad with support from Gland Pharma and another at the Mithu Tulsi Chanrai campus in Bhubaneswar supported by the ICICI Foundation.

In 2021, during the collapse of travel due to COVID-19, we began to offer ‘HomeCare’ for patients who were unable to make it to our centres. By 2022, HomeCare became a key aspect of our ‘Patient First’ approach for elderly persons who cannot visit a facility for an exam. LVPEI Vision Technicians offer these eye exams, giving this cadre a new avenue for their skills. These technicians are backed up by LVPEI’s robust teleophthalmology network connecting them to an ophthalmologist at the telecommand centre.

New Vistas

One of the major concerns among older adults is the risk of falling. HOMES has found that older adults with dual sensory impairment (hearing and vision loss) report 10 times more about their fear of falling—where the fear itself can be debilitating—than those with a single impairment. In India, various studies report a falls prevalence of 26%-37% among the elderly. This year, LVPEI began observing Falls Prevention Week, a global initiative held from the 18^th to the 22^nd of September every year. During this week, we inaugurated “Falls Prevention Experience Centres” as part of the Centres for Elderly Eye Care in our Hyderabad, Bhubaneswar, and Visakhapatnam campuses. Other activities carried out across our campuses included awareness talks, a guest lecture on supporting older adults experiencing mental health changes, eye screening at various old age homes, a free eye consultation drive for LVPEI staff’s elderly relations, and inter-generational activities.

In June this year, Avinash Pathengay, the network director for our elderly initiatives, and his team attended the annual conference of the International Federation on Aging (IFA) in Bangkok. IFA advocates for older persons around the world, ensuring their rights and roles are preserved as the world around them changes. The conference’s fresh ideas and insights have helped us realign LVPEI objectives with the UN Decade of Healthy Aging’s four pillars: combatting ageism, fostering age-friendly environments, implementing integrated care, and providing long-term support.

The delivery of eye care is key to understanding how India and the world will tackle this demographic upheaval in our times. As we seek to correct their eyes, we get a peek into the hearts and souls of a new generation of older adults. There are complex challenges ahead, but I am confident that LVPEI’s values of patient-first, service offered with compassion, dedication, and the belief that every individual, regardless of age, deserves the gift of sight and the warmth of care–will see us through.

Image on left: Elderly lady by Srinivas Marmamula