Short Term Programmes Admissions

Certificate in Geriatric Care

Location: Mumbai

Centre: Centre for Lifelong Learning


Intake: 20

Eligibility

  • Std. X
  • Above 18 years of age.

Description

RATIONALE

Geriatrics is a sub-specialty of internal medicine and family medicine that focuses on health care of elderly people. It aims to promote health by preventing and treating diseases and disabilities in older adults. There is no set age at which patients may be under the care of a geriatrician, or physician who specializes in the care of elderly people. Rather, this decision is determined by the individual patient's needs, and the availability of a specialist.

Geriatrics, the care of aged people, differs from gerontology, which is the study of the aging process itself. The term geriatrics comes from the Greek γέρων geron meaning "old man" and ιατρός iatros meaning "healer". However, geriatrics is sometimes called medical gerontology.

Scope of Geriatrics

Differences between Adult and Geriatric Medicine

Geriatrics differs from standard adult medicine because it focuses on the unique needs of the elderly person. The aged body is different physiologically from the younger adult body, and during old age, the decline of various organ systems becomes manifest. Previous health issues and lifestyle choices produce a different constellation of diseases and symptoms in different people. The appearance of symptoms depends on the remaining healthy reserves in the organs. Smokers, for example, consume their respiratory system reserve early and rapidly.

Geriatricians distinguish between diseases and the effects of normal ageing. For example, renal impairment may be a part of ageing, but renal failure and urinary incontinence are not. Geriatricians aim to treat any diseases that are present and to decrease the effects of aging on the body.

Increased Complexity

The decline in physiological reserves in organs makes the elderly develop some kinds of diseases and have more complications from mild problems (such as dehydration from a mild gastroenteritis). Multiple problems may compound: A mild fever in elderly persons may cause confusion, which may lead to a fall and to a fracture of the neck of the femur ("breaking her/his hip").

The elderly require specific attention to medications. They are particularly subjected to polypharmacy (taking multiple medications). Some elderly people have multiple medical disorders; some have self-prescribed many herbal medications and over-the-counter drugs; some adult physicians prescribe medications to their specialty without reviewing other medications used by the elder patient. This polypharmacy may result in many drug interactions and may cause some adverse drug reactions. In one study, it was found that prescription and nonprescription medications were commonly used together among older adults, with nearly 1 in 25 individuals potentially at risk for a major drug-drug interaction. Drugs are excreted mostly by the kidneys or the liver, either of which may be impaired in the elderly, and as a result the medication might need adjustment to avoid overwhelming the kidneys or liver.

The presentation of disease in elderly persons may be vague and non-specific, or it may include delirium or falls. (Pneumonia, for example, may present with low-grade fever, dehydration, confusion or falls, rather than the high fever and cough seen in middle-aged adults.) Some elderly people may find it hard to describe their symptoms in words, especially if the disease is causing confusion, or if they have cognitive impairment. Delirium in the elderly may be caused by a minor problem such as constipation or by something as serious and life-threatening as a heart attack. Many of these problems are treatable, if the root cause can be discovered.

Geriatric Giants

The so-called geriatric giants are the major categories of impairment that appear in elderly people, especially as they begin to fail. These include immobility, instability, incontinence and impaired intellect/memory.

Impaired vision and hearing loss are common chronic problems among older people. Hearing problems can lead to social isolation, depression, and dependence as the person is no longer able to talk to other people, receive information over the telephone, or engage in simple transactions, such as talking to a person at a bank or store. Vision problems lead to falls from tripping over unseen objects, medicine being taken incorrectly because the written instructions could not be read, and finances being mismanaged.

Practical Concerns

Functional abilities, independence and quality of life issues are of great concern to geriatricians and their patients. Elderly people generally want to live independently as long as possible, which requires them to be able to engage in self-care and other activities of daily living. A geriatrician may be able to provide information about elder care options, and refers people to home care services, skilled nursing facilities, assisted living facilities, and hospice as appropriate.

Frail elderly may choose to decline some kinds of medical care, because the risk-benefit ratio is different. For example, frail elderly women routinely stop screening mammograms, because breast cancer is typically a slowly growing disease that would cause them no pain, impairment or loss of life before they would die of other causes. Frail people are also at significant risk of post-surgical complications and the need for extended care, and an accurate prediction—based on validated measures, rather than how old the patient's face looks—can help older patients make fully informed choices about their options. Assessment of older patients before elective surgeries can accurately predict the patients' recovery trajectories. One frailty scale uses five items: unintentional weight loss, muscle weakness, exhaustion, low physical activity, and slowed walking speed. A healthy person scores 0; a very frail person scores 5. Compared to non-frail elderly people, people with intermediate frailty scores (2 or 3) are twice as likely to have post-surgical complications, spend 50% more time in the hospital, and are three times as likely to be discharged to a skilled nursing facility instead of to their own homes. Frail elderly patients (score of 4 or 5) who were living at home before the surgery have even worse outcomes, with the risk of being discharged to a nursing home rising to twenty times the rate for non-frail elderly people.

Geriatric Intervention

Modern geriatrics in the United Kingdom really began with the "Mother" of Geriatrics, Dr. Marjorie Warren. Warren emphasized that rehabilitation was essential to the care of older people. Using her experiences as a physician in a London Workhouse infirmary, she believed that merely keeping older people fed until they died was not enough; they needed diagnosis, treatment, care, and support. She found that patients, some of whom had previously been bedridden, were able to gain some degree of independence with the correct assessment and treatment.

The practice of geriatrics in the UK is also one with a rich multi-disciplinary history. It values all the professions, not just medicine, for their contributions in optimizing the well-being and independence of older people.

Another "hero" of British Geriatrics is Bernard Isaacs, who described the "giants" of geriatrics mentioned above: immobility and instability, incontinence, and impaired intellect. Isaacs asserted that, if examined closely enough, all common problems with older people relate back to one or more of these giants. The care of older people in the UK has been advanced by the implementation of the National Service Frameworks for Older People, which outlines key areas for attention.

Geriatric Training

In the United States, geriatricians are primary-care physicians who are board-certified in either family medicine or internal medicine and who have also acquired the additional training necessary to obtain the Certificate of Added Qualifications (CAQ) in geriatric medicine. Geriatricians have developed an expanded expertise in the aging process, the impact of aging on illness patterns, drug therapy in seniors, health maintenance, and rehabilitation. They serve in a variety of roles including hospital care, long-term care, home care, and terminal care. They are frequently involved in ethics consultations to represent the unique health and diseases patterns seen in seniors. The model of care practiced by geriatricians is heavily focused on working closely with other disciplines such as nurses, therapists, social workers, and pharmacists.

In the United Kingdom, most geriatricians are hospital physicians, whereas some focus on community geriatrics. While originally a distinct clinical specialty, it has been integrated as a specialisation of general medicine since the late 1970s. Most geriatricians are, therefore, accredited for both. In contrast to the United States, geriatric medicine is a major specialty in the United Kingdom; geriatricians are the single most numerous internal medicine specialists.

Minimum Geriatric Competencies

In July 2007, the Association of American Medical Colleges (AAMC) and the John A. Hartford Foundation hosted a National Consensus Conference on Competencies in Geriatric Education where a consensus was reached on minimum competencies (learning outcomes) that graduating medical student needed to assure competent care by new interns to older patients. Twenty-six (26) Minimum Geriatric Competencies in eight content domains were endorsed by the American Geriatrics Society (AGS), the American Medical Association (AMA), and the Association of Directors of Geriatric Academic Programs (ADGAP). The domains are: cognitive and behavioral disorders; medication management; self-care capacity; falls, balance, gait disorders; atypical presentation of disease; palliative care; hospital care for elders, and health care planning and promotion. Each content domain specifies three or more observable, measurable competencies. (Source:http://en.wikipedia.org/wiki/Geriatrics)

GERIATRICS: ITS IMPORTANCE AND PRESENT STATUS IN INDIA

Until the early 1980s, developing countries perceived that population aging was an issue that concerned the developed countries only. But as a consequence of rapid decline infertility, and a parallel trend of increasing life expectancy, the developing countries have become increasingly aware of a range of problems regarding aging. Asia holds the largest number of elderly (53 percent). Followed by Europe (25 percent). In 2050, 81 percent of the world's elderly population will be in the less developed regions of Asia, Africa and Latin America while only 19 percent of them will reside in developed regions of Europe and North America. In India, the population aging process has been observed form 1961. The older population of India, which was 56.7 million in 1991, was over 76 The older population of India, which was 56.7 million in 1991, was over 76 million in 2001 and is expected to grow to 137 million by 2021 (Raju,S ;2011,Pp:1-3)

Medical and Socio-economic Problems Faced by the Elderly

In India, the elderly people suffer from dual medical problems, i.e., both communicable as well as noncommunicable diseases. This is further compounded by impairment of special sensory functions like vision and hearing. A decline in immunity as well as age-related physiologic changes leads to an increased burden of communicable diseases in the elderly. The prevalence of tuberculosis is higher among the elderly than younger individuals. A study of 100 elderly people in Himachal Pradesh found that most of the patients came from a rural background. They were also smokers and alcoholics. It is shown that among the population over 60 years of age, 10% suffer from impaired physical mobility and 10% are hospitalized at any given time, both proportions rising with increasing age. In the population over 70 years of age, more than 50% suffer from one or more chronic conditions. The chronic illnesses usually include hypertension, coronary heart disease, and cancer. According to Government of India statistics, cardiovascular disorders account for one-third of elderly mortality. Respiratory disorders account for 10% mortality while infections including tuberculosis account for another 10%. Neoplasm accounts for 6% and accidents, poisoning, and violence constitute less than 4% of elderly mortality with more or less similar rates for nutritional, metabolic, gastrointestinal, and genito-urinary infections. An Indian Council of Medical Research (ICMR) report on the chronic morbidity profile in the elderly states that hearing impairment is the most common morbidity followed by visual impairment.(8) However, different studies show varied results in the morbidity pattern. A study conducted in the rural area of Pondicherry reported decreased visual acuity due to cataract and refractive errors in 57% of the elderly followed by pain in the joints and joint stiffness in 43.4%, dental and chewing complaints in 42%, and hearing impairment in 15.4%. Other morbidities were hypertension (14%), diarrhea (12%), chronic cough (12%), skin diseases (12%), heart disease (9%), diabetes (8.1%), asthma (6%), and urinary complaints (5.6%).(9) A similar study that had been conducted among 200 elderly people in rural and urban areas of Chandigarh in Haryana observed that as many as 87.5% had minimal to severe disabilities. The most prevalent morbidity was anemia, followed by dental problems, hypertension, chronic obstructive airway disease (COAD), cataract, and osteoarthritis.(10) A study on ocular morbidities among the elderly population in the district of Wardha found that refractive errors accounted for the highest number (40.8%) of ocular morbidities, closely followed by cataract (40.4%) while other morbidities included aphakia (11.1%), pterygium (5.2%), and glaucoma (3.1%).(11) In a community based study conducted in Delhi among 10,000 elderly people, it was found that problems related to vision and hearing topped the list, closely followed by backache and arthritis.

Elderly people who belong to middle and higher income groups are prone to develop obesity and its related complications due to a sedentary lifestyle and decreased physical activity. In a study conducted among 206 elderly persons attending the Geriatric Clinic at a tertiary care hospital in Delhi, about 34% of the men and 40.3% of the women were obese respectively.

Elderly people are highly prone to mental morbidities due to ageing of the brain, problems associated with physical health, cerebral pathology, socio-economic factors such as breakdown of the family support systems, and decrease in economic independence. The mental disorders that are frequently encountered include dementia and mood disorders. Other disorders include neurotic and personality disorders, drug and alcohol abuse, delirium, and mental psychosis.

The rapid urbanization and societal modernization has brought in its wake a breakdown in family values and the framework of family support, economic insecurity, social isolation, and elderly abuse leading to a host of psychological illnesses. In addition, widows are prone to face social stigma and ostracism. The socio-economic problems of the elderly are aggravated by factors such as the lack of social security and inadequate facilities for health care, rehabilitation, and recreation. Also, in most of the developing countries, pension and social security is restricted to those who have worked in the public sector or the organized sector of industry.(17) Many surveys have shown that retired elderly people are confronted with the problems of financial insecurity and loneliness.

The elderly are also prone to abuse in their families or in institutional settings. This includes physical abuse (infliction of pain or injury), psychological or emotional abuse (infliction of mental anguish and illegal exploitation), and sexual abuse. A study that examined the extent and correlation of elder mistreatment among 400 community-dwelling older adults aged 65 years and above in Chennai found the prevalence rate of mistreatment to be 14%. Chronic verbal abuse was the most common followed by financial abuse, physical abuse, and neglect. A significantly higher number of women faced abuse as compared with men; adult children, daughters-in-law, spouses, and sons-in-law were the prominent perpetrators.

The Central and State governments have already made efforts to tackle the problem of economic insecurity by launching policies such as the National Policy on Older Persons, National Old Age Pension Program, Annapurna Program, etc. However, the benefits of these programs have been questioned several times in terms of the meager budget, improper identification of beneficiaries, lengthy procedures, and irregular payment.

Strategies to Improve the Quality-of-Life of the Elderly: The Role of the Health Care System

At present, most of the geriatric out patient department (OPD) services are available at tertiary care hospitals. Also, most of the government facilities such as day care centers, old age residential homes, and counseling and recreational facilities are urban based. A study conducted to assess the unmet needs of the geriatric population in rural Meerut observed that as many as 46.3% of the study participants were unaware of the availability of any geriatric services near their residence and 96% had never used any geriatric welfare service. About 59% of them stated that the nearest government facility was 3 kilometers from their homes.

Since 75% of the elderly reside in rural areas, it is mandatory that geriatric health care services be made a part of the primary health care services. This calls for specialized training of Medical Officers in geriatric medicine. Also, factors such as a lack of transport facilities and dependency on somebody to accompany an elderly person to the health care facility impede them from accessing the available health services. Thus, peripheral health workers and community health volunteers should also be trained to identify and refer elderly patients for timely and proper treatment. An ICMR task force project, which was known as “Health Care of the Rural Aged”, conducted in the Primary Health Center area near Madurai found this strategy to be beneficial.

In difficult to access areas, screening camps for cataract and non-communicable diseases and mobile clinics could play a significant role in reaching out to the elderly population. Advocacy with non-governmental organizations (NGOs), charitable organizations, and faith-based organizations could play an important role in this aspect. Premier NGOs like Help Age India have already been organizing screening camps and providing Mobile Medical Units in rural and difficult to access areas.

Ensuring good quality geriatric health care services at the primary level would greatly help in improving the utilization rates of the available health services. Health care services should be based on the “felt needs” of the elderly population. This would involve a comprehensive baseline morbidity survey and functional assessment in health areas that are perceived to be important to them. This should be transformed into a community database that would help to prioritize interventions and allocate finances accordingly. The felt needs may vary depending upon gender; socio-economic status as well as differences would exist in the rural and urban areas. Until now, secondary prevention strategies in the form of screening and early management and tertiary care in the form of rehabilitation have been given more importance as compared with primary prevention by the geriatric health care services.

An ideal preventive health package should include various components such as knowledge and awareness about disease conditions and steps for their prevention and management, good nutrition and balanced diet, and physical exercise. For the promotion of a positive mindset and to create a feeling of well being, meditation, prayer, and strategies for motivation should also be included.

Capacity building may be done for different groups of health personnel. Training of Medical Officers and peripheral health workers has been discussed above. Besides this, an entirely distinct team of health providers known as “Community Geriatric Health Workers” may be trained to provide home care to the disabled elderly population. This strategy has been demonstrated to be successful in a community based project in Cochin, known as “Urban Community Dementia Services” wherein these health workers provide home-based care as well as care in day care centers.

Strengthening the elderly in the process of self-help can be done by means of physical, psychosocial, and vocational rehabilitation. Rehabilitation includes (i) provision of visual aids/mobility aids at geriatric health facilities, (ii) the availability of physiotherapy services, and (iii) imparting health education about staying mobile and providing practical tips. Rehabilitation comprises of provisions for counseling services wherein older persons can benefit from psychological assistance in the face of stressful life events, interpersonal conflicts, and changes imposed by ageing. Under rehabilitation, health care facilities should aim for holistic development by organizing training workshops in accordance with the skills of the elderly. This calls for advocacy with NGOs and charitable organizations. Opportunities for employment should be provided simultaneously.

Also, capacity building of the community leaders is essential for the success of community-based geriatric and rehabilitative health services. Community leaders can play an important role in identifying the felt needs of the elderly and in resource generation.

Among the secondary level health facilities, which mainly include the district hospitals, sub-district, and medium-size private hospitals, it is seen that India has about 12,000 hospitals with 7 lakh beds. Most of these beds are under the public sector. The need of the hour is to set up geriatric wards that would fulfill the specific needs of the geriatric population by provision of distinct OPD services. Providing screening services as well as curative and rehabilitative services and convalescent homes to provide long-term care, which may be a part of designated hospitals, is also a priority.

At the tertiary care level, which comprises of super specialty and medical college hospitals, there needs to be provision of geriatric wards and separate OPDs. A"multi-disciplinary team" specifically trained to meet the needs of the geriatric population need to be created. This team would be comprised of a physician, psychiatrist, orthopaedician, diabetologist, gynecologist, cardiologist, urologist, eye surgeon, psychologist, physiotherapist, dietician, dentist, and nurses trained in geriatric medicine. Elderly patients from poor and low income facilities should be supplied with free or reasonably priced treatment through public-private partnership.

Day care hospitals could play an important role in providing close supervision and follow-up of patients with chronic diseases. Moreover, the cost of a day care centre is comparatively less than that of a nursing home. India has very few hospices that can provide terminal patient care. Hospices should be set up at the district level. NGOs, charitable organizations, and faith-based organizations could play an important role in this area.

Professional training in Geriatrics and Gerontology needs to be promoted. Few universities, for example, the Indira Gandhi National Open University, offer a Post-graduate diploma in Geriatric Medicine. There is a need to give emphasis to geriatric medicine in undergraduate medical as well as paramedical courses. Geriatric dentistry should also be developed as a separate, independent specialty at the post-graduate level.

Research in Geriatrics and Gerontology needs to be further encouraged. An ICMR Workshop on “Research and Health Care Priorities in Geriatric Medicine and Ageing” recommended that research be conducted in areas such as the evaluation of the nutritional and functional status of the elderly, common chronic and neuro-degenerative disorders like Alzheimer's disease, cardiovascular disorders, depression, etc., basic sciences, dealing with the process of ageing, pharmacokinetics and pharmacodynamics of drugs, health system research and research in alternative medicine.(32) Certain lacunae in the field of research on gerontology have been identified, such as the lack of attention given towards the aged in rural India, failure to view elderly people as active participants in the economy, the perception of older persons as being mere recipients of social welfare services, and a lack of focus on policy recommendations. (Ingle, G and Nath,A; 2008)

Source:http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2763704/?report=printable)

Thus to improve the Quality of Life of the elderly and helping them to maintain their independence for as long as possible it is imperative to create a cadre of trained geriatric care professionals in terms of understanding the needs of the elderly and planning interventions accordingly.

Care is needed in the area of: health and nutrition, work and finance, security, property and housing, adjustment and acceptance within family, protection from neglect, violence and destitution. Hence a Geriatric Care professional needs to have a working knowledge of health and psychology, human development, family dynamics, public and private resources and funding sources while advocating for their clients throughout the continuum of care. Some of the critical disciplines in which they require to be trained are gerontology, social work, nursing, and counseling. They also require a basic understanding of physiology and the concept of lifespan human development.

It is proposed that the Geriatric Care professional should be a certified specialist who would assist seniors and their families in meeting their long term care needs. A brief review of literature as well as discussions with the medical community revealed that medical professionals generally feel the need for a programme in geriatric care, as they feel that care for elderly is different from care of the individual at other stages of life. However, it has remained a neglected area as there is no collective voice from senior citizens asking for it. Also it is not a very lucrative specialization in medical practice.

There is a special need for home bound domiciliary care. But the senior citizens or their families often can’t afford to pay for the same and hence they end up hiring semi trained and even untrained people for providing care. Also, there are very few institutions within the country which are providing courses on Geriatric care.

The Centre for Lifelong Learning, Tata Institute of Social Sciences having one of its thrust areas of working with the elderly, recognizes a need for creating geriatric care professionals and hence it is proposing the following Certificate in Geriatric Care. This is aimed at creating a cadre of geriatric care workers who would provide institutional and home bound domiciliary services possibly through linkages with hospitals in Mumbai and also provide skill based services in old age homes and NGOs working on elderly issues. It is proposed that practical aspects of the Programme could be undertaken at close-by hospitals especially those where the management holds elder care as a priority.

PROCESS OF EVOLVING THE CURRICULUM

The curriculum for the proposed Certificate in Geriatric Care has been arrived at through an intensive process of dialogue between social scientists, medical professionals,NGO administrators and academics. Three meetings were held during the period July-Sept.2011 to discuss all the aspects - academic and otherwise - of developing a curriculum on Geriatric Care.

Participants across all the three meetings unequivocally agreed that there was a huge unmet need for geriatric care workers. Medical professionals pointed out that even their fraternity rarely distinguished between adult health care and geriatric care. The five dimensions discussed included the need for developing human power for care-giving of senior citizens, the desirable eligibility criteria, the different academic levels (Certificate/Diploma) which could be offered,the optimum duration for each level, the proposed course content and the envisaged career prospects for such a course.

The Centre for Lifelong Learning circulated a concept note along with a collation of selected Indian and international pogrammes on Geriatric care. An important finding that emerged was, that none of the courses offered in India were through an university. They were through regional or national institutes. Whereas, courses outside India were offered by Universities and through both the classroom as well as the on-line mode. A review of the content of these programmes led to identifying the commonalities and differences across the courses.

It was observed that courses generally were of three types: a six month programme for para professionals, a year long programme for professionals and a short duration programme for NGO or institutional personnel. The contents across the courses focused upon concepts of Gerontology, Basics of Geriatric Care, Geriatric Health and Nutrition, Geriatric Counselling, Geriatric, communication, Geriatric Nursing, Financial and Legal aspects and Case Writing and Record Keeping.

The curriculum below has been developed keeping Indian realities in mind, particularly that large mass of senior citizens live in rural or semi rural areas. They have strong regional and cultural affinities. Health practices and care-giving practices vary from community to community and region to region. While holding on to the universal principles of Geriatric Care, the curriculum also needs to provide for diversity such that the senior citizen finds herself/himself comfortable with the care-giving that is provided.

EDUCATIONAL OBJECTIVES

  1. Goal of the Certificate in Geriatric Care
    To generate a cadre of skilled and compassionate geriatric care workers who will provide services in hospitals, old age homes, organizations of elderly and within any other institution which intends to move into the provision of geriatric care services
  2. Objectives of the Certificate in Geriatric Care
    The Educational Objectives are as follows:
    • To offer a comprehensive interdisciplinary human perspective in provision of geriatric care.
    • To inculcate a holistic understanding of the medical, biological, socio-economic and legal issues involved in the care and rehabilitation of Older Adults
    • To equip students with direct skills (medical and social) required for the care of Older Adults in the family as well as the institutional settings

WORK AND EMPLOYMENT:

  • Geriatric Care is a growing and upcoming field thus after graduating the Course participants will be able to:
    • Engage in direct services
    • nitiate and sustain programmes and services for Older Adults
    • Be active members of inter-disciplinary teams working with Older Adults
  • Application of the Course inputs will be possible in home-bound care, hospitals, nursing homes, homes & townships for the elderly, Day Care Services etc.

DURATION OF THE COURSE:

15 weeks full time Programme consisting of 4 Courses of 2 Credits each (30 hours) to be covered in 4 weeks and 8 weeks of supervised work (Field Practice) in institutions & hospitals. A detailed outline of each Course is given below.

ACADEMIC CALENDAR

Programme Inauguration & Orientation Day 1
Theory /Classes Weeks 1-4 (I month)
Preparatory Leave for Examinations Week 5
Examinations Week 6
Field Practicum/Internship Weeks 7-14 (8 Weeks)

Field Practicum Presentations & Evaluation;

Certificate Distribution

Week 15

INCENTIVES

Some implementing organisations may choose to provide ID cards, stationery study materials, hospital apron during practicals and first aid kit to the students. They may also provide a mid-day meal or snack.

CERTIFICATION

The student will receive a joint certificate from TISS and the implementing organisation.

JOB PLACEMENT

The implementing organisation may or may not take the responsibility for job placement. This will be stated in the MOU signed with the implementing organisation and stated in the specific course prospectus.

ENQUIRIES

For further information, please contact or write to:

Chairperson
Centre for Lifelong Learning
Tata Institute of Social Sciences
Naoroji Campus, Deonar Farm Road, Deonar, Mumbai - 400 088
Tel. No.: 2552 5682 / 5000

LOCATIONS BUS ROUTES

From Dadar Station : 92, 93, 504, 506, 521 (all Ltd.)

From Chhatrapati Shivaji Terminus : 21 (Ltd.).

From Bandra Station : 355, 505 (all Ltd.)

From Kurla Station : 362 and 501 Ltd.

From Sion : 352

Distribution of Credit Hours:

15 weeks full time Programme consisting of 4 Courses of 2 Credits (30 hours) each to be covered in 4 weeks and 8 weeks of supervised work (Field Practice) in institutions & hospitals.

BC 1

Issues & Concepts in Gerontology & Geriatric Care

2Credits/30 Hours

BC 2

Basic Geriatric Care

2Credits/30 Hours

BC 3

Geriatric Rehabilitation

2Credits/30 Hours

BC 4

Geriatric Communication, Counselling & Guidance

2Credits/30 Hours

 

Field Practicum/Internship

10 Credits/300Hours*

 

Total

18 Credits/420 Hours

* 36 hours per week for 8 weeks

Semesterwise Courses:

LIST OF COURSES

  • Issues & Concepts in Gerontology & Geriatric Care
  • Basic Geriatric Care
  • Geriatric Rehabilitation
  • Geriatric Communication, Counselling & Guidance

When upgraded to a Diploma in Geriatric Care, the following two additional Courses will be offered:

  • Legal & Financial Aspects of Geriatric Care
  • Geriatric Care Management

A detailed outline of each course is given below:

CGC I: ISSUES & CONCEPTS IN GERONTOLOGY & GERIATRIC CARE

Introduction:

This introductory course provides an overview of the multidisciplinary field of gerontology, ageing services, and community resources for geriatric care management. It will explain the fundamental concepts from different disciplines such as sociology, psychology, anthropology, social work, education and economics which relate to understanding the issues of the Older Adult. The course will emphasize cognitive and attitudinal aspects of work with older adults within the human rights framework.

Duration: 30 hours Weightage: 2 credits

Learner Objectives:

The student will

  • Apply the general principles and knowledge to integrate theory into practice
  • Understand the issues which affect Older Adults.
  • Develop the ability to analyse and apply relevant approaches to work with Older Adults.

Content:

  • Relevance of the study of Gerontology and Geriatrics. Definition and multidisciplinary nature.
  • Multidisciplinary approach to Gerontology including the biological, social, psychological, economic security and legal advocacy.
  • Human Rights perspective towards Senior Citizens, UN policy for the elderly. Moving from the Welfare to the Rights based approach.
  • Indian context of ageing and related policy and legislation.
  • Socio-economic situation of elderly in India. Some significant state wise and gender differences.
  • Demographic aspects : Population ageing, global trends and cross-country variations. Reasons for increase in life expectancy.
  • Difference between individual ageing and population ageing.
  • Myths and assumptions about ageing. Ageism as a concept.
  • Approaches to ageing – continuity, disengagement and activity approaches to understanding of the ageing process.
  • Active ageing – Factors in Successful Ageing.
  • Recognising and preventing Elder Abuse.

CGC 2: BASIC GERIATRIC CARE

Introduction:

This course covers the range of services for the elderly with specific focus on geriatric interventions and their management. It presents the basic elements and procedures for conducting a comprehensive geriatric assessment and care plan report.

Duration: 30 Hours Weightage: 2 credits

Learner Objectives:

The student will

  • Comprehend the basic knowledge and skills required for managing services in general and geriatric care in particular within an organizational frame.
  • Learn the skills to provide direct care to the elderly
  • Develop the ability to assess and identify client strengths, needs, concern preferences and establish a comprehensive plan of care

Content:

  • Basic biology, psychology, and sociology of the ageing process
  • Concept of Healthy Ageing; Distinction between Normal and Pathological Patterns of Ageing, Factors affecting Healthy Ageing.
  • Geriatric Health; Nature and Scope of Geriatric Care;
  • Common health problems in the aged: Falls, Beds Sores, Giddiness, Incontinence, Osteoporosis, Thirst and Nutritional Needs, Forgetfulness; Activities of Daily Living (ADL) & Instrumental Activities of Daily Living (IADL)
  • Hygiene & Safety
    For the aged person: personal, community, residence/dwelling;
    For the caregiver: use of hand gloves to wash and clean, how to bathe the elderly, laundering clothes (using appropriate detergents), keeping floors clean (disinfecting) and dry, disposal of biomedical waste, Importance of well illuminated areas in the home and living spaces of the elderly.
  • Practical Training for the care-giver: giving injections, dressing wounds,feeding, changing clothes, use of core appliances, hearing aids, spectacles, dentures, footwear, foot care, trimming of nails,changing diapers, using urine pots/urinary catheters, ryeles tubes & bedpans, walking sticks/ walkers etc.
  • Attending to telephones, door bells, running washing machines, air conditioners/fans, lighting, stoves and gas appliances.
  • Care of elderly with special needs: Visual and auditory impairment, ill patients & patients in coma, with HIV/AIDS, amputations/joint replacements, very old with poor ADL score, senior women, and those living alone, suffering from dementia, Alziehmer's.
  • Coordination with the treating doctor, hospital, family, police (keeping emergency contact numbers); Transferring from home to hospital (lifting with care and precaution, handling patients with fractures/in coma); Understanding instructions from physiotherapist/occupational therapist/nursing staff and assisting in prescribed exercises
  • Continuum of care, institutionalization, issues of care-giving and care-taking; end of life issues.
  • Patterns of service use and public and private resources to meet the individual needs of geriatric clients
  • Written Care Plan Process: conducting the client interview, gathering all necessary information, and incorporating that information into a cohesive written care plan

CGC3: GERIATRIC REHABILITATION

Introduction:

This course explores the importance, nature, scope and fundamental elements of geriatric rehabilitation along with the challenges encountered while making such interventions.. It emphasizes the role and the skills of the geriatric care giver working on an multidisciplinary team to enhance physical, psychological /emotional and social health and thus the overall quality of life of the ageing population. The outline of the course is as follows :

  • Fundamental elements of geriatric rehabilitation.
  • Challenges encountered during interventions.
  • Role and the skills of the geriatric care giver in a multidisciplinary team.
  • Focusing upon enhancing the quality of life of elderly person.

Duration: 30 Hours Weightage: 2 credits

Learner Objectives:

The student will:

  • Appreciate the need for and benefits of geriatric rehabilitation.
  • Learn the scope and aspects of geriatric rehabilitation.
  • Acquire the skills required for effective interventions in geriatric rehabilitation

Content:

  • Concept of rehabilitation as a multidisciplinary team consisting of a broad set of health care professionals with a set of evaluation, diagnostic, and therapeutic interventions aimed at restoring functional abilities or enhancing the residual functional capabilities of frail elderly.
  • The function of the multidisciplinary team and the geriatric care giver in an interdisciplinary manner in a wide array of settings, from inpatient and institutional to outpatient, residential and community settings.
  • Nature of Geriatric Rehabilitation in optimizing the quality of life and functional independence of the elderly :
  • Challenges in providing Geriatric Rehabilitation :
    1. Increasing its visibility in the public realm of health care, and to the consumer.
    2. Making care relevant to changing nature of the elderly population in terms of its, characteristics and needs and the available facilities.
  • Specific Areas : Auditory and Visual impairments Fall, Osteoporosis, Osteoarthritis, Malnutrition, Depression, Delirium & Dementia, Stoke, Fractures, Parking’s, Functional Capacity and Activity pacing.
  • Effective Geriatric Rehabilitation : Plan/Steps, Tasks and Skills
  • Skills
    1. Active movements for upper limb and lower limb.
    2. Passive Movements for upper limb and lower limb and positioning.
    3. General stretching Exercises.
    4. Fall prevention and Co-ordination Exercises.
    5. Neck, Low Back and knee Pain Exercises.

CGC 4: GERIATRIC COMMUNICATION, COUNSELLING & GUIDANCE

Introduction:

This course examines the psychosocial changes an individual experiences in the process of ageing which have a strong impact on his/her overall sense of health and well-being. It also looks at the role of communication and basic counselling in successful care plan implementation and coordination.

Duration: 30 Hours Weightage: 2 credits

Learner Objectives:

The student will

  • Develop conceptual clarity about the nature of psychosocial changes an individual undergoes with advancing age
  • Gain an insight about the implications of this aspect of ageing on an individual and the family
  • Enable and support caregivers in effective care giving through basic counselling and guidance
  • Perform on-going monitoring and reassessment of client status in order to evaluate progress toward goal achievement

Content:

Psychosocial Aspects of Ageing; Status of An Older Adult; Value System of an ageing individual; Cultural attitudes held by the elder as well as society at large; Financial Security; Housing and Shelter Changing Family and Kinship Structure; Transition in Roles and Relationships; Generation Gap; Issues of Acceptance, Rejection and Belongingness

Impact of family systems on the provision of care for individuals and ageing families.

Caregiver Assessment & Care Monitoring: Supervision of Caregivers (Family members or untrained institutional staff).

Helping mid-life children work together to care for ageing parents

Preparing for and facilitating family meetings for effective care-giving and coping with the life transitions of the ageing family member

Effective Communication & Basic Counselling : Definition, Nature, Scope,Types,

Counselling relationship : nature of relationship between the counsellor and the client.

Process (Stages): relationship building; reassessment of problems and concerns; goal setting; initiating interventions; supporting the implementation; evaluating action and sustaining change; termination and follow-up.

Techniques: Observation, Attending, Listening, Empathy, Reflection, Checking for Understanding, Paraphrasing, Summarising & Confronting.

FIELD PRACTICUM:

Duration : Eight Weeks

No. of Credits : 10

Practice in Care-Giving Skills

Studies show that patients and families are most concerned about the skill set of the caregiver, trust matters a lot, and satisfaction varies based on the presence of other caregivers. Generally people connect satisfaction with the technical abilities of their caregiver. These are basic people skills, which include effective verbal and written communication, being observant, and the ability to follow rules and protocol. These skills are critical to providing assistance with daily activities, such as taking medications, cooking, dressing, and bathing.

  1. Taking BP, Pulse & Temperature.
  2. Bed making and Bed disinfection
  3. Transfers: a) Bed to stretcher/chair b) Chair to toilet c) toilet to wheel chair etc. What is missing in the environment: like social area to interact; Indoor games – can improve cognitive behaviour,use of limbs,fingers and brain
  4. Lift to chair, sit & stand from bed or chair
  5. Elimination needs - Commode Chair /bed pans diapers.
  6. Physical environment- Water drinking, bathing, electricity. Door handles, grab handles, hand rallings. Uneven floors/wet toilets/varandas
  7. Care of patient post operation: Urine –colour/Smell/Quantity- : full bag/half bag/quarter bag, SPC into the bladder Daining.
  8. Injections: Insulin injections. Injections to diabetic patients – when not to give.
  9. Hygiene - Oral Care, Sponging & bathing, Foot and Nail care: daily check for ulcers/wounds, Attention to skin/skin care : daily check for ulcers & womds.
  10. Pressure care and prevention of bed sores, back care positioning.
  11. Grooming.
  12. Diet-selection for heart patients,stroke patients diabetic patients. Soft food, liquid diet, semi liquid diet. Low Sodium
  13. Ryle's tubes - not too hot food /not too cold food/ rinse with water after feeding/cleaning after & before feeding.
  14. Communication Skills – Verbal, Non-verbal, body language.
  15. Counselling: Interpersonal Skills, relationship skills, building trust, empathy and non-judgmental attitude
  16. Five R's of Medication:
    v Right name of the patient
    v Right name of the medicine and reffered by
    v Right route-oral tropical/topical/IV
    v Right dose/quantity: 500 ml / 250 ml
    v Right Time of Medicine: once-evening or morning/BD/TD
  17. Physiotherapy - active and passive exercises. Applications.
  18. Assessment-observation- physical,cognitive behaviour,impairments if any. Interview – Care Giver should interview-patient, family, relatives if possible.
  19. Learning to write a care plan.
  20. Practicing skills to make referrals and based upon class teaching of diverse roles of professionals such as nurses, physiotherapists, social workers and role and use of supports groups.

* Primary Care refers to : How to administer medication, sponging, maintaining body temperature, measuring and monitoring BP, Pulse Rate & Respiration Rate; ensuring overall hygiene of the elderly and appropriate Diet and Nutrition

15 weeks full time Programme consisting of 4 Courses of 2 Credits (30 hours) each to be covered in 4 weeks and 8 weeks of supervised work (Field Practice) in institutions & hospitals.

Fee Structure:

The Fees for the student are decided upon by the implementing organisation based upon their cost estimates. The Centre for Lifelong Learning has estimated that the basic cost per student is Rs. 9,000/- for 15 weeks. Some implementation organisations may charge upto 15 percent more or less, depending upon the facilities they propose to provide. The cost /fee per student is stated before the start of the course in the Memorandum of Understanding signed between TISS and the implementing organisation and is specifically stated in the specific course prospectus.