Community and Health Services a feature of the WHO Guidelines on Towards Building Age Friendly Community was adopted for community dwelling older women at Chattarpur Extension,New Delhi.Results of the collaboration betwwen WHO-SEARO and dharma Foundation of India is shared in these slides

1. TOWARDS BUILDING AN AGE
FRIENDLY COMMUNITY
Collaborative initiative of
WHO-SEARO
and
Dharma Foundation of India
Dr Alakananda Banerjee
President
Dharma Foundation of India

2. Contents
• Population Ageing India:
• Health issues of elder women
• About hypertension and joint pain in elder
women
• Towards Building an age friendly community
• Self Management and Community Wellness

3. INTRODUCTION
Population Ageing India
•The ageing of population is on the increase world
over in recent times.
•According to the census 2001, the population of
the elderly (age 60 years and above) in India was
75.9 million, i.e. 7.4% of total population.
•It is projected to be 113 million, i.e. 8.9% of total
population by the year 2016.

4. Health issues of elder women in India
• Various studies in India proved that the population of female
elderly persons especially in rural areas appears to be larger than
their male because of their higher life expectancy.
• The elderly are vulnerable to non-communicable diseases (NCDs)
which are clearly a major morbidity in this age group. NCDs are
responsible for 53% of deaths and 44% of disability in India.
• Compared to men, the health status of women is found to be
poor. Main health concerns in elder women in India is
hypertension, musculoskeletal disorders, diabetes, obesity,
metabolic syndrome etc.

5. • Hypertension is one of the most important treatable causes of
mortality and morbidity in the elderly population.
• It was found that 40.8% of females are suffering from
hypertension in India. Patients with hypertension may experience
adverse effects on well-being and health-related quality of life
which can be associated with headache, dizziness, and tiredness.
• Hypertension is the key disease which leads to cardiovascular
diseases.
• It has also been proved that more than half of the elderly females
(67.3%) represented various physical problems from which joints
pain is the commonest one.
• Joint pains in forms of arthritis, fibromyalgia, and osteoporosis
are common in elderly.

6. Towards building an Age Friendly City
The eight essential features taken into consideration which
make a city age friendly are
1. Outdoor spaces and buildings
2. Transportation
3. Housing
4. Social participation
5. Civic participation and employment
6. Respect and social inclusion
7. Communication and information
8. Community and health service

7. Towards Building an Age Friendly City
• The concept of Towards Building an Age Friendly City
emphasizes an active role of the elder.
• The WHO framework on Active Ageing also forms the basis for
success of an Age Friendly City.
• Active Ageing is the process of optimizing opportunities for
health, participation and security in order to enhance quality of
life as people age.
• In an age-friendly city policies, services, settings and structures
support and enable people to age actively by recognizing the
wide range of capacities and resources among older people

8. DFI Programs
towards
Building Community and Health Service
Chattarpur Extension, New Delhi and members of local Senior Citizen
Organisation ,Varishtha Nagrik Kendra Sansthan (VNKS)

9. Area profile of Chattarpur Extension
• The roads to the housing areas are broken and during rains the roads are
flooded making it absolutely inaccessible for people to manoeuvre or walk.
• The distance to the main street (which has public transport facilities like taxi,
autos, and buses) is almost 1km -2km from the houses which add to the woes
of elders as there is no transport facility from the houses to the main street.
• The pharmacy, grocery, bakery shops are situated on the main street .
• Most of the elders get health benefits from state and central government
health schemes.
• The government hospitals are situated 7 kms from Chattarpur Extension.

10. Establishment of Community Care
Centre
To help the elders of the area to avail basic health facility the
DFI runs a Wellness Clinic in a small space allocated by the
VNKS office.

11. •The clinic is run by active elder members of VNKS.
• A trained (graduate or post graduate physiotherapist) Community
Physiotherapist works for 4 hours in the Wellness Clinic. There are basic
equipments for physiotherapy pain relief modalities, walkers, gait training
sticks
• Equipments to measure blood pressure, blood glucose, and nebulizers
are available in the clinic. (Donated by the DFI).
• The Community Physiotherapist is a known face in the neighbourhood.
Rs 20/-is paid by elders for each consultation. The elders prefer her services
as they can walk to the clinic which is accessible to the elders staying nearby.

12. Collaboration initiative of
WHO SEARO-DFI
Self Management and Community
Wellness Program
For Older Women

13. Self-Management and Community
Based Wellness Program
• This program is a multi-dimensional intervention, a combination of
learning to self manage their health concern with community
initiatives through group programs that engages subjects with in a
series of classes in which they are helped to develop critical
knowledge, skills and motivation to move forward in their recovery
and achieve their personal goals.
• Proper nutrition and lack of exercises plays a major role in an
individual's overall health; psychological and physical health status.
• Nonmedical interventions like these can assist elders in coping with
and adapting to illnesses as proven through various studies provide
better functional outcomes and are more cost effective than
conservative care, surgery or more invasive procedures.

14. • The Self-Management Program consisted of home visits by the
Community Physiotherapist and Dietician to educate
participants on home exercise and diet modifications for
prevention and improving joint pains and hypertension
• The Community Wellness Program consists of participation in
workshop and group exercises, in the Wellness Clinic. Group
exercises of 4-5 subjects were done in a subject's home.

15. Subjects covered included
1) Techniques to deal with problems such as fatigue, pain
2) Appropriate exercise for maintaining and improving strength, flexibility,
and endurance,
3) Appropriate use of medications,
4) Communicating effectively with family, friends,
and health professionals,
5) Nutrition
6) Dynamic relaxation group therapy.

16. Methodology
• The venue chosen was Chattarpur Extension and Chattarpur Village in
South Delhi where a local senior citizen organization named Varishtha
Nagrik Kendra Sansthan (VNKS) was adopted for this project.
• The elder women members and spouse of elder men members of
VNKS aged 60 or more and having complaint of hypertension or joint
pain or both were screened.
• The Patron of the VNKS provided us with a list of all the members of
VNKS.
• None of the 250 members were females.
• Active male members of VNKS were explained regarding the project .

17. Methodology
• The Community Physiotherapist visited houses of members and
recruited their wives.
• They were explained thoroughly about the study and its
objectives.
• The elder women enthusiastically also helped more women with
similar problems in the locality participate in the project..
• A sample of 81 elder women eventually participated.
• A dietician was enrolled to consult all the recruited subjects
about their diet plans and modifications.
• Demographic and medical profile of subjects was documented
during the initial visit.

18. Outcome measures:
• Brief Pain Inventory (BPI)
• WHOQOL (WHO quality of life)
• Blood Pressure of subjects was measured
• Mini Nutritional Assessment
• Knowledge seeking behaviour towards dietary changes.
• Project Feedback Form

19. Interventions
The subjects were recommended all the exercises and
relaxation therapy according to their requirements and needs.
The interventions was based on the following
• Relaxation and breathing exercises
• Mobility Exercises
• Aerobic exercise
• Joint protection techniques
• Practical changes at home for better and safe mobility
• Managing pain
• Diet Modification
• Knowledge seeking behaviour

20. Follow up
• Follow up of recruited subjects were done
once in every week.

21. Booklets
Booklets in local Hindi language
were printed and distributed
to subjects

22. Community Wellness through workshop on
Dynamic Relaxation Group Therapy:
The Dynamic Relaxation Group Therapy is a process which
focused on muscle relaxation, smooth breathing pattern
and better blood circulation, Improvement in sitting and
standing postures (through seven simple alterations) of
the subjects were taught, followed by the rotational
exercises of each and every joint.

23. Small Group Exercise Therapy
• Small groups of elder women met for exercises in their
homes.
• Preferably one home was chosen for houses on the
same street.
• Exercises were supervised by the Community
Physiotherapist.

24. Caregiver Education
• During follow ups caregivers of elderly, like
son, daughter, daughter in law, husband were
counselled to motivate the subject to keep up
with exercises and diet modifications

25. Results and Discussion:
• The present study included 81 elderly women with the mean age of 62 years
belonging to low socio-economic status with an average annual income of Rs
75000. 85% of subject's were uneducated.
• The data was analyzed on the basis of pre and post-intervention results.
• Changes in areas of health status (disability, social/role limitations, pain and
physical discomfort, energy/fatigue, psychological well-being/distress, health
distress, self-rated general health, knowledge seeking behavior) blood
pressure and compliance to diet modifications.
• 47 participants had joint pains, 33 participants had both joint pains and
hypertension, and one participant had only hypertension.

26. WHO Quality of Life (QOL)
Pre and post-intervention results on quality
of life

28. BRIEF PAIN INVENTORY (BPI)
Pre and post intervention results in pain
and other areas

30. BLOOD PRESSURE
Showing pre and post-intervention results of Blood
Pressure Measurements

31. Result of Intervention of Diet
Modification:

34. Feedback on Self Management and
Community Wellness Programs
• 95% of the participants strongly agreed about the well laid out
objectives, proper time and place, good presentation and
demonstration of the exercises during the project, books and
hand-outs quality.
• 5% were simply agreed.
• Encourages participation of subjects having similar problems.
• Mutual support and success build the participants' confidence
in their ability to manage their health.
• Within the end of eight week repeated weekly follow ups
helped 82% of participants to perform exercises.

35. Conclusion
• As mentioned in the Global Age Friendly City: A Guide, health and social
services delivered within a city by local people in local establishments,
and community-based support and voluntary groups may play an
important role in delivering support and care to elderly.
• The model of The Self-Management and Community Wellness Program
will not conflict with existing programs or treatment as it is designed to
enhance regular treatment and disease-specific education given by
clinicians/family physicians in healthcare organization.
• It may form a cost effective way to introduce prevention of co morbidities
in elders This model may also help integrate various services of healthcare
in a city.

36. • The program was especially helpful for women as it gave
them the skills to coordinate all the things needed to
manage their health and participate in house work, which
can help them keep active in their lives.
• Social interaction and sharing of problems helped
participants take more interest in continuation of exercises.
• Small groups improved comradeship amongst participants.
Small group discussion regarding their health issue
improved confidence about self managing health problems.

37. References:
1.Todays Research on Aging ;
http://www.prb.org/pdf12/TodaysResearchAging25.pdf
2. Aging in Asia:
http://www.ncbi.nlm.nih.gov/books/NBK92618/pdf/Bookshelf_NBK92618
.pdf
3. Towards building an age friendly world:
http://www.who.int/ageing/age-friendly-world/en/

38. Acknowledgements
WHO-SEARO: Dr Kunal Bagchi,Regional Adviser for
Nutrition and Food Safety, WHO Regional Office for
South-East Asia
Project coordinator: Ms. Sakshi jain
Dietician: Ms. Akriti gupta
Project advisor: Mr Debadeep Bandyopadhyay
Clinical advisor: Dr Vinod Kumar Rai
Workshop on dynamic relaxation therapy:
Dr Subhasis Banerjee (Synphne Singapore)
Project in charge: Dr. Alakananda Banerjee

39. Thank You