Indian Gerontological Association

2008-01-14T21:02:00.000-08:00

NATIONAL WORKSHOP ON GERIATRIC NURSING CARE
JAIPUR (INDIA) 14-18 Nov.2007

As a country of approximately 10 million seniors, it was appropriate that India should host its first National Workshop on Geriatric Nursing Care. From the 14th to the 18th of November, 45 senior nurses( working in Government and private hospitals in Rajasthan) and teachers in nursing colleges from different parts of the country ( Delhi, Harayana, M.P. and different parts of Rajasthan ) to discuss the unique condition and special needs of the country’s elder patients. This 5 day workshop was held in Jaipur, Rajasthan at the State Institute of Health and Family Welfare (SIHFW) and was well attended by a number of distinguished guests comprising university professors, physicians and members of different NGO’s.in the inaugural function. Dr. Vimal Agrawal welcomed all the guests and introduced about the activities of Indian Gerontological Association.

“Just 40 years back in the year of 1967 a group of young and enthusiastic scholars of different branches of knowledge such as psychology, sociology, economics, biological sciences and medicine felt the need of research on ageing and wellbeing of senior citizens in India. This led to the birth of Indian Gerontological Association in 1968. To further this aim, Indian Journal of Gerontology, which was the first journal of its kind in India and 19th in the world, was published in the year 1969. It publishes research and review papers on ageing from biological, clinical and social sciences. Now the journal is on line.
Apart from conducting researches and publication of journal IGA runs a day care center for elderly belonging to unorganized sector of society and counseling center( rahat) for elderly. Under its program : Aging Gracefully- Extending Quality of Life which emphasizes positive aspect of ageing , we organize lectures on different diseases which are common in old age and self care practices and training to care providers in the family.

Indian Gerontological Association has prepared courses for six months certificate and one year diploma in Geriatric Nursing. IGA also has prepared a course on preparation of retirement. From the next academic session University of Rajasthan is going to start a P.G. Diploma in Gerontology.

We have also sent our suggestions to the vice- chancellor of Rajasthan university of Health Sciences, Jaipur to start M.D. or P.G. Diploma in Geriatrics and we are hopeful that the university will take the lead in this developing area in medicine in India.” After that she requested Dr. K.L.Sharma, secretary IGA to introduce the Programme of International Initiative of the Care of Elderly( Canada) and through light on the need and planning of this workshop. At this occasion Dr. K.L.Sharma expressed his views :

“Dr. R.S.Bhatnagar, Dr. Sandra P.Hirst, Faculty of Nursing, University of Calgary, Canada, distinguished guests, and participants, on the behalf of Indian Gerontological Association and myself, I welcome you all to this Inaugural function of a 5 day National Workshop on Geriatric Nursing Care.
The prolongation of average human life span in India during the last phase of twentieth century may be considered as a major event. By the end of 2021 the population of senior citizens will be approximately 12% of the total population. Like in the western societies, where elderly population is of substantial proportion, we need to wake up to this real change in the social system. This would have wider implications at social, cultural, economic and medical front. As is evident, it would be logical and beneficial to have a comprehensive approach to the issue. We at present still continue to have belief in the family and care of aged, and that I think is a good starting point. The changes in the social structure, as they unfold with time, are inevitable. I would at present, not deliberate into them, but it is important to mention that the elderly population is the one, most vulnerable to them.

The healthy body is the seat of prosperity and happiness, may it be of any age. Like, pediatrics is not just about ‘little people’ geriatrics similarly is not just about overgrown!! The medical profession, in our sub-continent, has to understand the need to consider this as a sub-speciality, and address it accordingly.

It is true that the practice of medicine already involves geriatrics but that is largely in management of acute illness. There is significant morbidity associated with chronic progressive disabilities of elderly patients. Outside the hospitals too little attention is paid towards the circumstances in which the elderly have to exist and to the kind of help available to them. Elderly people are subject not only to illness, but also have to cope with personal loses, as well as social, psychological and economic handicaps. Therefore, there is a need for a well planned system of health care to meet the challenges of acute illness, along with an emphasis on comprehensive management of chronic health problems. It is of utmost importance that the medical treatment is combined with care, social support, physiotherapy and domiciliary nursing alternatives.

The need to improve the quality of care for the elderly can be fulfilled if Indian Health Education Institutions (Medical and Nursing Colleges) seriously ponder on this issue and make necessary changes in the way geriatrics is approached in their curriculum. It is important to realize that even though the need of geriatric population in India is different than those in western world, we have to learn from them how to provide comprehensive care to elderly population, so that they can enjoy a life with self-dignity, health and happiness. It also opens avenues for research, both medical and social, on the aged population of our country, so as to identify issues with the aim to have a rational approach.
The Geriatric Nursing Care has similarly, not received its share of emphasis, and that is not a surprise. We need to start from somewhere, to prepare ourselves for the geriatric population. It is in keeping with this need and aims that Indian Gerontological Association, has decided to have a 5-day workshop on Geriatric Nursing Care (14-18 November, 2007) for the teachers who are teaching in nursing colleges and senior nurses working in hospitals.

This workshop aims to:
 provide improved ideas and practices in the care of elderly.
 refine existing practitioners’ skills in the care of elderly
 draw attention of general practitioner to the needs of care for elder adults.
 positively influence government policy initiatives on geriatric care.

For this workshop the financial assistance has been provided by International Initiative for the Care of Elderly a program of Institute for life Course and ageing, University of Toronto, Canada. This program has nine partners (China, South Africa India, Australia, U.K. Germany, Israel and Switzerland). From India, Indian Gerontological Association is one of its partners.
The major aims of this program are:

» to achieve an economy of scale in the transfer of knowledge about the care of the elderly by drawing upon world-wide knowledge and resources;
» to collaborate with those countries who have a long history of meeting the challenges of an ageing population;
» to help prepare Canada for an older ethnically diverse population never before seen in Canada;
» to provide a forum for Canadian and International students to learn how to collaborate and work together in interdisciplinary teams as a model for future professional practice.

The major areas of this program are : Dementia, Mental Health, Care -giving and End of life Issues. Indian Gerontological Association has chosen care-giving and mental health as its priorities.
This workshop would not have been possible without the keen interest of two persons: Dr. Lynn Mc Donald, Professor of Social Work and director of Institute for life Course and ageing, University of Toronto, Canada and Dr. S. Hirst, Associate Professor, School of Nursing, Calgary University, Canada who kindly consented to my request to come to India and conduct this workshop. At this occasion I would like to mention the names of Dr. Peter Donahue , Anthony Lombardo and Susan Murphy for their help since beginning of this programme.

Approximately 60 participants from different parts of Rajasthan, M.P. Haryana and Delhi are taking part in this workshop.

In these five days apart from Dr. Sandra,s presentations we have invited some well known scholars and physicians to give lectures on different aspects of ageing and management of geriatric patients in hospital settings.

I once again welcome and thank you all for coming over here and sparing some of your valuable time “.

Later on Dr. R.S. Bhatnagar, President of the Indian Gerontological Association addressed the assembly with insightful opening remarks: “each of us has a body. It is body which puts us in touch with the world. It is through body that we experience, enjoy and act. However, there is a self or mind which is housed in this body. Therefore when nurses take care of the body of the patient - an elderly patient they also encounter the mind or self of the patient. Most old people who in their indisposed condition have hardened attitudes, become perturbed by small and trivial things. It is difficult to tend them. They need a sympathetic understanding . Nurses have really a difficult task when they take care of them. These elderly patients demand psychic care. They are not merely objects of care but subjects of care. Some sort of empathy can a long way in trying to help them. This is really a taxing job. But with their usual patience and caring approach nurses can establish better rapport and obtain better results”.
After that Dr. Sandra P. Hirst the Director of this workshop was introduced to participants and guests present in the inaugural function. “ Dr. Sandi Hirst is as well as being an Associate Professor in the Faculty of Nursing at the University of Calgary, she is also a member of the National Initiative for the Care of the Elderly (NICE). NICE is a recent initiative, supported by the Canadian government, to increase the quality of care given to elderly patients and also the level of awareness regarding its need, both in Canada and abroad. It is through the establishment of an international partnership with the Indian Gerontological Association that NICE was invited to send Dr. Sandy to our shores so that she could share her experiences and expertise with the Indian colleagues”.
Dr. Sandi also introduced the theme of the workshop to the participants and gave an over view of such programme in Canada and the need of such workshop in India.
A tea break was announced
After the high tea all of the participants of the workshop assembled again in the lecture hall and introduced each other. Each participants before coming to participate was sent a questionnaire to express their views about the geriatric care in hospital in their respective hospitals and were asked what are their objectives of attending this workshop?
After this introductory meeting lunch break was announced. After the lunch break the participants assembled at 2.30 p.m. for workshop.

To be able to properly discuss gerontological care, the first day of the workshop was mostly spent discussing the question: what is normal aging? This was an important step in identifying a standard for what might be considered healthy aging, which in turn helps clarify what it is we aim to promote and facilitate as geriatric nurses. To achieve this goal, there was a discussion on what “normal aging changes” were to be expected of each body system (i.e. cells & tissues, the respiratory system, brain function, etc…), throughout which time many interesting points were brought forth and knowledge was shared. Establishing this common understanding would also serve as a helpful basis upon which to build the remainder of the workshop.

Since ultimately, the reason for discussing normal aging changes was the promotion of a healthy aging process, the day’s discussion then turned to how we as nurses can, should, and do facilitate this process. The major points that came up were the benefits of using older adults as teachers to promote active and healthy living and, most importantly, the significance of self-care. If an elderly patient is involved in their own care to the maximum degree, it is not only most effective in terms of sustainability, but it also increases feelings of self-worth, personal dignity, and self-respect: all qualities of immeasurable value.

At the end of the day, each workshop participant was asked to name one way in which their practice would change as a result of the day’s discussions and over-whelmingly, the response was related to patient and family interaction with increased awareness of promoting these values. It is sometimes a hard task, but we must remember that decision-making power still ultimately lies with the elder patient, and always treat them with the respect and dignity recognizing that fact. This can be done through simple gestures such as ensuring the patient is spoken to at eye-level, encouraging them to share a personal story, and/or asking the elder person about their needs.
After having begun this workshop by discussing the content of gerontological knowledge, we began our second day( 15th November) considering the ways in which we impart this information to students of nursing and also the community at large. Dr. Sandy pointed out that it has been found helpful for students of geriatric nursing to first work with healthy seniors, so that they may understand the high level of activity that can be expected of elders, while still recognizing their special needs, just as we understood this on the first day of our workshop through our discussions of healthy aging.

In terms of teaching students, the instructor’s attitude has been identified as one of the most significant factors in achieving positive results. As teachers, we must lead by example, showing students how to interact respectfully with patients and how to be sensitive to their body language. Through our various teaching methods, we must ensure that students become confident in what there are doing, which means that they know the reasons behind their actions. Sometimes this requires that we re-evaluate our previously held beliefs and question our actions: a lesson we must take with us beyond our student days.

After breaking for tea, we began to examine the nursing process. “Assessment” is a very important element of this process, used by nurses continuously, and so we began our analysis by considering this very important tool. This was done with the help of an activity suggested by Prof. Sandy, which caused us to critically evaluate the methods and effectiveness of our assessment skills. It reinforced the idea that using all our senses to perform continued and varying assessments would lead to a more holistic understanding of the patient and their needs.
After the lunch Mrs. Evelyn Kannan, Assistant Secretary, TNAI Delhi, who was also a participant of the workshop, gave a description on the services of old age and old age home carried out by TNAI.
From 3 P.M. to 4.30 Dr. Sandy continued the discussion regarding of nursing care of elderly adults. She emphasized on special care needs of female and male elderly. She differentiated life span and health span.

The third day of the workshop( 16th November) started at 9.30 a.m.. The main theme of the workshop was : “Coping with Chronic Problems”. Dr. Hirst Discussed common chronic problems which included:
Incontinence and elimination
Diabetes Mellitus
Stroke
Dementia
Depression
Coronary Disease
And common behavioural problems. She also differentiated the goal of acute problem and chronic problems.
From 12 noon on 16th November we were fortunate to welcome a guest speaker after lunch. Dr. Udai Pareek former Professor of psychology, IIM Ahemdabad and presently Visiting professor in IIHM Sanganer, Jaipur was able to share some of his extensive knowledge in the area of Positive Psychology and how it relates to care of the elderly. Dr. Pareek posited that, of all the biological changes inevitable in aging, most significant is the all too common feeling of worthlessness that develops among many elderly adults. He suggested that it was therefore essential to their care that we promote a higher level of flexibility and optimism, to increase self-loving.Ensuring that elder patients feel respected, useful, and generally happy is a basic premise present in all aspects of gerontological care. For this reason, it was an important theme during the first two days of this workshop.
The morning session ended at 1.30 and after the lunch break the second session started at 2.30
In the afternoon session we had two special invitees to address the participants.
Dr. Gurpeet Singh, Medical Director and Dr.. Namita Bhgat, Dietician from Fortis /Escort Hospital . Dr. Gurpeet Singh spoke on Gait, Balance. and Falls. He also talked about arthritis and osteoporosis in elderly and the need for vitamin D and calcium. Dr.Bhagat talked about the dietary requirements of elderly.

In the evening a special dinner was organized to participants in

As usual the morning session of fourth day ( 17th November) started at 9.30 and the theme was : Caring for Older Adults and their family. Dr. Sandi Hirst discussed about the families and aged, abuse of elder adults, family care giving and use of tools.In this context she informed that in her country there are more geriatric nurses then general nurses. She discussed theories of nursing and why we age at all.
After the lunch in the second session at 2.30 Dr. L.K.Kothari, former professor of physiology, S.M.S. Medical College, Jaipur was invited to speak on : Age related body system changes. He emphasized the physiological changes in the elderly and how the concerned person feels about it. He elaborated his point by giving examples.The lecture was very lively and every participant liked it very much.
After lunch participants were left for sight seeing and shopping. Dr. Sandi was taken to Jaipur milk dairy to know the working of dairy. She visited each and every department of dairy.

On 18th , at 7 a. m was taken to a village connected with a women dairy programme. Where she could see how milk is collected ,tested and analyzed for fat and protein .The she was back for workshop at 9.30.
In the morning session she discussed on elderly and HIV/Aids. She added that geriatric nursing is a challenge as older people are sexually active and they can be gay and lesbian by sexual or heterosexual.
Dr. Vimal Agrawal spoke on Cancer and tips for living happily with cancer in old age.
Valedictory Function
At 1 p.m. the valedictory session began. Professor P.P.S.Mathur, Vice Chancellor of Rajasthan University of Health Sciences was the chief guest and Dr. Sandi was our special guest and Professor R..S.Bhatnagar presided over the function. At this occasion Dr. P.K.Dev and Dr. Girendra Pal, Dr. I.P.Modi and others were also present
A brief report of the five day’s academic activity was read out .
Dr. Mathur apologized for not attending the inaugural function of the workshop due to some unavoidable official work .He appreciated the content of the workshop and thanked the organizers for the workshop. He also emphasized the need of such workshops in future since the number of elderly patients is increasing in hospitals. The trained geriatric nurses are the need of time not only in Rajasthan but throughout India. He said that very soon University of Health Sciences is seriously thinking to start a P.G. Diploma in Geriatrics for Doctors. He also asked IGA to send the copies of Geriatric Nursing courses prepared by them.
Dr. Sandi and Dr. P.P.S. Mathur distributed the certificates to the participants.
On behalf of the delegates Mr. Bissa expressed the views about the workshop. Arrangements of stay and food were appreciated by all. The schedule of classes and arrangements of lectures were highly appreciated by all, He expressed his gratitude for making such beginning of geriatric nursing in Rajasthan.
This was followed by vote of thanks.
All were invited for lunch.

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indianinitiativeforthecareofelderly

Indian Gerontological Association