Health care of senior citizens in Indian scenario: A technological perspective

Full text

978-1-5090-5515-9/16/$31.00 ©2016 IEEE
Health Care of Senior Citizens in Indian Scenario
A Technological Perspective
Neeraja R Menon
Department of Computer Science and Engineering
Aryanet Institute of Technology
Palakkad, Kerala, India
cs.neeraja@aitpalakkad.org
Annapurna P Patil
Department of Computer Science and Engineering
MS Ramaiah Institute of Technology
Bangalore, India
annapurnap2@msrit.edu
Abstract— This paper explores the health care scenario of
elder citizens. It compares the health care scenarios in first world
and India and proposes technological solutions that can be
implemented incorporating technologies like Internet of Things
(IoT), data analytics and Cloud Computing.
Keywords— Smart healthcare; senior citizens; IoT; cloud
computing
I.
I
NTRODUCTION
According to the constitution of India, public health and
sanitation, is the responsibility of the state government. The
constitution says every state is responsible for raising the level
of nutrition and the standard of living of its people [1]. In India
private sector is the primary source for health care. It provides
70% of health care facilities in urban area and 63% of facilities
in rural area [2], though this varies significantly across states.
The quality of medical care in major urban areas of India is
closer to first world standards. However, non-availability of
diagnostic tools and inadequacy of professionals gravely affect
the quality of health care in rural areas. According to studies,
the main reasons for reliance on private sector is cited as
inadequacy of staff in public sectors, waiting time for services
and inappropriate operating hours [3]. It can also be inferred
that reasons like long waiting time also apply to private sectors,
which prevent them from getting a further bigger role in Indian
health care scenario.
II. U
NIVERSAL
H
EALTH
C
ARE
India has a National Health Policy and the draft for its
revision has been released for public consultation [4]. A
nationwide universal health care system by the name National
Health Assurance Mission, which would provide all citizens
with free drugs, diagnostic treatments, and insurance for
serious ailments was discussed recently [5]. It was later stalled
due to financial constraints by the government, though plans to
implement it are still underway. The universal health care
system is intended at providing health and financial protection
to all citizens. It provides improved access to health services
and improved health outcomes [6]. The primary health care in
the country focuses on immunization, prevention of
malnutrition, pregnancy, child birth post-natal care and
treatment of common illnesses. Specialized care for
complicated illnesses is available in secondary and tertiary
hospitals situated in district or state headquarters. The toughest
challenge is getting quality health care in government hospitals
due to large number of people needing health care and the lack
of sufficient facilities.
III. H
EALTH
C
ARE
I
N
F
IRST
W
ORLD
Universal health care in most countries has been achieved
by a mixed model of funding, though primary source of
revenue remains taxation. Most of the European systems are
financed through contributions from public sector and private
sector. The non-government funding is obtained by making
contributions compulsory by employers and employees and
also by non-sickness funds [7]. In Singapore no medical care is
provided free of charge and in the government sector treats
patients like private patients without any subsidies. The
government follows a policy of compulsory savings and
payroll deductions to meet the financial cost and this is ranked
among the most successful systems in first world [8]. In the
United States of America most of the health care is provided by
private sector insurance companies and considered as one of
the most expensive systems in the world [9]. The salient
features of all these models are the accessibility of health care
facilities to the large population and also the special care
provided to the elders of the country.
IV. H
EALTH
O
F
S
ENIOR
C
ITIZENS
According to United Nations, a person above the age 60 is
considered as an old person. Though this definition cannot be
applied universally, a person above the age of 60 is considered
as a senior citizen for most purposes [10]. One of the sensitive
issues in global health care scenario is the health of senior
citizens. People are more susceptible to diseases while they get
older. Most of them may have limited or no access to health
insurance. The absence of long term policies for health care
adversely affects the quality of life. The care for senior citizens
involves fulfillment of the special needs and requirements
unique to them. This will include assisted living, adult day
care, nursing home care and home care. In different cultures,
health care of senior citizens is perceived in different ways.
People prefer government established elderly care in most
European countries and US, while in Asian countries older
people prefer traditional method of being cared by younger
generations of family.

A. In Developed Countries
The older population is 39.6 million in United States in the
year 2009. This constitutes 12.9% of the U.S. population [11].
Many of the large service providers of facilities for the elder
people are owned by government in USA. Most of them are
managed as for-profit businesses. But there are exceptions also.
Though most elders prefer to continue to live in their own
homes, most of them gradually lose functional ability and
require either additional assistance in the home or a move to an
eldercare facility [12].
In Canada, elder care is done by both for-profit and non-
profit facilities. Government funded public facilities are run by
Ministry of Health or cost of facility is subsidized. Elders may
pay based on income, on a sliding scale [13].
In Australia, the system is designed so that every citizen
can contribute as much as possible toward their cost of care and
the rest is paid by the government [14]. The Commonwealth
Government passed a Living Longer, Living Better
amendments of 2013, according to which assistance is
provided in accordance with assesses care needs, with
additional supplements available for people experiencing
homelessness, dementia and veterans [15].
B. In India
According to the cultural view of India, it is the duty of the
children to take care of their parents in the old age, courtesy to
its strong family relations and bondage unlike other countries.
Elderly citizens are viewed with high regard and traditional
values demand honor and respect for older, wiser people [16].
The elderly population of India is increasing tremendously with
a current estimate of 90 million over the age 60. According to
India’s 60th National Sample Survey, almost one fourth of
India’s elderly population suffers from poor health. This
reports of poor health is more clustered towards the under
educated, economically lower class [17]. Though homes and
volunteer care for elderly care are provided in India by NGOs,
people prefer to go for governmental facilities.
V. I
MPACT
O
F
T
ECHNOLOGY
The advances of technology have revolutionized the field of
medical health care globally. Compared to the first world, in
India there is no specific project for the health care of the elder
population of the country. Palliative health care in India largely
banks on charitable societies and institutions, which have little
penetration in the rural population of the country [18]. The
problem of accessibility restricts the availability of facilities to
a large chunk of population. The need of the hour is to solve
the problem of accessibility which increases the gap between
the public and the facilities, both in public and private sector.
Technologies like Internet of Things can play a crucial role
in these areas. If the facilities available in an area can be
categorized geographically and made available to the people,
the long waiting hours can be brought down. The real time
update on the statuses and working hours can be carried out
over a cellular network which has better penetration in
population.
Various technological projects are being initiated in this
field in international scenario. There are home automation
projects like “assistive domotics” which helps elders and
people with disabilities to remain at home, safe and
comfortable rather than move to a healthcare facility [19]. This
field uses much of the same technology and equipment as
home automation for security, entertainment, and energy
conservation but tailors it towards older adults and people with
disabilities. Home automation systems for the elderly can be
classified into two - embedded health systems and private
health networks. Embedded health systems integrate sensors
and microprocessors in appliances, furniture, and clothing that
can collect data which is analyzed and used to diagnose
diseases and recognize risk patterns. Private health networks
implement wireless technology to connect portable devices and
store data in a household health database [20].
To maintain privacy home networks can be programmed to
automatically lock doors and shut. This can include systems
and tools to include personal alarms and emergency response
telephones. A small wireless transceiver in the shape of
pendant to be worn around the neck can activate the controls
required for this. Systems can be made to connect the elderly
and disabled individuals to internet that may reduce their sense
of isolation and help them to deal with loneliness and
depression [21]. Sensor based systems can be fully integrated
into a home network and allow health professionals to monitor
patients at home. The system consists of an antenna that a
patient holds over their implanted device. The collected data
can be accessed by the patient or family members. This can
generate alarms and send alerts automatically if significant
changes are observed in the user's vital signs [20].
A sample scheme of implementation of healthcare facility
for the elders is given in figure 1. This scheme incorporates
Internet of Things (IoT) and Cloud Computing to monitor and
care the health of elder citizens. It consists of an Ubuntu server
which runs on a Raspberry Pi 3 board. This server is connected
to the wearable device or sensor that will monitor the vitals of
the person. The data from the sensor will be sent continuously
to sever. The range of the device is limited within the house or
surroundings. The hardware specifications of this device have
been figured out. The device monitors pulse rate, blood
pressure and body temperature. It can also be programmed to
sense the movements and identify if the person is falling sick or
sleeping. This is done as an initial step. This can be further
enhanced so that the device can track various activities and
vitals. Security protocols are implemented so that the data from
the device to the sensor is secure and cannot be accessed by
outside party. The server and device are configured such that
only the authorized person can access the details from the
device through the server. The program is protected by
passcodes and also by second layer of security is being
implemented using biometrics to provide an extra layer of
security.
The server analyses the data and pushes it to the
cloud. The server can identify first level of threats and can
directly alert the health professionals. Emergency procedures
can be incorporated which will require the use of data
analytics. A two level support system is part of the scheme.
The first level consists of a first aid center or help desk which

will act spontaneously when a threat is detected. The second
level can be a medical facility with experts or care takers. They
can be intimated by the first aid center if necessary. This is
done by defining a threshold value for the threat. Various
thresholds are configured according to the health professionals
considering the health conditions of the user. All these will be
connected to the cloud. The cloud controls all the devices. All
the data will be structured and stored in the cloud. Cloud also
analyses the data and informs the first aid or the care takers
according to it. The scheme requires integration of IoT to cloud
computing facility. It also requires sensing and visualization of
data in IoT environment. Resource positioning has to be carried
out for the effective use of medical care. Data analytics
technologies also play a decisive role. It has to decide what
data has to collect from the client and send to the cloud. Also
from this data the threats have to be identified and classified so
that the respective supporting centers are alerted. The data can
be transferred periodically to the help desk and care takers. In
addition this cloud has to be made secure with the help of
cryptographic protocols. If there is more than one health
professionals involved the security is configured in such a way
that only the particular health professional access the data
intended to him/her. All this will require security of cloud
services, information retrieval and resource positioning.
Privacy and data security has to be ensured in all
communications. All this data management will be done by
cloud and data analytics.
Fig. 1. Scheme for Implentation using IoT and Cloud Computing
VI. C
ONCLUSION
The paper surveys the healthcare scenario of senior citizens
in first world and India from a technological perspective.
Though the Indian scenario lags behind that of the developed
nations, various projects are being initiated recently by the
Central government for the health care of senior citizens which
incorporate technological advances. We also propose a scheme
of implementation of healthcare facility for elders
incorporating IoT and cloud computing facilities. This is a
practical and cost-effective solution, which can be materialized
to improve quality of life of senior citizens in the Indian
context using technology.
R
EFERENCES
[1] Jugal Kishore, “National health programs of India: national policies &
legislations related to health”, Century Publications, 2005.
[2] Ministry of Health and Family Welfare, Government of India. “National
Family Health Survey (NFHS-3), 2005–06” pp. 436–440
[3] Ramya Kannan "More people opting for private healthcare" The Hindu,
30 July 2013.
[4] Ministry of Health and Family Welfare. "Draft National Health Policy
2015”
[5] Aditya Kalra, “India’s Universal Health care rolls out to cost 26 billion”
Reuters, 30 October 2014
[6] “The world health report: health systems financing: the path to universal
coverage”, World Health Organization, Geneva, November 22, 2010.
[7] Director General of Research, European Parliament, “Health care
systems in EU- a comparative study”, 1998.
[8] Mark Britnell, “In Search of the Perfect Health System”, London:
Palgrave, 2015, p. 42.
[9] Christopher J L Murray et al. "The State of US Health, 1990–2010:
Burden of Diseases, Injuries, and Risk Factors", Journal of the American
Medical Association 310 (6): 591–608. July 10, 2013.
[10] Roebuck J. “When does old age begin? : The evolution of the English
definition.” Journal of Social History. 1979;12 (3):416-28.
[11] “Aging Statistics”, U.S Department of Health and Human Services, June
2010
[12] “Assessing the Financial Implications of Alternative Reimbursement
Policies for Nursing Facilities". American Health Care Association,
December 2011
[13] “Assisted Living Vs Long Term Care”, ElderCare British Columbia
[14] “Aged care Australia”. Department of Health and Ageing,
Commonwealth of Australia.
[15] “Living Longer, Living Better - legislative changes”, Department of
Health and Ageing. Commonwealth of Australia, 12 July 2013.
[16] Sivamurthy, M and Wadakannavar, A.R “Care and support for the
elderly population in India: Results of a survey rural North Karnataka
(India)”, Proc. of 24th IUSSP International Population Conference,
Brazil 2001.
[17] Sumit, Mazumdar, Ulf-Goran Gerdtham, “Heterogeneity in Self-
Assessed Health Status Among the Elderly in India”, Asia-Pacific
Journal of Public Health, 2011, 25 (3): 271–83
[18] Divya Khosla, Firuza D Patel, and Suresh C Sharma, “Palliative Care in
India: Current Progress and Future Needs”, Indian J Palliat Care. 2012
Sep-Dec; 18(3): 149–154.
[19] Cheek, Penny. “Aging Well With Smart Technology”. Nursing
Administration Quarterly, 2005. Vol. 29, No. 4: 329-338.
[20] Eriksson, Henrik and Timpka, Toomas. “The potential of smart homes
for injury prevention among the elderly”, Injury Control and Safety
Promotion, 2002, Vol. 9, No. 2: 127-131.
[21] [Celler, Branko, Nigel Lovell, and Daniel Chan. “The Potential Impact
of Home Telecare of Clinical Practice”, The Medical Journal of
Australia, 1999: 518-521.