Future of Aging in India (Part 2)

Happy seniors laughing

Goal – Healthy Longevity

“I believe that aging is a disease. I believe it is treatable. I believe we can treat it within our lifetimes. And in doing so, I believe everything we know about human health will be fundamentally changed.”

David A. Sinclair, Ph.D. (From his book Lifespan)

Professor in the Department of Genetics at Harvard Medical School.

 In the first part of this article, we discussed how aging in India is likely to be different than in the developed world. The next two parts deal with how to achieve a common goal for every Indian a long, healthy, and happy life during their golden years in an affordable manner.

At MyCare we have a shared vision and commitment to work towards this goal.

This part deals with thoughts pertaining to the goal of Healthy Longevity. The last and concluding part will focus on the goal of Happy Longevity.

Reimagining Senior Care:

A very traditional way of approaching the aging population is to augment the capacities of various types of clinical establishments like Hospitals, Home Health providers, Rehabilitation Centres, and Assisted Living facilities, etc., This alone may not be the right solution for India as the prevalent sick care model is inherently inflationary. It may put lots of strain on individual savings either in terms of higher out-of-pocket expenses or higher insurance premiums.

To achieve this goal in a sustainable manner, the fulcrum of the reimagined senior care must be prevention. A smart ecosystem of prevention needs to be developed to solve our problem of unhealthy aging.

Current Status of Preventive Care:

One of the major differences between preventive care and clinical care is the responsibility of action. In preventive care, it is of the individual while in clinical care it is of the caregiver. This difference creates its own issues like.

No Scientific and Holistic Knowledge:

Many times, people acquire their health knowledge through WhatsApp forwards, the Internet, and recommendation by friends & family. In most cases, their understanding of prevention is like the example of six blind people describing an elephant based on whichever part of the elephant they touched.

No Application of Knowledge:

Even in some cases, people have the right knowledge but are still not able to implement these measures due to various factors. Just like all smokers know that smoking is injurious but are not able to quit smoking.

No Tenacity

Many people start their preventive care measures with lots of enthusiasm, but it wanes as time goes by. Prevention is not a one-time event but a continuous iterative process starting with the assessment then planning improvements wherever required then execution and then again assessment to check the results.

What can we do to overcome these issues?

Preventive Care of the Future:

Some of the features of an effective preventive care system are:

1.   Holistic: As humans, our existence consists of the body, mind, spirit (consciousness), and environment. For overall health harmony of all factors is required and often they are interdependent.

  • Physical Health: Physical Health includes metabolic health for preventing noncommunicable diseases, Immunity to prevent communicable diseases, and musculoskeletal health to prevent falls and improve mobility.
  • Cognitive or Mental Health & Behavioral or Emotional Health: Many people use mental health and emotional health interchangeably but there is a subtle difference between the two. Mental health deals with reasoning or how well your mind works while emotional health deals with expressing or capacity to oversee and communicate the feelings from what one has realized or experienced.
  • Social Health: A Blue Zone project which studied communities with longer lifespans has found that one of the key ingredients for longer living is social connection. It is one of the very important factors in prevention.
  • Financial Health: Financial health is the ability to meet regular and catastrophic expenses without compromising the standard of living. This also plays a very important part in overall health.
  • Spiritual Health: A spiritual bent of mind generally helps in terms of improved behavioral health and in turn also helps physical health. It helps a person to provide a stable emotional response to any external events.

 2.   Embedded:

 Prevention should intertwine in our daily life. It can be achieved by various means. For example, wearing a seatbelt was not followed by many people even when it was made mandatory. However, nagging the driver and front seat passenger through an alarm has improved compliance to nearly 100% and must have saved many lives. Similarly, if there are appropriate reminders for any pre-defined preventive action it can improve adherence significantly.

 3.   Outcome Oriented

 Any preventive action should have a specific goal in mind backed by scientific evidence.

 4.   Measurable and gamified

 For avoidance and management of metabolic diseases, the active participation of the person is as important, if not more as the doctor’s guidance. One of the major challenges of getting something done by the individual is motivation and inertia. The success of pedometers and 10,000 steps has demonstrated that measurement and gamification can work wonders for adherence.

 5. Cost-effective

 The adoption of a prevention philosophy will directly depend on the measurable value it can deliver. The value must be conspicuous, and the cost of the prevention activity needs to be shared by other beneficiaries like insurance companies to make it widely acceptable. Also, the 80:20 rule should be used by undertaking those 20% activities which can deliver 80% outcomes.

 6.   Without conflict of interest:

 The nonaligned nature (The healthcare provider makes more money if a patient remains sick) of the predominantly ‘fee-for-service’ healthcare industry often creates a trust deficit and often results in avoidable overtreatment. It increases the cost of healthcare.

 Health System

 A model where a healthcare financer is combined with a healthcare provider (classic HMO – Health Maintenance Organization model) can result in aligned interest, prevention focus, and lower cost. In India ESIC (Employee State Insurance Corporation) runs such a model but often there are complaints of poor customer satisfaction due to a lack of competition and government management. Like the insurance sector, the privatization of ESIC-like healthcare systems should be encouraged as an alternative to ESIC. Such HMOs are aligned with their members as the healthier the members the more profit they make.

 7.   Technology enabled (Age Tech):

 Since the Developed world is ahead in terms of an aging population, lots of research is undertaken and products and services are rolled out for seniors. Many of such developments can be useful for Indian Seniors as well to improve the quality of their lives. Some examples are Fall Sensors, Continuous Glucose Monitors, Smart Biometric devices for Telemedicine, continuous ECG monitors, etc.

Adoption of such Age-Tech solutions can be accelerated through a platform which

  • Curates such technologies through clinical and regulatory due diligence.
  • Have appropriate last-mile connections with a large customer base.
  • Have the ability to assist seniors with training on the installation and use of devices and apps.
  • Have a central control room that can act on alerts for necessary advice and action promptly.
  • Have a central repository of storing such data on a central platform for future clinical analysis as well as AI-based future risk assessment.

If we can create such an ecosystem for preventive health care for seniors, it will go a long way in achieving our objectives.

In the third and concluding part of the Article will discuss the goal of Happy Longevity.