Every Saturday, in a small space in Geriatrics Society of Nepal’s office, senior citizens wait for their turn to go through their free routine check-up. In Satdobato, the place is small, but it is equipped with the necessary equipment to carry out ECGs, ECHOs, blood tests, and urine tests.

According to the Nepal’s Senior Citizen Act (2006), people above the age of 60 are considered to be of geriatric age. In Nepal, there are more than 2.1 million older adults, according to the 2011 census, but there are only three registered geriatric specialists to take care of them.

Geriatrics or Geriatric medicine refers to the branch of medicine focusing on the healthcare of older adults. As ageing causes one’s body to go through various changes, it invites many health problems in older-adults, which demand special care. With the significant increase in population of older adults—more than one million in 1991 and more than 1.5 million in 2001—availability of geriatric care in the country is imperative, say health care professionals.

“My mother had difficulty in talking, eating and moving. She was then admitted for about two weeks and fed through an IV, after which the doctor told us to take her home because they could help us anymore,” says Ramila Limbu, whose 81-year-old mother was diagnosed with Chronic Obstructive Pulmonary Disease (COPD) at Birendra Army Hospital in Chhauni.

But after getting in touch with a geriatric health specialist through Hope Hermitage Elderly Care, an assisted living home for older adults, she found out that her mother had Alzheimer’s.

Limbu’s plight is not an exception, says Dr Ramesh Kandel, Nepal’s first geriatrics specialist. While pursuing his MBBS at BP Koirala Institute of Health Sciences, Kandel noticed the older patients found it difficult to navigate the health infrastructure and human resources.

“I felt like they didn’t get enough attention for their complex health conditions. Care for old-age patients require special skills, which were not possible with the existing training of medical professionals,” says Kandel, who specialised in geriatric care in India due to lack of medical colleges providing the specialisation course in Nepal.

But even now, only a handful of hospitals have geriatric departments and wards, that too only in the Capital. The disparity between the older adult population and geriatric specialists is alarming in Nepal, which leaves older adults and their families with no alternative but to go through many trial and error by non-specialist health care professionals.

Limbu says that her mother’s misdiagnosis has made her question the overall health care services in the country. “I lost my father due to the carelessness of untrained staff; I don’t think I would have been able to live if something had happened to my mother,” says Limbu. But she says that her mother’s situation has been improving since her treatment and therapy started.

According to Kandel, the guidelines and the goals of care are different compared to that of the adult population when it comes to geriatric services.

Dr Umesh Bogati, a geriatric specialist working at Bir Hospital, agrees with Kandel. “Multiple diseases mean multiple medications, which sometimes influence each other and cause adverse effects to the patients,” he says. “So, as a geriatric specialist, it’s my responsibility to find out whether ageing is causing the patient’s symptoms, or its due to multiple diseases, or due to some medicine he or she is taking that is adding more discomfort.”

However, despite the growing need of geriatric healthcare specialists, the number of trained health care professionals is negligible. Kandel blames the unavailability of training opportunities and further studying options within the country as two of the main reasons why fewer people choose to specialise in geriatric medicine.

“Also a lack of awareness among the general public and the stake-holders regarding the essence of Geriatric Medicine and Gerontology can also be considered a major reason why people aren’t specialising in it and patients aren’t demanding specialists,” he says.

But recognising the need of the geriatric services, a few medical professionals have come together to establish Geriatrics Society of Nepal, a non-profit organisation. “We try to conduct health camps in the rural areas often, as the health posts and hospitals there aren’t equipped with required equipment and medicines. Also, health professionals aren’t properly trained who may misdiagnose the older adult’s symptoms,” says Amrit

Bahadur Thapa, medical coordinator of Geriatrics Society of Nepal. Even though the organisation doesn’t have a Geriatric specialist on board, Dr Sumanta Banjade, after having attended workshops, training and conferences regarding geriatric healthcare in Nepal and abroad, leads the group. This seems to be a consistent problem in all medical institutions. Nepal not only lacks geriatric specialists, but geriatric nurses and caregivers are also lacking.

Pramila Bajracharya Thapa, CEO of Hope Hermitage Elderly Care, went through a similar ordeal when she had just opened the assisted living home for older adults. “The way you approach older adults, talk to them, hold them, bathe them, give them medicine is different. Also, there is a whole another issue of geriatric sensitivity,” she says. 

In the absence of trained health professionals, Thapa herself took geriatric caregiver training from international trainers. But despite being part of the geriatric service in Nepal and helping many older adults, she isn’t optimistic about the improvement of geriatric care in Nepal.

“The situation still isn’t good. I am afraid that there won’t be trained caregivers and specialists by the time I grow old,” she says. But Dr Bhaskar Raj Panta, Chief Consultant & Head of Orthopedics & Trauma at HAMS hospital, believes that proper geriatric healthcare can be provided even in the absence of a geriatric specialist.

“A geriatric specialist diagnoses the problem and refers to the related department. If all medical professionals make an effort in understanding older adults’ conditions, they can be treated properly without a specialist,” Panta says. “The focus should be more about health professionals’ sensitivity towards older adults.”

Kandel, however, disagrees that geriatric services can sustain in the absence of professionals who have essential knowledge and skills in geriatrics and gerontology.

“Geriatric medicine in itself is a unique clinical discipline; it is both a science as well as art,” he says.

Patan Hospital has also been running geriatric ward without a specialist and providing healthcare services to older adults. Bogati says that rather than looking at this from a negative light, it should be considered progress towards availability of geriatric care in Nepal. “Everything needs time. It shows that people are aware of the need to address geriatric healthcare,” he says. “If we start from whatever resources we have, with an intention to further improve the services, it will definitely elevate the services for older adults.”