Older adults in India commute up to 45 kilometres to avail in-patient care: Lancet study estimates

New Delhi: Older adults in India could be commuting up to 15 kilometres to avail out-patient services, and almost 45 kilometres for in-patient care requiring hospitalisation, according to a research.

Estimates published in The Lancet Regional Health-Southeast Asia journal also showed a significant urban-rural disparity -- urban older adults availed out-patient facilities within 10 kilometres of reach, while the distance was nearly 30 kilometres for their rural counterparts.

Researchers from the World Health Organization, the Ministry of Health and Family Welfare and the Indian Council for Medical Research, analysed data of nearly 32,000 older adults, aged 60 and above, collected during the first wave of the Longitudinal Ageing Study of India (LASI) in 2017-2018.

Older adults in India are estimated to be about 138 million in number, with the fraction of this cross-section of society increasing from 7.4 per cent in 2001 to a projected 13.2 per cent in 2031.

Rates of availing both out-patient and in-patient services were found to be high -- 73 per cent and 40 per cent, respectively -- when a facility was within 10 kilometres of reach.

However, with an increase in commute distance, a commensurate decline in the use of out-patient services was found -- 17 per cent utilisation of facilities for 11-30 kilometres distance, and 10 per cent for 30 kilometres and above, respectively.

A longer commute and far-away facility is a barrier for receiving timely, essential healthcare for people in this age group, often seen grappling with multiple long-term, debilitating conditions requiring continuous care, the team said.

They wrote, “Older adults, on an average, travelled a distance of nine miles (14.54 kilometres) to seek outpatient services and 27 miles (43.62 kilometres) for inpatient care respectively.”

State-wise, Tripura, Manipur and Kerala, had the highest in-patient and outpatient

visits within 10 kilometres -- over 80 per cent, 75 per cent and 59 per cent of older adults availed in-patient services, respectively, while 88 per cent, 78 per cent and 84 per cent availed out-patient ones, respectively.

The authors attributed Kerala’s high rates to “easy access and better availability of infrastructure”. In Manipur and Tripura, it may be because people rely on nearby facilities during emergency in-patient situations, they said.

Hilly states such as Nagaland, Sikkim and Himachal Pradesh could pose geographical challenges as zero per cent, 17 per cent and about five per cent of older adults in these areas made in-patient visits within 10 kilometres, the study found.

Further, in northeastern states, such as Mizoram and Nagaland, a higher percentage of older adults were found to travel more than 60 kilometres to access in-patient and out-patient services, indicating a poor and limited access to nearby facilities.

Uttar Pradesh, Bihar, and Madhya Pradesh showed a moderate proximity of 11-60 kilometres for older adults accessing out-patient care, but a higher share of in-patient visits at distances beyond 30 kilometres.

The authors added that less variability in commute distance among southern states indicated a well-distributed healthcare infrastructure.

For an equitable and inclusive healthcare system in India, improving access to services and reducing geographical barriers are paramount, the team said.