Activating the knowledge-to-action cycle for geriatric care in India

The size of India's older adult population is greater than the total population of many developed and developing countries. According to World Health Statistics 2011, 83 million persons in India are 60 years of age and older, representing over 7% of the nation's total population [1]. Over the next four decades, India's demographic structure is expected to shift dramatically from a young to an aging population resulting in 316 million elderly persons by 2050 [2]. The aging population is a sign of successful development in medical sciences and technology, living standards, and education, but the elderly also raise unique social, economic, and clinical challenges, including a growing demand for increasingly complex healthcare services. Chronic diseases now constitute the leading cause of death and disability among India's old in both urban and rural areas [3,4].Despite an aging population, geriatrics - the branch of medicine that focuses on healthcare of the elderly - is relatively new in India with many practicing physicians having little knowledge of the clinical and functional implications of aging [5,6]. According to the World Health Organization's (WHO) multi-country study, Integrated Response of Health Systems to Rapidly Ageing Populations, India's old, their caregivers, and healthcare providers passively accept ill-health as part of old age [7]. In fact, healthcare providers often view elderly patients in a "negative and mechanistic fashion" [6]. Condemnatory attitudes and limited awareness, knowledge or acceptance of geriatrics as a legitimate discipline can manifest in inaccessible or poor quality care. For example, elderly persons in India often die from preventable conditions like bronchitis, asthma, and pneumonia [8]. India's old are hospitalized for an average of 32 days, often due to inadequate community-based health and social support rather than ongoing acute needs [9]. This population takes an average of six prescription drugs concurrently [10,11] and