Towards healthy aging: Eye health as an entry point to holistic health care for the elderly – The concept and the need : Indian Journal of Ophthalmology

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Towards healthy aging: Eye health as an entry point to holistic health care for the elderly – The concept and the need

Marmamula, Srinivas

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Indian Journal of Ophthalmology 70(11):p 4094-4095, November 2022. | DOI: 10.4103/ijo.IJO_1995_22
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Dear Editor,

The United Nations’ World Population Prospects 2022 report released this July projects a steep increase in the elderly population around the world.[1] The report estimates that every fifth person in the world will be in the elderly age group by 2050. It also notes that India will overtake China to emerge as the most populous country in the world next year. A key driver for these big demographic shifts is a shrinking birth rate and an increasing life expectancy rate, all of which leads to more elderly people. Indeed, the elderly will be more than twice the number of children under the age of five by 2050. This shift has significant implications for the world’s ability to achieve the Sustainable Development Goals (SDGs). It also increases the pressure to develop and deliver universal health care to all our citizens and to mitigate the many social and health demands placed on the country by an aging population.

A recent study has indicated that over 30% of the elderly have vision loss.[2] Vision loss adversely affects their quality of life and results in mental health issues such as depression. The sequelae of non-communicable diseases (NCDs) such as diabetes and hypertension are emerging causes of irreversible vision loss in the elderly. Research also suggests a link between vision loss and cognitive decline.[3] Every fifth elderly person is reported to have at least one self-reported disability and a third of the elderly have at least one NCD.[4] Hence, elderly health is an intricate matrix of health conditions and choices. It is evident then that healthy aging is only possible with an integrated and holistic approach to health care system that understands the health needs of the elderly beyond a narrow specialty focus. Health care offered in silos where each condition is addressed separately and often oblivious to other issues is grossly inadequate.

Eye health has the distinct advantage and immense potential to serve as a gateway or entry point for holistic health care for the elderly. Eye care is most sought after by the elderly, as indicated by a higher prevalence of spectacle use compared to other assistive devices.[4] Moreover, eye care is reaching deep into the country, with several non-governmental organizations (NGOs) working to grow networks in many states. The increasing cataract surgical rate (number of surgeries done per million people) is another indicator of the reach of eye care service providers. Thus, eye care has the necessary reach and scale to deliver an integrated model of care.

Eye exams enabling opportunistic screening for NCDs and disabilities coupled with appropriate horizontal referral linkages with other health care providers can be a strategy to achieve a holistic health care model for the elderly. Making eye care accessible, affordable, and integrated into a larger health care package of services is the way forward to achieve the goal of healthy aging, in line with the WHO’s call for integrated people-centered eye care (IPEC).[5]

There is a need to derive on a set of common minimum assessments (CMA) that can be carried out as part of the opportunistic screening protocol for NCDs and disabilities in different settings. These assessments should be practical and easy to apply in a short time, using limited resources in eye care settings at different levels of care. Along similar lines, CMA for screening of eye health by other health care providers need to be developed and validated for use in various health care settings with linkages to eye care service providers [Fig. 1]. The robust evidence on the effectiveness of these approaches will propel processes to contribute toward healthy aging through collaborations in an integrated manner.

Figure 1:
Pathways for holistic health care

In conclusion, research in elderly health leading to the development of evidence-based protocols and their wider application in routine practice for realizing holistic health care for the elderly is the way forward. All of these efforts combined will contribute towards the overarching goal of achieving healthy and happy aging in India.

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Conflicts of interest

There are no conflicts of interest.


1. United Nations Department of Economic and Social Affairs, Population Division (2022). World Population Prospects 2022: Summary of Results UN DESA/POP/2022/TR/NO. 3
2. Marmamula S, Challa R, Khanna RC, Kunkunu E, Rao GN Population-based assessment of vision impairment in the elderly population in Telangana state in India-Policy implications for eye health programmes Ophthalmic Epidemiol 2021 28 144 51
3. Lim ZW, Chee ML, Soh ZD, Cheung N, Dai W, Sahil T, et al. Association between visual impairment and decline in cognitive function in a multiethnic Asian Population JAMA Netw Open 2020 3 e203560
4. Marmamula S, Modepalli SB, Kumbham TR, Challa R, Keeffe JE Prevalence of disabilities and non-communicable diseases in an elderly population in the Telangana state, India:A population-based cross-sectional study BMJ Open 2021 11 e041755
5. World Report on Vision Geneva World Health Organization 2019
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