The advancement in medical science and technology has certainly been the most important contributors to the growth in life expectancy and thereby to the growth of human population.

Indeed the lifespan of the individual has increased considerably over the last five decades or so – almost 50 per cent growth (World Bank, World Development Indicators); however, the quality of life has become an area of concern owing to lifestyle diseases. This in effect has shot up the average medical spending and is estimated to be close to 10 per cent of the world GDP (US $ 6.8 trillion vis-à-vis 63.04 trillion). Non-infrastructure healthcare spending in BRIC countries is estimated to grow by around 51 per cent from 2010 – 2020 (Courtesy: PwC).

Chronic diseases
Chronic diseases are a major public health problem worldwide. In 2005, the World Health Organization (WHO) estimated that 61 per cent of all deaths - 35 million - and 49 per cent of the global burden of disease were attributable to chronic diseases. By 2030, the proportion of total global deaths due to chronic diseases is expected to increase to 70 per cent and the global burden of disease to 56 per cent.

Yet another added dimension to this burgeoning healthcare issue is the phenomenal growth of the geriatric population (60+), which is expected to reach 1/5th of the total population. This is quite alarming more so for India, since the 60+ would be largely income less and would be dependent, unlike in developed countries. It would certainly be an uphill task to tackle the huge burden of rapidly increasing healthcare expenditure for the 60+ population, unless novel strategies are devised to provide Health Insurance to them as well.

But from the Indian pharmaceutical perspective, it is more important to visualize the emerging disease pattern and plan an appropriate new product strategy.

Different studies show varied results
Different studies show varied results in the morbidity pattern of the geriatrics.
A study conducted in the rural area of Pondicherry in Tamil Nadu state reported decreased visual acuity due to cataract and refractive errors in 57 per cent of the elderly followed by pain in the joints and joint stiffness in 43.4 per cent, dental and chewing complaints in 42 per cent, and hearing impairment in 15.4 per cent. Other morbidities were hypertension (14 per cent ), diarrhoea (12 per cent), chronic cough (12 per cent), skin diseases (12 per cent), heart disease (9 per cent), diabetes (8.1 per cent), asthma (6 per cent), and urinary complaints (5.6 per cent).

A similar study that had been conducted among 200 elderly people in rural and urban areas of Chandigarh in Haryana observed that as many as 87.5 per cent had minimal to severe disabilities. The most prevalent morbidity was anaemia, followed by dental problems, hypertension, chronic obstructive airway disease (COAD), cataract, and osteoarthritis. A study on ocular morbidities among the elderly population in the district of Wardha found that refractive errors accounted for the highest number (40.8 per cent) of ocular morbidities, closely followed by cataract (40.4 per cent) while other morbidities included aphakia (11.1 per cent), pterygium (5.2 per cent), and glaucoma (3.1 per cent). In a community based study conducted in Delhi among 10,000 elderly people, it was found that problems related to vision and hearing topped the list, closely followed by backache and arthritis.

Elderly people who belong to middle and higher income groups are prone to develop obesity and its related complications due to a sedentary lifestyle and decreased physical activity. In a study conducted among 206 elderly persons attending the Geriatric Clinic at a tertiary care hospital in Delhi, about 34 per cent of the men and 40.3 per cent of the women were obese respectively.

A more simplified perspective would be to enlist the geriatric diseases in alphabetical order: Alzheimer’s disease, arthritis, cardiac diseases, COPD, constipation, dementias, depression, diabetes, dyslipidaemias, falls, gout, hypertension, incontinence, memory loss, osteoporosis, Parkinson’s disease, sleep disturbances and stroke.
 
Lifestyle disease
Indeed, lifestyle disease or the non-communicable disease looms large as the most potential health risk for the future. Bringing about a change in their lifestyles may not be within the purview of the industry, excepting for conducting educational campaigns and health camps. However, providing comprehensive healthcare with the prime social objective of preventive medicine could be a viable solution for the industry.

Indian pharmaceutical industry can innovatively work on this important and growing therapeutic need with a thorough understanding of the pharmaco-therapeutics in the geriatric population and evolve effective solutions such as, drug delivery systems, polypills, novel absorption enhancers, nanotechnology, toxicity busters, innovative pharmacokinetic manipulation methods, etc.