The crowded public transport systems, the heavy traffic on the roads, and broken pavements coupled with shifts to nuclear family structures, rapid technological changes, and longer life spans have left Bengaluru’s elderly citizens in the lurch in a general sense.

One of the few saving graces for the elderly in the city – who make up nearly 10 per cent of the over nine million population – has been a nearly three-decade endeavour by a doctor and a social entrepreneur to anticipate the needs of the ‘increasingly isolated’ senior citizens in Bengaluru and to build facilities for their well-being.
Starting as a simple effort to provide medical assistance at home for the elderly in north Bengaluru in 1996 – with a garage as an office – Dr Radha Murthy, an alumnus of the St John’s Medical College in Bengaluru, and S Premkumar Raja, an MPhil degree holder from the Annamalai University, have built one of the backbones for elderly care in Bengaluru.

The Nightingales Medical Trust, which was co-founded by Dr Radha Murthy and Premkumar Raja in 1998 on the back of their experience with providing home medical assistance for the elderly in 1996 from the garage of Dr Murthy’s home in Sadashivanagar, has over the years addressed issues like abuse of the elderly, care of the homeless elderly, as well as illnesses.

An Elders Helpline (1090) started by the Nightingales in association with the Bengaluru police two decades ago – to address the issue of elderly abuse for the first time in the country – remains a mainstay for assisting elders in Bengaluru in dealing with family abuse as well as issues like getting delayed pensions.

The Nightingales also run two homes for destitute elderly men and women from the weaker sections of society – Sandhya Kirana and Sandhya Suraksha – in association with the Bengaluru city municipal council, and multiple elderly enrichment centers around Bengaluru to engage senior citizens who are healthy but often home alone in creative and vocational pursuits.

With the incidence of dementia and Alzheimer’s rising on account of longer life spans, the Nightingales Medical Trust has ventured in recent years to create one of India’s largest residential care facilities for elders affected by age-related diseases.

The trust now trains paramedics in elderly care and earlier this year was chosen to create an Elders Helpline (14567) for the whole of Karnataka by the state and the Union governments.

“Before starting Nightingales, we were working in a hospital at Sadashivnagar. At that time, we saw a genuine need for providing medical care at the doorstep of older persons. We noticed how difficult it was for elderly patients to get medical help due to health and mobility issues. Visits to the hospital by the elderly with chronic health conditions taxed the patients and their caregivers equally,” Nightingales Medical Trust co-founder Raja said.

“Responding to this need, we started Nightingales Home Health Services in January 1996, with the sole aim of serving elders who needed routine or emergency medical care right at their homes. This made us the pioneers of home health care in the country,” he said.

The Nightingales Home Health Services initially comprised Dr Radha Murthy as the medical practitioner, a couple of nursing staff, and Premkumar Raja as the administrator. In the course of providing care for the elderly in their homes, Dr Murthy and Raja realised that a lot of the “emotional, social and economic needs” of the elderly were also not being addressed.

“After visiting many old age homes, we believed old age homes cannot be the only solution for these problems and felt there was a need for a comprehensive community-based approach. To look into these aspects, we formed the Nightingales Medical Trust (NMT) in 1998, a not-for-profit organization to work for the well-being of the elderly and persons with dementia and Alzheimer’s from all socioeconomic groups,” Premkumar Raja said.

One of the first services for the elderly that Dr Murthy and Premkumar Raja created, under the umbrella of the Nightingales Medical Trust, was an elders enrichment centre at Malleshwaram in 1999.

The centre provided senior citizens a forum for social interaction and enrichment with access to a library, medical care, counselling on health, and advice on diet and financial planning.

“The purpose of this centre was to address the loneliness of the elderly by fulfilling their social and emotional needs,” Dr Radha Murthy said.

During interactions with seniors at the enrichment centre and while providing home-based medical care, the Nightingales co-founders realized that many elders from middle-class homes were being subjected to abuse at home by family members and caregivers. This prompted the idea of creating a helpline in Bengaluru for the elderly.
“We came across a lot of unaddressed issues such as elder abuse which involves physical, emotional, and psychological abuse and it needs direct interventions that informal counselling could not address. Some elders came up with legal concerns for which they hesitated to approach the judicial courts as it was unaffordable…” said Dr Radha Murthy.

“We approached the Bangalore City Police to initiate a Helpline for senior citizens. At that time, the woman Helpline and child Helpline were already established as community-based interventions by the police department,” she said.

The Bengaluru police invited the Nightingales Medical Trust to establish the Elders Helpline in Bengaluru and “for the first time in the country, a police department and an NGO joined together to address elder abuse” on the 1090 helpline in April 2002.

“Initially, the calls were few as older people hesitated to come forward and complain. Over time, the Elders Helpline slowly gained recognition. So far, the Elders Helpline 1090, has handled 2,35,541 calls/contacts. As many as 10,591 complaints of a serious nature were registered with 69 per cent of the complaints being successfully resolved,” Premkumar Raja said.

During the experience of running the enrichment centre for the elderly in Malleswaram and the helpline, Dr Murthy and Raja realised that although they were addressing issues concerning the elderly from the middle class in Bengaluru, there was still a major lacuna in addressing the issues of the elderly from the weaker economic sections of society.

“We wanted to set up a similar centre (like the enrichment centre) for the marginalised elders. We approached the BBMP with this proposal and were provided space to set up a Sandhya Kirana daycare centre for the elderly at Shantinagar. The services were curated to the needs of the elders from lower-income groups and the focus was on providing nutrition support, medical intervention, and income generation activities,” Raja said.

In 2018 and 2020, the Nightingales Medical Trust also set up two residential facilities for the care of poor and destitute elderly men and women in Bengaluru.

“The intention was to make Bengaluru free of homeless elderly beggars. With this intention in mind, Sandhya Suraksha, a home for destitute elderly women, was set up in November 2018, since elderly women were seen as the most vulnerable. In 2020, a home for destitute elderly men was set up at the Sandhya Kirana premises,” Raja said. The two residential facilities now care for around 105 destitute elders, he added.

The increasing association with issues affecting senior citizens in Bengaluru brought Dr Murthy and Raja in close proximity to the growing incidence of dementia and Alzheimer’s disease among the elderly with the advancement of age and longevity, as well as the struggles that families were experiencing in understanding and looking after seniors affected by the age disorders.

“As longevity increased so did the medical complications that come with it. That’s when we realized that dementia and Alzheimer’s were a rising worry,” said Raja. “Currently, there are 6.1 million people with dementia in India. The numbers are expected to triple in 2050. It’s estimated that in Bangalore about 46,000 elders live with dementia” he added.

The Nightingales Medical Trust has started services ranging from diagnosis of dementia and Alzheimer’s, training programmes for caregivers, and daycare, to long-term residential care facilities for seniors affected by age-related diseases.

The NMT has three residential care services for people with dementia. One of India’s largest residential care facilities in Kasturi Nagar, Bengaluru (100 beds), a 74-bed telemedicine-enabled residential care centre in Kolar, and a 24-bed exclusive residential care facility for women with dementia in Kothanur.

“When we started the home care services we had less than a dozen staff and we presently have 252 staff members,” Premkumar Raja said.
“Ageism is an issue that has been prevalent in society. Due to the shift to the nuclear family system, generational gaps, and the inability of elders to cope with advancing technology, the societal outlook for seniors has changed. Revered for their experience and knowledge, they are slowly seen as people who are unable to keep up with changing times,” the Nightingales Medical Trust co-founder said.

“Although some elders, especially the middle class have tried to keep up with technology and this has been a great way to keep socially connected, it has definitely alienated the elderly who don’t have the means of learning and keeping up with the changes in technology. There is a need to push for digital literacy for all elderly so that they can be empowered,” he pointed out.

Over the coming years, the Nightingales Medical trust co-founders are hoping to scale up their spectrum of services to reach out to more of the elderly population.

“The NMT aims to set up a state-of-the-art dementia village using therapeutic environmental design concepts to deliver individual-based care to improve the quality of life of residents. The proposed village would be created in such a way that residents can lead normal and independent lives to the maximum extent without compromising their safety,” Raja said.