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EFFECT OF DIFFERENT TYPES OF

HOUSEHOLDS ON QUALITY OF LIFE OF

ELDERLY IN INDIA & THE NETHERLANDS. - A Proposal for Grants

In recent years, an increasing elderly population proved to be a major social

issue for nearly every country in the world. As a result, attention is being paid

on how to manage the unique problems associated with people of increased

age. To be able to create good social policy the population first needs to be

better understood. One of the elements needed to be understood is the quality

of life (QoL) since it is theorized a higher QoL will lead to a more independent

individual. A potential aspect of QoL which has not been researched before is

the different types of living arrangements or households. The proposed cohort

study, being done in two different countries (India and the Netherlands) with

very different social backgrounds, is meant to establish a relationship between

living arrangements and QoL. We expect the knowledge obtained in this study

to serve the academic society and provide arguments why it is good policy to

invest in improving QoL of the growing elderly population.

Aug 2015

Dr Ashok Kumar Biswas MBBS, DPH

Leyden Academy on Vitality and Ageing

04-Aug-15

Vernieuwingsimpuls Innovational ResearchIncentives SchemeGrant application form 2016 Veni scheme

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Registration form (basic details) 1a. Details of applicant Title: MBBS, DPH First name: Ashok Kumar Initials: A.K.B. Prefix: Dr. Surname: Biswas Male/female: Male Address for correspondence (for the whole period of the Veni-round): Herengracht 33J, 2312 LA, Leiden, The Netherlands Preference for correspondence in English: Yes Telephone: +31 627381003 Fax:- Email: Website (optional):[email protected], [email protected] 1b. Title of the research proposal

“EFFECT OF DIFFERENT TYPES OF HOUSEHOLDS ON QUALITY OF LIFE OF ELDERLY IN INDIA AND THE NETHERLANDS.”

1c.Summary of the research proposal: Assessment of wellbeing and measurement of health is directly related to the quality of life (QoL). QoL in elderly people differs from others because they are more susceptible to multi-morbid physical conditions and hence they require special care to achieve relatively better life. However, the betterment of QoL at old age depends on Quality of Care (QoC) which is received either or both of informal and formal caregivers. Now the question remains, which type of care is better in terms of better QoL for elderly; care from family members and informal resources, or from formal individuals and organizations such as elderly home? Indeed, we all know that globally the elderly population is increasing in number. Therefore, social scientists are paying more attention to the care and social supports at old age. They aim not only to find how to manage the growing group of elderly population in the society but also to ensure best possible QoL for them. However, research on the effects of cultural differences and/or family involvements on QoL in an elderly population are still rare. The research that is available on this topic is mostly either incomplete, with extensive limitations, or did not report on the effects on different households. Hence, a logical step should be carried out to bridge the gap of knowledge in this regard. The proposal is aimed to assess the effects of different households on QoL in elderly from two distinct countries, i.e. India and the Netherlands. These countries were selected for the study area because of their different economical, social and cultural structures. Different databases with a large cohort of elderly from both the countries are already available online, one of which (i.e. SHARE) will be assessed using the standard tools to measure QoL (e.g. WHOQOL-BREF). The result of this proposed research is supposed to


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serve insights in parameters of QoL in elderly based on cultural, economical and social differences. Moreover, in turn that result will hopefully help to ensure better QoL for the elderly in both the countries. 1d. Keywords The quality of life, Elderly, Households, Quality of care, Social support. 1e. Host Institution Leiden Academy on Vitality and Ageing 1f. NWO Division (Choose one) Interdivisional* ALW CW EW GW MaGW ZonMw x N STW * Elucidation of the interdivisional character of the proposal (only to be filled out if you have chosen to submit your application as interdivisional, 50-100 words): 1g. Main field of research (compulsory) The main field of research would be a Socio-Behavioral aspect of wellbeing of Elderly in two different countries.


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Research proposal 2a. Scientific/Scholarly quality

“EFFECT OF DIFFERENT TYPES HOUSEHOLDS ON QUALITY OF LIFE OF ELDERLY IN INDIA AND THE NETHERLANDS.”

Overall Aim : The overall aim of this study is to compare and understand the potential differences in the quality of life of elderly living alone or living with family members in India and the Netherlands. Key objectives:

1. To get clear information on QoL of the elderly population from both India and the Netherlands from the available online database.

2. To assess the QoL of the elderly (above 65 years of age) living alone and with family members in both countries with the help of standardized QoL measurement tools.

3. To compare the QoL in the elderly living in the Netherlands with the elderly residing in India. Moreover, comparison of QoL will be done between the elderly living alone versus those who are living with their family members in both the countries.

4. To analyse the collected data critically and understand the reasons for differences in QoL of the elderly. Moreover, to find and understand the elements of households which potentially changes the QoL among the elderly population.

5. To use the research results as a background information with insights on effects of different households on QoL in the elderly population for future endeavours.

Scientific / Scholarly Background: The elderly people from the western part of the globe are more individualistic, freedom-loving and self-dependant which is why they usually prefer not to live with their children or family members.1,2 On the other hand, in countries from the eastern world, older generations are more close to their family, mostly living with their children and/or other family members. No wonder, family plays a significant role in their life as well as society does. Within the European Union, the majority of the elderly aged 65 and older lives alone (31.1%) or as a couple (48.3%). Approximately nine out of ten persons aged 65 and above in Germany, France, Finland and the United Kingdom lived independently in their home according to the reports in 2009. Surprisingly, in the Netherlands, the percentage was 95 percent.2 On the other hand, according to Census 2011 data, of the nearly 250 million households in India, 31.3% have at least one elderly person.3 Although one in every seven seniors in India lives in a household where there is nobody below the age of 60, it is still very low compared to the situation in the Netherlands. These two cohorts differ in several aspects of society, like economic power, cultural and religious views and, most importantly, QoL. In 2015 mid-year assessment, India reached a quality of life index of 115,15 while the Netherlands scored 220,81.4 At the same time, the score of QoL among the older people in the Netherlands was 7,94 out of 10 while India’s score was only 5,67.5 Although development in the country and economics play a significant role in QoL of every citizen, there can be other factors involved such as culture, households and pattern and quality of care, especially when it comes to the elderly population. Unfortunately, no research is available on potential factors like the ones mentioned above, including


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different types of households. The clear gap in knowledge gives sufficient reason to plan more research and activities in the field concerned. The World Health Organization (WHO) says that health is not defined only by physical fitness but includes mental and social wellbeing as well6 and the elderly population is no exception. Since they are more prone to physical, mental and social disabilities, assessment of health in the older generation(s) is relatively more important. Their wellbeing can be measured by determining the QoL using various available standardized scientific tools such as WHOQOL-100 or WHOQOL-BREF.7

Quality of life can be determined by many dimensions: wellbeing in several areas, including physical, material, social and emotional, as well as development, (physical) activity, etc.8 Physical activity is directly related to physical wellbeing in present and later life. However, psychological wellbeing is weakly related to physical activity.9 Hence, the physical activity alone cannot be the sole solution to achieve a higher quality of life. For example, nutrition, the number of meals per day and the quality of the each meal play a useful role in wellbeing of the elderly population. Evidence depicts that improving mealtime experience is directly related to increased QoL. However, this alone cannot determine better wellbeing for them either.10

Beerens et al. showed in their study on dementia patients that care of elderly at institutions, or at home makes a difference. QoC and QoL vary according to the time and place. Their research on eight different European countries clearly showed that QoC may even vary from door to door.11 The level of deprivation in old adults is visible in terms of income, material living, health conditions, and, of course, social relationships. Because of the conflicts in the social policies nowadays, there is a low level of welfare to the elderly which results in an unacceptable standard of unhappiness, marginal status, and alienation among the older generation.12

Apidechkul established the fact that physical QoL in elderly is better in suburban areas than rural areas. However, mental health related QoL is much better in rural places where the elderly gets informal care from family members while living with their family.13 Moreover, family members play a significant role in preparation of ageing for the older adults. The preparation is always better once surrounded by family members.14

During the illness of an older adult, in most of the cases physicians prefer to explain conditions of the patient to family members first. The importance of household members in this cases are definite.15 The health status of an elderly with dementia is relatively poor to same aged person without the disease. However, the situation becomes worse when dementia patients start suffering from other co-morbidity (sight, oral, genito-urinary troubles, etc.) which demands for day to day care or support obviously.16

Ghassemzadeh et al. reported that elderly people has better QoL at their home compared to those who live in nursing homes.17 Patients with dementia reported a higher need of care following their diagnosis compared to patients without a diagnosis of dementia syndrome.18 The study of Leon et al. on Alzheimer’s patients showed advanced dementia among the patients getting treatment in the institutions in comparison with those who were staying at home.19

All the studies mentioned above and background research showed that there are potentially positive effects of the involvement of family, informal care, living environment, society and food on QoL in the


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elderly population. Hence, a study of the households and their effects on QoL in elderly between two countries with different cultures and living preferences at old age may provide a better understanding of QoL in the elderly. The knowledge will help the caregiving industries to provide a better life to the elderly while family members with one or more elderly at home will get to know the best way to provide social support to their older family member(s) and increase their QoL. The study results could become an example for both Eastern and Western countries to decide how to manage the increasing number of elderly in the society. In addition to all discussed above, currently there has been a reverse activity noted in both Eastern and Western part of the world. The Netherlands, being the fourth best country for the QoL in elderly, recently started plans on shutting the elderly care homes down and the Dutch Government is encouraging all citizens to keep their elderly family members home as longer as possible. The situation makes an impression that living in the elderly house at old age, which is almost 95% in the Netherlands, is not longer effective or putting the Government into trouble. Possibly (not known yet) the reason can be high social and economic burden of the current system. The reason may also be the failure in providing good quality of life for instance. Regardless of the reason, it is clear that one of the best places for elderly in the world is changing their households and living preferences. In contrast, in Asian countries (Japan and India for instance), where living with family members is a million years cherished tradition, business organizations including government are investing in building elderly houses to manage their growing elderly cohort. Therefore, centuries-old traditions do not seem to work either. Altogether current trends influence to come up with similar research proposals like this piece. Originality and/or innovative elements of the topic: Although the assessment of the QoL in elderly has been addressed in a couple of countries separately, comparisons between two or more countries and effect of preferences of living upon QoL have not been done. To date, although few researchers have tried to focus on certain elements of QoL in a particular culture or cohort of the elderly, cultural effects across countries, especially overseas, were not covered. While anthropologists are studying the behaviour of elderly and their QoL, none of them reported the impact of various types of living conditions that may alter their QoL. This proposal is mainly focusing on two very different cohorts of older people from India and the Netherlands. The idea of comparing the effect of the culture of living preferences at old age (with or without family members) on QoL in two different countries is by itself new and original. Apparently, being an Indian physician with working experience of more than two years in Cardiology, I have come across a good number of elderly people from different households. Moreover, I have found significant differences in their behavior, appearance and response and both mental and physical strength. On the other hand, currently while living in a Dutch environment in the Netherlands, it is an extraordinary experience to look at the elderly with different views and ways of life. This study is to establish the fact that there are definite effects of types of various living preferences on QoL of elderly in two countries. As because there is no data available to answer the particular research question, this study along with its aims and objectives remains novel on its own. Moreover, the study is intended to use all 26 items (4 domains) of the QoL measuring tool WHOQOL-BREF which will increase the chance of success in assessing correlations, and maybe even causality, between event and items in the questionnaire to answer the research question. Clearly, it is an original initiative that was not taken


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before in any past study with same objectives. The Netherlands is the 4th country in the world where the life of elderly is good20 while India maintains it's position on top of the news reporting a sicker older population with the poor quality of life in the country.21 Looking back at the literature, we could assume that QoL of elderly in India should be higher than the elderly in the Netherlands because most of the elderly in Indian are living with family members. Unfortunately, current reports do not seem to support our assumption. Hence, the intention towards answering the conflicts again is unique innovative and novel. Research plan including practical timetable over the grant period: Table 1: The timeline of the project work.

1styear 2nd year 3rd year

Discussing the whole plan and distribution of responsibilities among team members with proper understanding. Making a primary schedule of each milestone for the entire project.

All the data will be stored in a separate master table or database for future analysis. In this case, SPSS software probably would be best for use. MS Office Excel or Access will be used for data storage.

Scientific and statistical data analysis will be done for all factors of QoL questionnaire.

Write up of the result in the scientific way with a focus on the important point found in the study.

Data collection would be started from the selected online databases. A collection of data will be based on the aims and objectives.

Cross checking of data will be done while a background data collection will continue to replace the rejected participants in a cohort to fulfill the criteria scientifically.

Comparison of data and finding out the significance of the changes in variables.

An understandable and authentic discussion would be written with both positive and negative (if any) results obtained.

Data collection should satisfy the WHOQOL BREF questionnaire so that for each single elderly there will be sufficient information for analysis.

Fresh data will be entered into a new database or master chart.

Final statistical analysis has to be done. Statistical analysis will be noted down separately for each finding.

A logical, scientific and fruitful conclusion will be made, and final cross check of the paper would be done.

While collecting data, a pilot of the small cohort will be done followed by scientific analysis to cross check if that satisfies the hypothesis.

An academic writing on the topic and its background, methodology, etc. will be started.

Write the report will continue with a continuous cross check on grammar and academic parts of it. By this time, results of the study will be written.

The finished report will be submitted to the authority.


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Figure 1: The schematic diagram showing the timeline of work.

Experimental techniques and/or methodology

Type of research: The research proposed will be observational cohort study. No intervention will be made by any of the researchers on the findings even after report submission. Place: The study involves data on elderly population from India and The Netherlands which will be collected from the massive online databases available. Though travel across the countries is not required, different teams will work data collection of two distinct countries. The whole project work will be done at the Leyden Academy on Vitality and Ageing at Leiden, the Netherlands. Duration: Maximum 3 years Sample (inclusion and exclusion criteria): Only complete data of the elderly above 65 years of age will be eligible for the study irrespective of physical wellbeing at the time of data collection. The database should have minimum information about their country of residence, type of living (alone or with family members), and full information to complete the QoL questionnaire (all 26 items). Sample size: As we know that sample size for unknown population is: Sample Size = (Z-score)² * StdDev*(1-StdDev) / (margin of error)²

1st Grant Year

Pilot

Work Distribution

2nd Grant Year 3rd Grant Year

Data Collection

Sampling

Data Cross Check and Storage

Writing Introduction & Methods

Data Analysis

Statistical Analysis

Writing Resul & Discussion

Peer review & revision

Report Submission


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Here is how the math works assuming you chose: - 95% confidence level, - 0.5 standard deviation (for safety since population size is unknown) - Margin of error (confidence interval) of +/- 5%. Hence, our sample minimum sample size = ((1.96)² x .5(.5)) / (.05)² = (3.8416 x .25) / .0025 = .9604 / .0025 = 384.16 So, the minimum sample size would be 385 respondents. For each of 4 groups (elderly living alone in India, elderly living with family in India, elderly living with family in the Netherlands and elderly living alone in the Netherlands) 385 complete interviewed data will be taken randomly from the large cohort data SHARE-Project. In that case, the minimal total population would be = 385 x 4 = 1540. Techniques and tools: Large data on the social and behavioral aspect of the elderly population from both selected countries is available in the database of ongoing projects such as SHARE Project. They have their broad range of publications on various aspects of research on the elderly population. This data will be used only after ethical approval of the proposal; authentically, and a significant, useful portion of the information will be collected for our study. As a tool the WHO standard questionnaire of QoL, WHOQOL-BREF, will be used for data collection (The domains are given in Table 2). For our study, we will use all 26 items on the questionnaire. Before the main data collection gets started, a pilot study with the same questionnaire will be done to test and validate the questionnaire for the specific research question. If required necessary modification would be done on the questionnaire.

Table 2: WHOQOL-BREF Domains and Facets (BOLD facets are typical topics of interests)

Domains Facets incorporated with domains

1. Physical Health Activities of daily living; Dependence on medicinal substances and medical aids; Energy and fatigue; Mobility; Pain and discomfort; Sleep and rest; Work capability.

2. Psychological Bodily image and appearance; Negative feelings; Positive feelings; Self-esteem; Spirituality/ Religion/ Personal believes; Thinking, learning, memory and concentration.

3. Social Relationships Personal relationships; Social supports; Sexual activities.

4. Environment

Financial resources; Freedom, physical safety and security, Health and social care: accessibility and quality; Home environment; Opportunities for recreation/ leisure activities; Physical environment (pollution/ noise/ traffic/ climate); Transport.

Although the social relationship and environment of living are main domains of interests, we are going


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to use all 26 facets of all four domains. The reason for taking all 26 topics in an account is not to avoid the fact that all domains and topics are interrelated. One has the effect on another subject. Therefore, we do not want to leave the chance to find any potential factors that may pay particular result while analyzing the data.

Originality and/or innovative elements of the approach As explained before the idea of the study of two different cultures with different economic background and geographical locations is unique by itself. Being Indian, I have experienced Indian families and culture related to elderly and their care. Moreover, being an international student at Leyden Academy on Vitality and Ageing at Leiden gives me the ultimate opportunity to experience the Dutch culture, as well as other European cultures from proximity. I believe not only the data which is needed for a productive research but also experiences being a physician, and a citizen of India is fruitful which will give the research study a proper shape. As per the approach concerned, usually the proposed types of studies are done by anthropologists, not medical doctors. Involvement of medical physicians and their experiences will provide insights on the capability of an elderly during analysis. Multi-morbidity almost always limits the capacity of any person and therefore, it has a significant effect on QoL of the person as well. Moreover, taking all four domains and analyzing each of 26 facets of it will provide a larger view on the topic. Furthermore, taking two different country and their participants into the study is a significant challenge because of the immense diversity of cultures and lifestyle. Altogether, the initiatives are of course original and innovative to make it more successful. Local, national and international collaboration (if the host institution is known, please provide details of the research group) The study will be nourished with the collaboration with the ongoing research projects at Leyden Academy of Vitality and Ageing (LAVA). Thomas P and Dr. Jolanda L are working on psychosocial aspects of the elderly population. As LAVA is solely dedicated on how to improve the quality of life of elderly around the world, a collaboration server in everyone’s best interest. Also, the Indian Council of Medical Research (ICMR) in New Delhi has always shown an interest in intercultural studies and studies to improve geriatric life and their value in the society. On ethical clearance, I am confident that ICMR will cooperate in this project that will in turn open a chance to collaborate with Geriatric Association of India (GAI) for future endeavors. Expected results: Considering all the literature and theories it has been already clear that there is a remarkable gap in QoL in elderly in India in comparison with elderly in the Netherlands. The effect of living patterns at old age (with or without family members) would provide a different horizon in understanding the parameters of QoL in elderly. This proposed study will hopefully provide the potential factors of QoL, which will establish the fact that there are other variables that determineQoL at an old age other than economy or development of the country. The study will not only elaborate the areas for which the Netherlands becomes one of the best countries for elderly but will provide information why India is lagging behind and if there is a chance to improve it considering living patterns. Moreover, the Netherlands will be able to look at the positive side of life with family members and probably will get a chance to increase QoL among elderly in the Netherlands to become the best countries for elderly.


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I also hope that study will establish the fact that living with family members is the best place at old age, especially when QoL is calculated on the psychological strength, social relationship and living environment. The Dutch Government has already taken the initiatives to encourage families to keep their older family member at home where in contrast, there are plenty of elderly homes budding everywhere in India. The social situation seems very confusing, and I am sure, our study will be a real contribution to solving it.

2b. Knowledge utilization The knowledge can be mainly useful in three following fields although not limited to:

1. Academic impact: The knowledge acquired from the proposed research will give a wider picture on insights of QoL and its parameters mainly focused on elderly. There are possibilities of new findings that may incorporate theories to the social science, sociology and human behaviours. Moreover, intercultural studies would be more understood after the result is published. Health education, mental and rehabilitation institutes would be benefitted as well. Politically, for both the countries, the theory would be useful for their advantages of current and future older generation.

2. Social impact: A growing number of elderly all over the world has forced every country to focus on social security and long-term care for older persons. Some are busy making elderly houses (e.g. Japan, India, etc.) while some (e.g. the Netherlands) are convincing and encouraging family members to keep their elderly as longer as possible at home. This research will probably be helpful in this current shift to decide what is best for them. Therefore, the society will be more elderly-friendly and manageable.

3. Economic impact: A growing population has always proven to be a burden for any country. However, it becomes worse once it involves an elderly generation because of they are less productive while needing more social support or help. If QoL can get better for the elderly, they will become more productive, self-dependent and will seek less formal social support that will in turn decrease the social and economical burden for a country.

2c. Number of words used: - Section 2a: ... 3,407 - Section 2b: ... 257 2e. Literature references

1. How the elderly are treated around the world [Internet] by Karina Martinez-Carter (Available at http://theweek.com/article/index/246810/how-the-elderly-are-treated-around-the-world. Last accessed on 2nd January, 2015)

2. Living in Old Age in Europe - Current Developments and Challenges [Internet] by Sabrina Stula. June 2012. (Available at http://www.qualres.org/HomeSemi-3629.html. Last accessed on July 29th, 2015)

3. 15 million elderly Indians live all alone: Census [Internet] by Rema Nagarajan. October 1, 2014. (Available at http://timesofindia.indiatimes.com/india/15-million-elderly-Indians-live-all-alone-Census/articleshow/43948392.cms. Last accessed on July 29th, 2015)

4. Quality of Life Index for Country 2015 Mid-Year [Internet] [Author and date of publication is not available] (Available at:http://www.numbeo.com/quality-of-life/rankings_by_country.jsp. Last accessed


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on July 29th, 2015) 5. The Where-To-Be-Born Index [Internet] by Barry Ritholtz. January 15th, 2015. (Available

at:http://www.ritholtz.com/blog/2015/01/the-where-to-be-born-index. Last accessed on July 29, 2015) 6. Measuring of Quality of life [Internet] by World Health Organization. 1997. (Available at

http://www.who.int/mental_health/media/68.pdf. Last accessed on July 29, 2015) 7. http://www.who.int/substance_abuse/research_tools/whoqolbref/en/ (last accessed on 17.10.2015) 8. Felce D, Perry J. Quality of life: its definition and measurement. Res Dev Disabil. 1995 Jan-

Feb;16(1):51-74 9. With all J, State A, Davis M, Coulson J, Thompson JL, Fox KR. Objective indicators of physical activity

and sedentary time and associations with subjective well-being in adults aged 70 and over. Int J EnvironRes Public Health. 2014 Jan 2;11(1):643-56.

10. Barnes S, Wasielewski A, Raiswell C, Drummond B. Exploring the mealtime experience in residential care settings for older people: an observational study. Health Soc Care Community. 2013 Jul;21(4):442-50.

11. Beerens HC, Sutcliffe C, Renom-Guiteras A, Soto ME, Suhonen R, Zabalegui A, Bökberg C, Saks K, Hamers JP, RightTimePlaceCare Consortium. Quality of life and quality of care for people with dementia receiving long-term institutional care or professional home care: the European Right Time Place Care study. J Am Med Dir Assoc. 2014 Jan;15(1):54-61.

12. Arun Ö, Cakıroğlu-Çevik A. Quality of life in an ageing society: a comparative analysis of age cohorts in Turkey.Z GerontolGeriatr. 2013 Dec;46(8):734-9.

13. Apidechkul T. Comparison of the quality of life and mental health among elderly people in rural and suburban areas, Thailand. SoutheastAsian J TropMed Public Health. 2011 Sep;42(5):1282-92.

14. Rattanamongkolgul D, Sritanyarat W, Manderson L. Preparing for aging among older villagers in northeastern Thailand.Nurs Health Sci. 2012 Dec;14(4):446-51.

15. Thai JN, Walter LC, Eng C, Smith AK. Every patient is an individual: clinicians balance individual factors when discussing prognosis with diverse frail elderly adults. J Am Geriatr Soc. 2013 Feb;61(2):264-9.

16. Martín-García S, Rodríguez-Blázquez C, Martínez-López I, Martínez-Martín P, Forjaz MJ. Comorbidity, health status, and quality of life in institutionalized older people with and without dementia.Int Psychogeriatr. 2013 Jul;25(7):1077-84.

17. Ghassemzadeh R, Nasseh H, Arastoo AA, Kamali M, RahimiForoushani A, Arzaghi M. Quality of life in elderly diabetic: comparison between home and nursing home.Acta Med Iran. 2013 May 7;51(4):254-9.

18. Van der Ploeg ES, Bax D, Boorsma M, Nijpels G, van Hout HP. A cross-sectional study to compare care needs of individuals with and without dementia in residential homes in the Netherlands.BMC Geriatr. 2013 May 24;13:51.

19. León-Salas B, Olazarán J, Cruz-Orduña I, Agüera-Ortiz L, Dobato JL, Valentí-Soler M, Muñiz R, González-Salvador MT, Martínez-Martín P. Quality of life (QoL) in community-dwelling and institutionalized Alzheimer’s disease (AD) patients.Arch Gerontol Geriatr. 2013 Nov-Dec;57(3):257-62.

20. Netherlands fourth best country for elderly [Internet] by Audrey Graanoogst. October 2, 2013. (Available at http://www.nltimes.nl/2013/10/02/netherlands-fourth-best-country-for-elderly. Last accessed on July 30th, 2015.)

21. No rest for the elderly in India [Internet] by Neeta Lal. April 2, 2015. (Available at http://www.ipsnews.net/2015/04/no-rest-for-the-elderly-in-india. Last accessed on July 30th, 2015)


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Cost estimates 3a. Budget (nog aanpassen)

3b.Indicate the time (in fte) you will spend on the research Three years 3c.Intended starting date January 2016 3d. Have you submitted the same idea elsewhere or have you requested any additional grants for this project either from NWO or from any other instituti on? NO

Staff costs: (in k€ incl. surcharge, per calendar year) Intensity

(fte) Duration (months)

2016 k€/pm

2017 k€/pm

2018 k€/pm

TOTAL k€

Applicant 1 36 2 2.5 3 90

Non-scientificstaff (NWP)

Intensity (fte)

Duration (months)

2016 k€/pm

2017 k€/pm

2018 k€/pm

TOTAL k€

Academic level 1 36 1,2 1,3 1,4 46,8

HBO/Bachelor-level 1 36 1,1 1,2 1,3 43,2

MBO/Foundation Degree-level

1 36

1,0 1,1 1,2 39,6

Non-staff costs: (in k€) 2018 (for six months) kEuro/PM TOTAL

Give a description of the non-staff cost, as detailed as possible

1,4 8,4

Travel cost 5

Instrument cost 7

Consumable 10

TOTAL 250


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Curriculum vitae 4a. Personal details Title(s), initial(s), first name, surname: Dr. Ashok Kumar Biswas MBBS, DPH Male/Female: Male Date and place of birth: 31.07.1988, Halisahar, India Nationality: Indian 4b. Master's (‘doctoral’) University/College of Higher Education: Leyden Academy on Vitality and Ageing Date (dd/mm/yy):01.09.2014 to 08.07.2015 Study/main subject: Vitality and Ageing Geriatrics and Gerontology 4c. Use of extension clause (See Notes): yes/no (if ‘yes’, give reasons and calculation) 4d. Current employment: Unemployed 4e. Work experience since graduating 2014: Emergency Medical Officer, Jaymala Memorial Hospital, Kalyani, India.

My duties included, but were not restricted to, the primary care to all patients coming to the emergency room, including primary diagnosis with primary and emergency management and referral to specialised centres and/or departments in our hospital when needed.

2013 – 2014: Medical Officer Intensive Cardiac Care Unit and Intensive Thoracic Unit, Majumder Millenium Nursing Home, Kalyani.

My duties included, but were not restricted to, the day to day care for patients admitted to the Intensive Cardiac Care Unit and Intensive Thoracic Unit, including daily assessment of their clinical progress, admittance of new patients and post-operative care in case of cardiothoracic surgery.

2011 – 2013: Junior Resident in Cardiothoracic medicine, Gandhi Memorial Hospital, Kalyani. My duties included, but were not restricted to, the assessment of referred patients to the department for cardiothoracic

diseases from the emergency room, the day to day care for patients admitted to the ward in the department for cardiothoracic diseases, consulting other specialists when needed or referral to different specialties when the primary problem proved not to be cardiothoracic in nature or when the cardiothoracic problem was adequately diagnosed and treated.

2011 – 2014: General Physician in private practice, Kalyani. My duties included, but were not restricted to, the primary care of out-clinic patients in multiple small hospitals and health centres with referral to specialist care when needed. General health care according to Indian model is done with single-handed responsibility while supervision is possible in emergencies.

Internships 2010 – 2011: Rotational practice in all general medical fields, Midnapore Medical College and Hospital, Midnapore. Other working experience 2013 – 2014: Assistant manager medical services, Trach 4 Infotec (MEDICARE), Kolkata 2008 – 2011: News Anchor, Darshan Communication (24 hours News Channel), Midnapore 2008 – 2010: Lecturer, examiner and guide in charge in Anatomy and Clinical Skills, Midnapore Alternative Medical College,

Midnapore. 2006 – 2008: Lecturer, examiner and guide in Anatomy and Clinical Skills, Midnapore Alternative Medical College, Midnapore.


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4f. Man years of research I will need a team to work with me to complete the project within three years of time frame.

1. Data collector: two people including me. Another person will work in India. (Full time) 2. Data Analyst: three people including me (Full-time) 3. Statistical Advisor: one person for last six months 4. Writing thesis: two people including me. Another person will be responsible for the cross-checking

academic write-up. (for last six months) So, these sums up into (2 x 3) + (2 x 3) + (1 x 0, 5) + (1 x 0, 5) man years [N.B.: In first and second category I am being the common employee. Hence avoided to be included as data analyst] = 6 + 6 +0,5+0,5 man years = 13 Man-Years required for this project. 4h. Brief summary of research over the last five years (Max. 250 words) In last five years, I have been working on various research projects either as principal investigator or co-investigator in the field of medicine. These include but not limited to Public Health, Internal Medicine, Gynaecology and Obstetrics, Physiology, Microbiology, etc. I have also been lucky to encounter a few rare case reports that I could publish successfully. All completed research have been either published in indexed international journals or submitted for publication. Although I never worked in the field of Geriatrics Medicine, Psychology or Sociology in the past, I have a definite interested in them. I am also confident that my training and experiences both in successful medical research, academic writing and publishing scientific articles will help to make this proposed work a success. 4i. International activities and other academic activities 2015: Crew member Leiden International Medical Students Conference (LIMSC) 2014 – present: Member, Board of the medical team project 71/071. 2014 – 2015: Member of Program Advisory Board, Leyden Academy on Vitality and Ageing, Leiden, the Netherlands. 2014 – 2015: Ambassador for Leiden University during the International Student Congress of (Bio-) Medical Sciences (ISCOMS-

15), Groningen, the Netherlands. 2011 – present: Deputy Director for India and Bangladesh for Journal of Pioneer Medical Students (JPMS) 2010 – present: Member of the Forum for Medical Students’ Research, India (INFORMER) 2008 – present: Reviewing for multiple international medical journals and conference organisations, including but not limited to the

British Medical Journal (BMJ), The Lancet Student edition, SharinginHealth and International Online Medical Council (IOMC).

2011: Founder and President of Biomedical Students Research Initiatives (BMSRI), resulting in Konference ’12 (2012) for medical and biomedical students, Kolkata, India.

4j. Scholarships, grants Fellowship 2010: NMRI, MRI; All India Institute of Medical Sciences (AIIMS), New Delhi, India. 2009: Radiology, Oncology and Biophysics, Indian Academy of Sciences (IASc), Bangalore; Indian National Science Academy

(INSA), New Delhi; National Academy of Sciences India (NASI), Allahabad, India. Studentship 2009: Gynaecology & Obstetrics, ICMR, New Delhi, India 2008: Gynaecology & Obstetrics, ICMR, New Delhi, India 2007: Public Health, Indian Council of Medical Research (ICMR), New Delhi, India.


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4k. Honours / Awards and Prizes: 2011: Best Paper Presenter, International Online Medical Council (IOMC), Malaysia and United Arabic Emirates. Best Reviewer, International Online Medical Council (IOMC), Malaysia and United Arabic Emirates. Best Active CSB of the year 2010, International Online Medical Council (IOMC), Malaysia and United Arabic

Emirates. 2009: Among best 12 clinicians, Clinico Pathological Competition, MEDICON-2009, Mangalore, India. Best Paper, SIMSCON-2009, Puducherry, India Best Presenter, SIMSCON-2009, Puducherry, India Grand First Prize best presenter, Journal of Young Investigator (JYI), Los Angeles, United States of America. 2006 – 2010: 5 consecutive Short Term Studentship Award for Undergraduate Medical Research, Indian Council of Medical Research (ICMR), New Delhi, India

5a. Publications - International (refereed) journals

2014: Congenital limb abnormality. Ashok KB. Submitted for publication. 2014: Peak Expiratory Flow Rate in Childhood and teenage. Ashok KB. Submitted for publication. 2014: Rare case of Amelia. Ashok KB. Submitted for publication. 2014: Surgical wound and Secondary infection. Ashok KB. Submitted for publication. 2014: Thalassemia prevalence at Midnapore and epidemiological aspect. Ashok KB. Submitted for publication. 2011: Ashok KB. In Search of Efficacy of Valethamate Bromide, a Cervical Dilator. Review of Global Medicine and Healthcare

Research. 2011; 2(1): 17-21 2011: Magnetic Resonance Spectroscopic Imaging (MRSI) Study of Breast Cancer. Ashok KB. International Journal of

Collaborative Research on Internal Medicine & Public Health. 2011; 3(5):370-376. 2011: Old Disease…New Location…Surgeons Be Alerted. Ashok KB. International Journal of Collaborative Research on Internal

Medicine & Public Health. 2011; 3(4):328-332. 2011: “Sex” is a gift of nature. What if she betrays? Ashok KB. International Journal of Collaborative Research on Internal Medicine

& Public Health. 2011; 3(8):645-648. 2011: Solitary hydatid cyst in the thigh without any detectable primary site. Pathak TK, Roy S, Das S, Achar A, Biswas AK. J Pak

Med Assoc. 2011 Dec; 61(12):1244-5. 2011: Special Issue of the IOMC 2011 Conference Abstracts (Conference e-Proceedings). Ashok KB. International Journal of

Collaborative Research on Internal Medicine & Public Health. 2011; 3(3): 225, 277-279, 283 2010: Tobacco use among urban school boys of Midnapore. Biswas AK, Sarkar J. J Pak Med Assoc. 2010 Sep;60(9):786-9.

5b. Average impact factors for your field Only compulsory if your proposal is to be submitted to the Medical Sciences Division (ZonMw), otherwise optional, see Notes. Average impact factor own publications: NA Median impact factor own field: NA

List of publications


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Statements by the applicant X� My thesis manuscript has been approved, and I will send the official declaration to NWO

(Compulsory for Veni applicants who have not yet received their doctorates, to be sent by post or as PDF using the electronic system.)

Ethical aspects If applicable, please describe which measures have been or will be taken concerning ethical aspects of your research. Possible relevant issues are: - informed consent - privacy and data protection - research involving developing countries If applicable, you need to send a copy of (one of) the following documents to NWO when your application has been granted and before your project can start.

- Approval from a recognised medical ethics review committee applicable x not applicable

- Approval from animal experiments committee applicable x not applicable

- Permission for research within the Population Screening Act applicable x not applicable

Please indicate for each approval necessary whether the approval has been received, applied for or not yet applied for. I endorse the code of conduct for use of laboratory animals and will act accordingly:

YES x NO not applicable I endorse the code of conduct for biosecurity/possibility for dual use of the expected results and will act accordingly:

YES x NO not applicable X I have completed this form truthfully Name:Dr. Ashok Kumar Biswas Place:Leiden Date: 01.04.2015

There is a possibility to submit a list of non-referees (maximum of three (group) names) to NWO. This is optional for every applicant. The non-referees will NOT be asked to assess your application as referees. Please send the list with yourapplication in a separate PDF-file. Please submit the application to NWO in electronic form (PDF format is required!) using the Iris system, which can be accessed via the NWO website (iris.nwo.nl). The only exception to this rule concerns applications in the Medical Sciences. The Medical Sciences Division uses a similar system called ProjectNet, to which access is provided via the division’s website (www.zonmw.nl). For any technical questions regarding submission, please contact the Iris helpdesk ([email protected]) or the ProjectNet helpdesk ([email protected]).