I appreciate your endeavour as Chairperson of FOGSI Geriatric Gynaecological Committee for preparing and editing such a useful handbook for FOGSI Practitioners.

Galaxy of expert leaders of FOGSI deserve congratulations for writing fifteen chapters on geriatric gynaecological problems. I hope these chapters have been written in context of Indian senior citizen women.

A chapter on preventive aspects could be useful though I believe in all chapters, preventive aspects have been included. In this context I like to present before FOGSI Practitioners my non HRT Care of Menopausal Indian women. I could prove by clinical research that heart attack and osteoporotic fractures are less common (Asian Woman's Immunity) in Indian postmenopausal women, rural ones in particular. This is due to Indian aged women's life style of daily meditation (prayer or puja) preventing heart attack, taking vegetarian food including soyabean (having phytoestrogen) and two glasses of milk or milk products (in place of tab. Calcium). Moreover they walk daily and do domestic work to keep their muscles strong to prevent fractures. Thus there is no need of long-term HRT for Indian postmenopausal women (DAWN, 2003).

I wish all the members of FOGSI a happy New Year.

Investment in the Health Care is the way to ensure that more women will reach old age in good health and will be in a position to contribute to society, physically, socially and intellectually.

Geriatric people require special health care which has lead to development of geriatric medicine which is in its initial phases. Geriatric medicine is defined as the branch of medicine that concerns itself with aging process; the prevention, diagnosis, and treatment of health care problems in the aged and the social and economic conditions that affect the health care of the elderly. Unique features of illness in geriatric women are chronicity and heterogenicity of the disease, its greater severity and slower recovery. Hence, the focus is on diagnosis and management of the disease rather than its cure. Functional impairment may be so severe that it limits the ability to live alone and dependency prevails. If severe impairment occurs, cure becomes less likely and under these circumstances rehabilitation becomes the main issue. The older people responsed differently to stress whether it is physical, emotional or socio-economic in nature. The Nation is gradually getting equipped to take care of growing geriatric population. It is a big dilemma for policy makers to plan for catering to the health needs of a big geriatric strata of the society. In our country, out of 168 medical colleges, only one at Chennai has a geriatric department with postgraduate course in geriatrics. Medical Council of India has now recognised geriatric medicine as a speciality and there are plans to include it in undergraduate curriculum. Geriatric clinics and departments are being started by the medical colleges and associated hospitals.

WHO is committed to improve the knowledge and skill of primary health workers through training activities to deal with age-related problems. Indian Medical Association plans to start CME programmes for all its members to upgrade their knowledge of geriatric medicine, so that they can take better care of elderly people. Geriatric population is being provided health care by the doctors posted at primary health centers and district hospitals. There are approximately 28000 primary health centers and 580 district hospitals, spread all over the country. Unfortunately, doctors rendering health care have no special training in geriatric medicine. Medical research in the field of geriatrics is lacking in our country.12

Aging of population has become an important issue that requires urgent attention. It is crucial to create awareness among policy and decision makers about the pace of aging population and associated public health consequences. The time has come to wake up and make joint efforts at National level in collaboration with various NGOs, IMA, WHO, UNO and others for formulating plans to cater to the needs of the increasing geriatric population. The issue of training doctors, nurses and paramedical staff should be given top priority. Postgraduate courses in geriatric medicine should also be started.

There is urgent need to develop concept of geriatric day care centers and geriatric homes. This is specially important in view of disintegration of joint family system which is being replaced by nuclear families.

Indian literature does not reveal much published work on geriatric problems. This book is being written to initiate and enhance awareness among health care providers in the management of common problems among geriatric women. The book contains 15 chapters contributed by eminent teachers and skilled professionals. The topics have been selected carefully. Physiology of aging and its effect on different systems and presentation of disease in old age have been highlighted. Nutrition in elderly has been discussed. Diet plays an important role in slowing aging process, while malnutrition can predispose to infections by its adverse effect on the immunity. Prescribing in elderly is important due to variability in physiological response to drugs. Gynaecological disorders in elderly women have been highlighted. Salient features in the management of osteoporosis, and changing trends in prescribing HRT have been brought to light. Alzheimer's disease and recent developments in its management have been discussed. Management of common urinary, cardiovascular and breast problems in geriatric women have been reviewed. Last but not the least the salient features in the care of critically ill women and legal issues in the elderly have been discussed.

There was a time when Medical Students had to read only books published abroad. There were no medical books written by Indian authors and published in India. A lot of water has flowed down the rivers since those days. Today there are books written by Indian authors, published in India, on almost all subjects. Moreover these books are affordable and easily available to our Students and Practitioners.

FOGSI has taken a lead in publication. We have several books, many of which are into second and third editions. Monographs are available on many subjects enabling our students to research into special problems and diseases.

This is one such monograph which will be very useful to practicing gynaecologists. With the “graying” of our population, we will have a large population of elderly women to look after. Their special needs will have to be addressed. They need to be given a better “quality of life”.

I congratulate the editors and all the authors for bringing out this beautiful publication. I am sure their efforts will be appreciated by all readers.