Elderly Friendliness of Hospitals in the Ernakulam District of Kerala, India: A Cross-Sectional Study

Background: An aging population is a major demographic transition with significant implications for healthcare systems, particularly in low- and middle-income countries. Ensuring age-friendly healthcare services is essential to meet the complex needs of the elderly population. Objective: The objective of this study was to assess the elderly friendliness of government and private hospitals in Ernakulam district, Kerala, India. Methods: A cross-sectional study was conducted among 70 hospitals (34 government and 36 private) with inpatient facilities in Ernakulam district. A structured checklist was used to assess six domains: accessibility, medical care services, physical environment, inpatient services, admission and billing, and spiritual environment. Data were collected through interviews with administrative personnel and direct observation and analyzed using descriptive and inferential statistical methods. Results: The mean elderly friendliness score was 27.36 ± 4.78. Overall, 31 (44.3%) hospitals were classified as elderly friendly. Among these, a higher proportion were private hospitals (52.8%) compared with government hospitals (35.3%). The physical environment domain showed the highest performance, whereas accessibility performed the poorest. Private hospitals scored significantly higher in admission and billing (p=0.002) and spiritual environment (p=0.001). Government hospitals showed higher scores in medical care services, but the difference was not statistically significant (p=0.057). No significant difference was observed in overall elderly-friendliness scores between the two sectors (p=0.369). Conclusion: Less than half of the hospitals in the study were elderly friendly, with major gaps in accessibility infrastructure, geriatric care services, and safety features such as grab rails in toilets. Strengthening hospital accessibility, improving geriatric training among healthcare personnel, and implementing standardized age-friendly policies are required to improve elderly healthcare services.