The human population is greying, and with it concerns about the aged have been growing. Even as birth rates fall steeply, improved healthcare systems have contributed to unprecedented longevity levels. The challenges of taking care of the elderly now increasingly face developing nations.
In India, the proportion of the elderly has risen from 5.63 per cent in 1961 to 8.3 per cent in 2012. Figures cannot be generalised across States. The proportionate number of the elderly in Kerala is 13 per cent and 10.8 per cent in Tamil Nadu, against 4 per cent in less progressive States.
In a developing nation like India, with the majority of its population aged 30 or less, the focus of national policy is perforce directed to the basic developmental needs and welfare of children, adolescents and young adults. The problems and issues of its greying population occupy the back-seat.
VulnerabilitiesThe elderly constitute a vulnerable section. Frailty and fatigue create physical limitations and social withdrawal. Common locomotor, visual, hearing and psychomotor deficits may compound problems. Depression may set in. Many expect greater attention from children. However, with drastic changes family dynamics brought about by modernisation, the younger family member is unable to provide day-to-day support and care to them. For the young, holding a job effectively and moving up, involves competitive work demands, extra hours and a stressful lifestyle. This in turn tells on peace and harmony at home. Many older people find living with adult children to be more difficult than living alone. There are others who do not have a choice. Under these circumstances, we must face the inevitability of the nuclear family system gaining ground and the elderly moving into old age homes.
The general unpreparedness to face this situation compounds the task. India needs a comprehensive, replicable, sustainable and need-based elder care model.
The developed world has evolved many models for elder care — sheltered homes, home care, and hospital admission for acute health problems, continuing the recovery/rehabilitation phase in hospitals, followed by home care with specialised nursing if required. By following this protocol, elder care is effectively managed in their own home surroundings, and institutional care, which is tedious and expensive, is deferred.
In most western countries, advanced stages of development preceded population ageing, but the same is not true for many developing and middle-income countries, including India. India is going through a demographic paradox where it has to capitalise on the window of opportunity by investing on youth and at the same time focus on an increasing elderly population.
Governments in India have made efforts to tackle the problem of elders’ economic insecurity by launching schemes such as the National Policy on Older Persons, the National Old Age Pension Programme and the Annapurna Programme. Keeping in view the recommendations made in the National Policy on Older Persons, as well as the state’s obligation under the Maintenance and Welfare of Parents and Senior Citizens Act 2007, the Ministry of Health and Family Welfare has formulated a National Programme for the Health Care of Elderly. NPHCE envisages dedicated healthcare facilities at all levels of the health delivery system with provision for long-term and short-term training of health professionals to address problems of the elderly. In the first phase, NPHCE is proposed to be implemented in 21 States with eight medical institutions. It will take time to build up before the impact of this ambitious project of elder care reaches us.
Geriatric health care services with qualified professionals are sparse in India and are mostly city-based. Currently, elder care is part of the general health care system which is poorly sensitised to the health needs of elderly. The undergraduate medical curriculum does not cover all aspects of geriatric care. And, post-graduate geriatric care courses are deficient. The only teaching institution in India to introduce a geriatric unit was Madras Medical College, as early as in 1978. It now offers a post-graduate degree in Geriatric Medicine.
Homes for eldersThe last decade has witnessed the mushrooming of old-age homes to meet the demand, to suit every purse.
What would be the ideal senior-citizen home offer? Comfortable living accommodation meeting basic amenities, enough open spaces with tree-lined paths and a garden, common recreation and dining rooms for senior citizens to meet, a balanced diet, activities with inmate-community participation — from cutting vegetables to gardening to fondling pet dogs, prayer meetings, library and some intellectual activity, space to meet relatives who visit and spend time with them, a medical dispensary with the doctor, a nurse on full-time duty, and perhaps a shop-cum-restaurant.
How do the elderly view these institutionalised settings? Do they feel depressed and sad? Do they compromise with the situation or are they happy and free to live life with their peer group?
The concept of old-age homes is one that is still viewed with misgivings in Indian society. Unlike the current generation of elderly who form a transitional one, the inevitability of the old age home phenomenon will possibly result in a change of mindset in the elderly, with a move towards a natural shift of acceptance from “what cannot be cured, must be endured” to reach the next level of being enjoyed in the twilight years as a liberated state.
(Professor Srinivas is a distinguished neurologist.
Dr. Subbulakshmy and
Dr. Sailakshmi are associated with the Institute of Neurological Sciences, Voluntary Health Services, at Taramani in Chennai. srinivas@neurokrish.com)
