There is something very enticing about the edentulous smile of old people. It is childlike. Whenever I spoke to Lakshmi, her smile and incessant speech would be captivating. She was a breast cancer survivor, and had lived courageously braving the troubles of a major surgery, chemotherapy, periodic scans and innumerable doctor visits for eight years.
When I first met her in the clinic a year ago, she had back pain which turned out to be the recurrence of breast cancer with spread to the spine. She went through a major spine surgery and recovered well. But the mandatory post-surgical radiotherapy to the spine resulted in a wound breakdown. She was in her eighth decade now and the coexistent diabetes and cardiac issues were serious challenges to heal her wound. But she never missed sporting her smile whenever I met her.
Finally, she was discharged after a month-long stay. Like a ghost movie, when we thought that she had successively come out of our hell, she returned to the hospital six months later, with a clot in her lungs. Now she had lost her smile. The long periods of hospitalisation, multiple tubes likely to be inserted into her, battery of investigations and prospects of another surgery loomed large on her. I was pretty sure that with intensive care and high-end medications, we can prolong her survival but she had lost her will.
The life expectancy of an average human being was around 40 in the early 20th century. Due to dramatic improvements in modern medicine and public health initiatives, the life expectancy has soared to 75 now across the globe (the global population aged 60 and above in 1980 has doubled by 2017). In particular, vaccines to reduce the incidence of communicable diseases, early diagnosis and treatment of non-communicable diseases, effective surgical treatment and handling of complex injuries have made humans live longer than their ancestors. Though many lifestyle diseases such as diabetes, hypertension and heart diseases are affecting people earlier than before, a barrage of medications are available to keep these diseases under control. Many take these medications for 20 to 30 years decreasing the risks of early death. Modern cancer chemotherapy, precision surgery and focused radiotherapy have made survival of cancer patients much longer than before. All these have delayed death, but at the risk of disability. Elderly people living with colostomy bags, indwelling urinary catheters, dialysis thrice a week, tracheostomy tubes, multiple surgeries, oxygen cylinders and respiratory supporters have become relatively common, especially in developed societies. This poses philosophical questions of prolonging disability due to ageing.
As we age, the incidence of neural diseases such as Alzheimer’s and Parkinson’s diseases, and musculo-skeletal diseases such as osteoporosis, sarcopenia and arthritis are natural accompaniments, making the mobility of elderly people difficult and painful. In developed societies where an adequate social healthcare system is in place, the lives of elderly are reasonably well supported. Social discussion groups, home care nurses, delivery of essential goods and recreation centres help them tide over the disability with reasonable comfort. All governmental and private places are equipped with ramps, easy access to toilets, elevators and comfortable parking places, helping the elderly continue to have a better life.
Little support
However, in developing countries such as India, the increasing life expectancy among the elderly seems to be a bane for many. The disintegrated joint family system and lack of governmental societal support are a double whammy on the plight of elderly. With many children working abroad or having odd working hours, the old people are left to fend for themselves with their disabilities. Many of them find it difficult to tread along our pothole-ridden roads even to access basic groceries. They are dependent on online delivery agents and good Samaritan neighbours and auto-drivers. The problems are further magnified by the psychological effects of “empty-nest syndrome” adding to the physical impairments.
Unlike other animals and plants whose life expectancy has remained the same for millions of years, humans have tricked nature and prolonged their life, albeit with a bad baggage. Modern science is evolving in leaps and bounds every day, finding treatments for many diseases and postponing the inevitable. I am not arguing that science should not evolve and diseases should not be treated. But there should be simultaneous changes in the way how we move into old age and how we are supporting the elderly. Similar to retirement financial plans, physical fitness to reduce future musculo-skeletal disability should be focussed on, at least from mid-life. Sedentary lifestyle, job stress and obesity are fodder for disability in old age. Physical infrastructure of offices, buildings and entertainment zones, and societal system should be improved drastically to engage the senior citizens comfortably instead of caging them indoors.
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