Most of my patients don’t know their age and my usual way of calculating it is by adding twenty to the age of the eldest child. Recently I asked an elde rly patient her age and she said, “teesiyan saal ki toh hogi” ( must be around thirty), regarding her wrinkles and grey hair with mild irritation I asked her the age of her eldest child,” teesiyan saal ki toh hogi” she repeated nonchalantly . With some amusement, I asked her the age of her eldest grandchild and she gave me the same reply, “teesiyan saal ki hogi”. She did not see the absurdity of her statement and when I tried to explain why she, her child and her grand child could not be of the same age, she didn’t seem to understand why I was making such a fuss about it. Age is, as Mark Twain had remarked, an issue of mind over matter. If one doesn’t mind, it shouldn’t matter. Or should it ?
My dad, who turned eighty recently, was very impressed with the ideals of a political party, and logged on its website to join in. He was crushed to note that the age option ended at sixty years. Despite an increase in life span and better medical care ensuring a sound body and mind, well into the sunset years, society has done little to accommodate the elderly. This has brought them face to face with their biggest fear, of becoming irrelevant, when one’s advice is neither sought nor heeded.
The census of 2011 reveals that India has experienced a dramatic demographic transition in the past 50 years with tripling of the elderly population. This pattern is predicted to continue and by 2025 the proportion of Indians above 60 will rise from 7.5% to 11.1% which means 158.7 million people. Of the elderly population, a majority (70%) are women, two-thirds live in villages and nearly half are of poor socioeconomic status. Half of them are dependents and (2.4%) live alone. Here’s the sad part, surveys have found that one out of every six elderly persons living in urban India isn’t getting proper nutrition, every third does not have adequate health care, and half of them are abused.
An analysis of morbidity patterns indicate that the elderly fall sick more often than other age groups. The Indian elderly are more likely to suffer from chronic illness than acute. There is a rise in non communicable diseases, particularly cardiovascular, metabolic, and degenerative disorders, as well as communicable diseases. While cardiovascular disease is the leading cause of death, multiple chronic diseases afflict them like chronic bronchitis, anemia, high blood pressure, kidney problems, digestive disorders, visual disability, diabetes, rheumatism, and depression. Increasing disease and debility with advancing age is expected, yet Geriatrics, which deals with the health of the elderly is not a well developed science in India and there are few medical schools offering it as a specialty. What is more troubling is that the elderly population does not receive care commensurate to the conditions it suffers and even when care is accessible, costs are prohibitive.
No man loves life like him who is growing old. But it is not just any life he loves. He clings to the life which is a semblance of his youth. He wants to retain his autonomy, his freedom , to be the author of his life and keep what he has made of himself. As Dr Atul Gawande so beautifully reasons, ‘This is why the betrayals of body and mind that threaten to erase our character and memory remain among our most awful tortures. The battle of being mortal is the battle to maintain the integrity of one’s life—to avoid becoming so diminished or dissipated or subjugated that who you are becomes disconnected from who you were or who you want to be.’
And yet with urbanisation this is happening. A large number of people who have spent most of their lives in joint or extended families face the threat of loneliness and marginalisation in their advanced years. Abuse is rampant and Nagpur tops with a shameful 85 % of the aged interviewed reporting it. The abuse is not occasional but sustained with verbal abuse, disrespect and neglect emerging as the three most frequent types reported. In rural areas, with the joint family still in place the elderly command more respect but the situation is far from ideal. An elderly patient once remarked , ” Accha hai budhape mein behre ho jaate hain nahin to kya kya sun na padta.” (Its good that the old become deaf, it protects them from verbal abuse.) I have often observed that as they grow older, time contracts. So while a baby’s age is told with the accuracy of within a month ( paanch chhe mahine), it becomes ( das barah saal) to ( tees paintees saal) to ( saath sattar saal) by the time my patients reach old age. Ten whole years, squished together…… unaccounted and unlived, It seems that in youth the days are short and the years are long while in old age the years are short and days long.
The government has done precious little for the elderly. Apart from providing concessions on travel, increased interest rates and a measly monthly pension not much has been done to make their life easier. The Union Cabinet’s latest offering – Maintenance and Welfare of Parents and Senior Citizens Act, 2007, aims to help the elderly live with dignity. The Bill places legal responsibility on children to maintain their parents and on the state to create old age homes. But few in the last innings of life will seek legal recourse. Despite their helplessness, the elderly tend to philosophise, blaming their ill treatment on emotional and economic dependence. Most will not report abuse.
The question is should we rethink the norms of old age which was once considered a sign of status. Or should we treat it as redundant and pathological, a problem for policy makers and social workers? If we accept that old age is a problem for the state, then new institutions of support have to be built. In modern India, the family seems too ruthlessly indifferent, culture seems too distant and fragile to sustain the elderly. As children, we used to scoff at the western idea of abandoning parents in old age homes. Are we ready to accept that the western world had a better sense of the future than we did , that the idea of India, of all the pride in our culture is a farce. For a country where the aged are left to die or live in indifference can never claim greatness.
( published in Reading the Pulse , the Sunday Tribune on 13/12/15) Be