Millennium Post

Act while the Sun is bright

In the twilight of one’s life, it is no longer sufficient for joint families to be the only viable support structure and safety net

Those who are in the evening of their lives are often called old or respectfully, senior citizens by society and are often attributed to having some of the following:

Candles that cost more than the cake on their birthday; investments in insurance are paid off; they wish their easy chairs have more options than their car; their arms are too short to read a newspaper; their mind makes contracts which their body cannot keep; they cannot remember when they are absent-minded; the colour of their hair is grey unless they dyed it; they have less hair on the head than on the ears and nose or on other parts; they have wrinkles where smiles were present earlier; selective deafness to the spouse being replaced by actual deafness; they cannot distinguish between said spouse or a young pretty person at a distance; have a third leg in the shape of the walking stick; do not sleep with their teeth; they wet their pants like a four-year-old; they know everything but cannot remember it; they are stiff everywhere except where they want to, etc.

In such a period of life, the diseases one may suffer are high blood pressure, diabetes, hypothyroidism, degenerative disorders, autoimmune diseases, failing hearing, eyesight, painful stiff joints (arthritis), difficulty in breathing (COPD), cancer, dementia, and senility. In addition, the proneness to accident and resultant fractures and disabilities add to the discomfort. Earlier, most of these lifelong ailments were seen in the age group of 60 years. Now the ages at which they have become prevalent are lowered. Does this mean that the definition of old age has to be redefined? Would the duration of the evening of life expand?

Gadgets like fans and air-conditioners have eliminated normal sweating which is a process of elimination of unwanted products from the body. Ever-increasing dependence on automobiles for travel reduced walking and has affected fitness and mobility while also increasing exposure to pollutants. Disuse of human physical capability and misuse of comfort gadgets has affected the health of people.

While modern medicine has prolonged the life span of individuals and has cures for many diseases, it is yet to reduce the disabilities occurring in the evening of life. Thus, it makes living more frightful and painful at this stage. Modern health care has enabled more people to survive and to live to old age with disabilities, and diseases, for longer periods.

Modern medical care also made it possible for the world to control and limit families to one or two children. The first two born are selected. They may not be the fittest to survive but they are made to survive. Small family norms have changed the dependency ratios of young and old and there are less numbers of young now to support the increased number of aged.

The great scientific inventions in the last few decades, especially in the areas of transport and communications and IT, have greatly changed life styles of populations. Huge demand is created for white-collar jobs which promoted migration and emergence of nuclear families. It resulted in the breakage of joint families which was a safety net. It worsened the dependency ratios. Physical distances with kith and kin widened.

In a child, there are uniform growth and development markers like crawling, sitting, walking, speaking, and feeding, etc. All these are generally determined and marked to determine at which age generally all children would acquire these growth markers. In children, they are not deficiencies or disabilities but are part of growing up and learning. It is not so in the old age.

Different people acquire so-called disabilities or deficiencies at different ages in the evening of life. As there is no uniformity, there cannot be a uniform solution. It is highly individualistic. The needs may be physical assistance in routine chores, communication and companionship, assistance to manage property and allied things, home nursing, assistance in travel, entertainment, nursing of bedridden etc.

The senior citizens used to play a useful role in the joint family and community earlier. They were transferring the knowledge on many issues, settling differences, and were able to imbibe values amongst juniors. This was possible as most of the time the successors in the family were also adopting the same profession, artisan work, or avocation and were living in the same place. Currently, various members of the family practice different avocations and the seniors may not have any knowledge of the same to contribute.

The contribution of the seniors to the family structure is vague. They are not able to continue to earn anything with their physical labour and retire after reaching the age of superannuation. Only a minuscule percentage receive a pension. Few lucky professionals like lawyers, doctors, politicians and businessmen who are physically and mentally fit may continue to earn and be independent. All seniors are in search of a solution. They all require a new 'safety net' for their old age.

The rich weave alternate safety nets to take care of their health and physical existence with their wealth including getting remarried at late in age to address the problem of companionship and overcome loneliness. They can engage the services of others for their needs at huge costs, and overcome disabilities through advanced medical procedures if necessary. The poorer senior citizens, on the other hand, may be getting some subsidy from the governments for food.

However, seniors in the middle-income groups are far more numerous. Their aspirations are high. They have not yet found a solution and are still in search of a new safety net. They sulk by themselves, curse at their fate, muse at their helplessness and blame others for their current status. They spend their life savings or the contributions from their children abroad on medical procedures to give relief for a while. They spend their remaining period of life in and out from hospitals even for some incurable and irreversible ailments like final stages of cancer etc instead of seeking relief from pain in palliative care. They live with false hope.

It is time for them to get united and organise integrated, comprehensive services they require for assisted living through one window call centres. However, before they do anything, they must remember the famous and wise advice of Bernard Shaw in the book 'Doctor's Dilemma', 'Do not try to live forever. You will not succeed'.

Death is certain, accept it. Persons who cannot keep themselves alive by their own activities, cannot, beyond reason, expect to be kept alive forever by the activity of others. Let us use our health, even to the point of wearing it out totally. That is what it is for. Spend all energy that one has before they die as one cannot carry it with him or her. Let us not outlive ourselves. Let us be realistic. The period of joint family as a safety net is over. Let us join with peer groups and build safety nets for the evening of life. Better act while the Sun is still bright.

The writer was a doctor by profession and the chief architect of FDHS, 108, 104 Ambulances and Telemedicine Services. The copy was traced and edited by Vanam Jwala Narasimha Rao. Views expressed are personal

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