Old Age

T Vijyayendra

Old age is a human phenomenon with all the complexity that entails one. In nature, that is, in plant and animal kingdom, there is no such comparable phenomenon. And contrary to popular understanding, among humans also it is relatively recent—starting roughly since mid 19th century when it became possible to control reproduction. The knowledge of controlling reproduction became popular in modern societies due to technology, which made the availability of these devices cheap and easy. Although the Catholic Church frowns upon it, it rapidly spread in the developed capitalist countries.

However, today old age is not healthy people naturally growing old. One may still see some such people, particularly those who used a bicycle all their life. Today by and large old people are from relatively affluent families. Majority of them are not in good health but are kept alive because of modern health care system. These old people and their families suffer a lot in terms of agonies, harassment of frequent hospitalisation and drain of money. The doctors have forgotten the wisdom of their seniors, like, 'Any medical intervention is advised only if it improves the quality of life'. Today, saving life at any cost is the mantra. It would be alright if the patients were young but in the case of senior citizens the mantra should be reducing suffering.

Historically, old people were cared for within the family. With the increase in their number and increase in wage employment, more and more old people are getting care through old age homes. The funding for this comes from the welfare state, charities and the pension of the old people themselves. However, these 'homes', of which there are not enough to take care of all the old people, suffer from many defects. To begin with, they are often inadequately furnished or maintained and lack adequate funds. Also, because old people are vulnerable, they are often exploited by the owners of these homes (or the individuals who run them) and the medical industrial complex.

 Today, the burden of the care of the elderly on the government is so big that it often exceeds the pay check of the working people. In Kerala, for instance, the pension of government employees is more than the current wages of the employees. As a result, today's governments desperately want to get out of it.

The fact is, care of old people is rapidly becoming an unsolvable problem, and only more so in the coming resource crunch due to peaking of non renewable resource and economic crisis.

In such a situation Palliative Care offers a viable solution. Although it has evolved mainly for terminal illnesses like cancer, it has been used for normal care for old people also.

 The state of Kerala has managed to develop an integrated health service delivery model with community participation in palliative care. Institute of Palliative Medicine, Trivandrum, has been playing a major role in shaping up this model. The evolving palliative care system in Kerala tries to address the problems of the incurably ill, bedridden and dying patients irrespective of the diagnosis, age or social class. The programme in Kerala is also expanding to areas like community psychiatry and social rehabilitation of the chronically ill. Palliative care has been declared by Government of Kerala as part of primary health care. Combined efforts by Civil Society Organisations, Local Self Government and Government of Kerala have resulted in the best coverage anywhere in Low and Middle Countries for palliative care. The 'Quality of Death' study by Economist Intelligence Unit (2010) states that "Amid the lamentably poor access to palliative care across India, the state of Kerala stands out as a beacon of hope. While India ranks at the bottom of the Index in overall score, and performs badly on many indicators, Kerala, if measured on the same points, would buck the trend. With only 3% of India's population, the tiny state provides two-thirds of India's palliative care services.

 Palliative care is a relatively basic and relatively cheap healthcare provision. It requires simple facilities and by most healthcare standards basic nursing and medical care. With the present economic crisis and resource crunch, expensive and irrational geriatric health care should come down and be replaced by palliative care wherever possible. It will enable old people live in comfort with reduced suffering and die peacefully at home with their family. And in the end it will reduce the carbon foot print of the old people and reduce the population to manageable.

Vol. 53, No. 33, Feb 14 - 20, 2021