Care of the elderly

Opinion

By Dr R Neerunjun Gopee

According to the WHO website, the International Day of Older Persons, commemorated on 1 October each year, is meant ‘to raise public awareness about the opportunities and challenges with ageing populations and to mobilize the families, community groups and stakeholders to address the difficulties faced by older people.’

This year’s theme is ‘Ageing with Dignity: The Importance of Strengthening Care and Support Systems for Older Persons Worldwide’ and ‘encourages governments, policy makers and social services across the world for a concerted and sustained action to address the physical, social, psychological and health needs of older persons. The commemoration also underscores the importance of promoting healthy living conditions for elderly that respect the dignity, beliefs, needs, and privacy of older persons, and for the right to make decisions about their care and quality of their lives.’

Improvements in public health and medical care along with individual practice of a healthier lifestyle mean that people are living longer. Thus, the proportion of the elderly population keeps increasing, and brings with it the concerns raised above relating to them. How these are addressed in different countries varies according to their historical, social and cultural contexts, but what is certain is the need for robust support systems that involve the family, the community and the state.

Broadly speaking, we can identify a few settings where we find the elderly.

For a start, what we could call self-care, namely those who are physically and mentally fit, living alone or as a couple either by choice or by the force of circumstances, such as – this being increasingly the case – children being abroad, or living separately sometimes not too far away if they are lucky. Many prefer their own accommodation – it could be the house they have always lived in for sentimental and practical reasons, or an apartment to which they have shifted to reduce the burden of domestic chores such as cleaning or maintaining a yard. They have sufficient means and are able to look after themselves.

An example is the case of a 94-year-old lady who recently passed. She lived alone in her own house; her two children who lived a few km away took turns to be with her during the day and had arranged for a carer at night. Another lady in the south whom I was delighted to meet several years ago was a centenarian whose only child, a son, had passed away some years prior in an unfortunate work accident. She was hale and hearty, didn’t even use specs, and there was a kindly soul who stopped by every Saturday to whom she would give money to do her shopping.

There are many more such lovely people I have been privileged to know, but I will come to the next category of those who have medical conditions that are stable and controlled by regular attention to them. They have a minimum of ailments that don’t interfere with their normal functioning, also in their own accommodation with sufficient means, with access to home help as required. They too have a similar family context, but as in the first category they also have their own peer group in a limited social circle which is mutually supportive and engage in common activities.

The key to this kind of living is to have discipline, regular habits, and consume everything in moderation.

Then there are those who need institutional care, either for health or social reasons. This means staying in homes for the elderly or in retirement facilities where these exist. I am familiar with one such facility where a relative of mine had put up. She had been a consultant pathologist in London, worked a few more years after retirement, then shifted to another town where her son was consultant paediatrician. She rented a single room studio in a retirement complex a short distance from her son’s home. She had house help, but did her own cooking, and on days when she didn’t feel like doing so, she would notify the management and have her meal in the common dining room. In addition to participating in the regular gatherings held in a common room, she also entertained her son and his family, and her friends in her studio. Some years later, health problems made her shift to a home for the elderly, where I chanced to visit her a few months before she left us.

Homes for the elderly are, for good or bad, part of contemporary social reality in the developing and developed world. Wherever they exist, even in the most advanced countries, in a significant percentage of them there are complaints about the quality of care, often because of a lack of qualified personnel. Just a few days ago I read about a case in the US where the family of an elderly lady who had died from an infected pressure sore was awarded a substantial compensation by a court because the home didn’t follow the proper protocol of changing her position in bed at regular intervals.

I believe that the Prime Minister of Singapore Lee Kuan Yew had put his foot down as regards such homes, on the grounds that this was not part of our Asian culture. Instead, he insisted that families should take care of their elderly at home, where their presence benefited children and grandchildren. And to this end, he gave a special tax incentive to the families. Perhaps Mauritius, where the Singapore model is often quoted, should give some thought to this idea.

On the other hand, the electoral promise of the nascent opposition alliance that, if they come to power, the pension of the widows and the allowance of the handicapped would not be suppressed when they start receiving their old age pension is a salutary and long overdue move.

On another note, the measure announced to pay for the medicine bills in private clinics is a very risky one that has serious logistical, financial, economic and national health expenditure implications that it doesn’t appear have been sufficiently thought through. The possibility of what is known as ‘therapeutic overkill’ – excessive and unnecessary treatments especially in end-of-life situations with unwarranted prolongation of stays, over and above the ‘diagnostic overkill’ that is already rampant — is a genuine matter for debate and discussion, along with all other aspects, before going any further.

Healthcare costs are spiralling all over the world for many reasons that we cannot go into here, and do not necessarily result in better outcomes, so there is a lot to reflect on in advance. Such a proposal may be financially manageable in a short term, but is not sustainable in the long term, entrapping as it will future generations in a burden of intolerable debt.

A better approach is to consider incentivizing people to pursue healthier lifestyles and establish a state driven scheme for monitoring using the existing Primary Health Care network of Health Centres and Mediclinics. This raises the possibility of generating employment for a dedicated cadre for this purpose, which is a more positive fallout, but also has the potential of reducing the need for more and more medications.

As the saying goes, making haste slowly is definitely well-advised here.

Mauritius Times ePaper Friday 4 October 2024