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BIOLOGICAL CONSIDERATIONS

Ageing involves a progression or certain biological changes characteristic of the species which occur with time, if the individual lives long enough. The main theme of ageing is one of declining ability or natu颅ral body defence mechanisms and decreas颅ing capacity to withstand the stress of life鈥檚 journey. Stress may be defined as any factor or process which adversely effects the inter颅nal 鈥榟omeostasis鈥�, the physiological balance and equilibrium so characteristic of health, physical as well as psychic. The end-point of such immunological degradation is death. In other words, the internal bodily envi颅ronment declines till it becomes incompat颅ible with life and its physiology.

Though senescence and biological decay are inevitable processes, yet there are many other factors which influence the life-颅pattern of the aged. Hence the need for a study of ageing and the aged. In fact, the process of ageing and the problems of the aged, are attracting currently greater re颅search importance in all developed coun颅tries.

POPULATION STUDIES

For purposes of easy classification, all individuals over 65 years are termed 鈥榚lderly鈥� and those over 80 years are termed 鈥榚lderly-elderly鈥� or 鈥榲ery elderly鈥�. This may be value in the context of longer life expect颅ancy in developed countries. For Indian standards, we may consider 60 and 75 years as 鈥榚lderly鈥� and 鈥榚lderly-elderly鈥�. The most rapidly growing segment of American and European population today is the 鈥榚lderly鈥�. However, detailed studies have clearly es颅tablished that the life-span of a species is genetically pre-determined. Man is no ex颅ception. For a few decades in the twentieth century life expectancy kept parallel with scientific advances in medical care and pub颅lic health but soon it ground to a halt, despite further breath-taking scientific advances like open-heart surgery, organ transplantation, antibiotics etc. In fact, life expectancy never crossed nor is likely to cross 75 or 80 years. A few may live longer but only very few, All the scientific achievements can only improve the quality of life but cannot increase the life span beyond a certain limit, Divinely or颅dained as it is.

Life expectancy in the United King颅dom has increased during the period 1901 to 1975, so that in 1975 persons over 65 years form about 13% of the total population and about a third of this group constitute the 鈥榚lderly-elderly鈥�. In all communities, women out-live men. In the United States of America the ratio of elderly men to elderly women is as 100 to 180. In Andhra Pradesh the per颅centage of persons over 60 years has in颅creased from 6.33% to 6.66% of the total population during the period 1971 to 1981. Persons over 75 years constitute only 0.9% of the total population. In absolute terms, per颅haps, we may roughly take that there are over 28 to 30 lakhs of people over sixty years and above, of whom those over 75 years constitute about four to five lakhs. What applies to Andhra Pradesh may be equally applicable for the other states to some ex颅tent.

GENERAL WELL-BEING OF THE AGED

Religious and spiritual considera颅tions apart, individual 鈥榚go鈥� plays the great颅est role in the attainment of one鈥檚 life 颅satisfaction and contentment, if not, a sense of achievement. While this is true for all age groups, it is more so with the aged. The sense of well-being in the elderly depends mostly upon physical and financial independence. Nothing seems to demoralise the elderly more devastatingly than to be reduced to dependency for physical existence and fi颅nancial sustenance.

CERTAIN ATTITUDES OF THE ELD颅ERLY

The elderly often present peculiar attitudes which must be taken into due consideration in formulating any scheme for their welfare.

i. Individual Health: The health status of elderly is the most important factor contrib颅uting to the well-being of the individual. The elderly in good health tend to function more adequately than unselected group of corresponding age. Functional age does not always coincide with or run parallel to the chronological age. Senility and senescence are not synonymous. The problems of health and disease of the elderly are quite different from those of the younger age groups. There is an all-round deterioration of body immu颅nological defences and hence poor response to therapy leading to chronicity.

The elderly are not often enthusias颅tic or cooperating patients. This is true even for elderly medical doctors. They seek medi颅cal aid late and do not take the treatment seriously. It is not unusual to find a lot of unused and time-expired drugs in their cup颅boards. Therefore the clinical approach should be persuasive and the objective should be not so much the cure or control of the disease as the preservation of their most prized possession, viz. physical and financial independence. Preservation and restoration of their personal dignity should be the first consideration. It was the late President, John Kennedy who said, 鈥淚t is not enough for a great nation to have added years to life. Our objective must be to add new life to those years.鈥� Medical profession cannot do this in isolation.

ii. Social Disengagement: In the present day turmoil of life, society has little time for the elderly. But there is also a concept that the isolation of the elderly in current life scheme is really a two-way process. While the society does not go out of the way to welcome the elderly, the elderly, in their turn, do not exhibit any particular enthusi颅asm to interact with the society. This is a phenomenon known as 鈥榮ocial disengagment鈥� - approximating to our own Indian concept of 鈥榲补颈谤补驳测补鈥�. The elderly are content to with颅draw and reduce their social involvement and even actively resist any such opportu颅nity that comes in their way. This social disengagement is considered to be an intrinisic process of ageing and what is more, it often gives them some personal satisfac颅tion. Disengagement is natural and often ben颅eficial. In many cases quality compensates for quantity. The person gets more deeply involved in his chosen field of activity.

Again temporary disengagement is often a way of coping with some specific life situation as bereavement. So it is in all age groups but more so in the elderly. Hence the social worker who desires to help the aged, should study first the individual鈥檚 receptiv颅ity rather than rush with a pre-determined programme.

INDIVIDUAL REAC鈥橳IONS AND ATTI颅TUDES OF LIFE CRISES

Life-satisfaction is essentially a matter of adjusting onself to periodical de颅mands made by changes and events in life and living over which one may not have any control. Given optimum health, one is better placed to cope with a given crisis and make peace both within and without. Age does not change the basic personality. But strangely enough, all the accumulated wisdom and experience of the elderly are more often serviceable in solving other鈥檚 problems rather than their own.

i. Retirement: There is a concept which is quite valid, that retirement from active ser颅vice or employment, augurates the process of ageing. From a social point of view, retirement happens to be a major socio-economic challenge to the elderly. It involves a sudden and clean-cut termination of a life pattern to which one is used to for years to the point of a routine. This affects radically one鈥檚 social, economic and even domestic stability. Be it remembered that it is often only the head of the family (perhaps the only earning mem颅ber in the family) that retires, and the do颅mestic and monetary demands on him re颅main the same. It is even likely that added responsibilities may descend on him with retirement. This is particularly true of the upper middle class. To give an example, the free perquisite of a driver-driven motor car disappears and the boss himself has now to drive his vehicle to meet the demands of his wife鈥檚 shopping expeditions and children鈥檚 school-going. Perhaps he may be forced by circumstances, to sell his car and commute by public transport.

In a lighter vein, a cardiologist once opined that the high incidence of heart-颅attacks in early post-retirement years is due, more often than not, to the nagging of his spouse. It is remarkable that even in the more advanced communities, very few plan in advance for the day of their retirement and the days after. There is absolutely no element of surprise in the event. It seldom comes as an unexpected catastrophe. There is ample time to plan. A survey conducted in U.S.A. shows that hardly 13% of the subjects have made reasonable plans for their post颅retirement life and of them 30% planned only for their financial self-sufficiency. But the problem of retirement is not limited to finance. It involves many a far-reaching challenge-rescheduling of time, personal life, activities, social and domestic readjustments, etc.

It will be a wise venture if some social organisation initiates a programme for educating, guiding and conditioning the to-be-retired in the immediate pre-retirement months, so that they can respond to the challenge with confidence and wisdom and come out in a better shape. Considerations like the desirability of graded but time-bound retirement procedures may be considered by the employers in deserving cases. It is better to fade out than black out!

Perhaps, we Indians are better placed because of our ancient tradition and philosophy. Our culture presupposes an age for retirement as much as an age for worldly pleasures. Poet Kalidasa in his 鈥楻aghuvamsa鈥� defined this concept in clear terms;

鈥淪aisavebhyastha vidyanaam,
Yavvane visha yaishinam,
Vaardhate munivritteenaam,
Yogenanthe thanuh thyajaam.鈥�

Childhood is for learning; youth is for fruits of worldly life; old age is for renunciation and finally for salvation. But how many of us are blessed with this philosophy of life?

ii. Bereavement: Death spares no one. If there is one supreme example of an unfail颅ing democratic force, it is death. Though it may visit anyone and at any age, yet it has the most devastating effect on the elderly in its onslaught. Loss of spouse constitutes a most irreparable catastrophe. It is wisely said that one should not lose his mother in childhood and the spouse in old age. Simi颅larly loss of a child, grand-child or even a dose friend can shock the elderly as nothing else can. It needs great strength of character, fortitude, and philosophical detachment to get over the shock. Bereavement as a 鈥榩shycho颅somatic鈥� disease with its own mortality and morbidity is now well recognised and there is a growing literature in this rather morbid subject. Bereavement, like physical pain, displays thresholds of tolerance varying from individual to individual. While some totally collapse, others stoically face the ca颅tastrophe. A study in 1984 in the United Kingdom shows that only 55% of the victims of bereavement feel that they are able to manage alone and do not need the help of others. The rest need the support of their close friends, family members or social and religious workers. Here is a field for social workers interested in this rather depressing problem of the elderly. Perhaps, the best qualified are those who themselves had been victims of bereavement.

SOCIAL MILIEU

Problems of the elderly are not the same all over the world but develop aspects peculiar to the prevailing social milieu. In the developed countries, the social concept of joint family and moral obligation of the chil颅dren to take care of their infirm parents and grand-parents has already faded out and what little survives is limited to symbolic artifices as sending greeting cards for X-mas and flowers for birth days. Values and pri颅orities have changed and gone are the days when an aged person was thought to be family asset.

Are we better placed? Probably so, with that section of our population, not yet exposed to urban sophistication, living in either virgin villages or urban slums. The prevailing economic poverty wipes out the difference between the child, youth and the aged. Everyone is a daily-wage earner in his own way. And when the ravages of time and stress tell on the elders, the children are not found wanting in their devotion to look after these tired souls. They take it as their moral responsibility to do so. The vicious impact of film-world and T.V. media has not completely dehumanised these sons and daughters of the soil.

Unfortunately the attitudes and values have changed and are changing rap颅idly in the so-called enlightened, civilised urban population, be it at the middle class or higher-up levels. It is not without reason. The jet-speed tempo of life, stresses and strains in professional life, the sky-rocket颅ing cost of living, the wide-spread and far-颅flung location of children from their families due to exigencies of employment are some of the factors to make it difficult for the chil颅dren to adequately respond to the needs of their elders. We are marching fast, willingly or unwillingly, to approximate to the sorry dehumanised situation obtaining in the western world. The future looks bleak. If the children would not look after their parents, who else will? The answer is not there for the mere asking.

To quote from a popular fortnightly Journal (India Today, 30th. Sept. 1991), 鈥淚ntense loneliness makes matters even worse (for the aged parents). Many old people living alone will open the door just to hear a human voice. Old age then is becoming a bitter saga. A retired Major General of Delhi is completely disillusioned with his family. 鈥楨very time I go out, I pray for a bus to run over me.鈥� No wonder that a large percentage of the aged suffer from depression. Again the same journal observes, 鈥淭he elderly may be at fault at times, they are autocratic, un颅bending and demanding. But they do keep the family together.鈥� Again, 鈥渓ike planets, the old and the young move in their own orbits without touching one another.鈥� Indeed, this is a sorry state of affairs but perhaps, inevitable.

Though the report detailed by the Journal is based upon careful sociological survey of a large section of our population, yet one would like to believe that it is rather a biased one. The parental neglect is not so universal and one does meet a number of welcome instances to the contrary. A cynic may doubt whether the economic status of the elderly is not an important factor in determining the attitude of the youngsters in the line. A wise propertied elder invari颅ably keeps his will a zealously guarded se颅cret to the last.

鈥淔or many, old age may have become a wait for death, a long winter of neglect, but for others it is a second summer of renewal, the age to see life more clearly, the time to slough off cares and responsibilities. And death is not so final an event, atleast for those who believe in reincarnation.鈥�

RISK FACTORS

Several 鈥榬isk factors鈥� are enumer颅ated in literature that upsets the welfare of the aged;

i.                     Living
ii.                   Widowed within the last two years,
iii.                  In-hospital treatment in the last one year,
iv.                 House-bound,
v.                   Registered blind and
vi.                 Major physical disability including deafness.

Obviously every one is inevitably prone to one or more of these 鈥榬isk factors鈥�. It is only the chosen few that can sublimate the, misery of solitude into the bliss of 鈥榶ogic meditation鈥� and beatitude.

CARE OF THE AGED AND THE ROLE OF VOLUNTARY ORGANISATIONS

We are fast marching towards the situation when the care of the attention of the society and the government, if not on moral grounds, atleast on the strength of sheer numbers. The public and the private sectors have to work in close cooperation, if anything reasonable is to be achieved.

Now one must clearly distinguish two distinct categories of the aged in as much as the needs of the one are quite different from those of the other. The first category consists of the destitute, disabled, unwanted and uncared for. The second cat颅egory consists of the comparatively healthy, economically self-sufficient, but yet frus颅trated and depressed craving for human love and companionship.

The needs of the destitute call for massive and sustained charity from both the Government and social organisations. Old Age Homes have to be founded and liberally maintained. It is not an easy matter. A note of caution may now be sounded. I have my颅self visited a number of Geriatric wards in England which are, more or less, Old Age Homes. I, for one, would never care to go into them. The prevailing condition of these geri颅atric wards cannot be better described than in the memorable words of the immortal poet, John Keats (who, incidentally, died too young to have experienced to rigours of old age);

鈥淗ere where men sit and hear each other groan,
Where palsy shakes a few, sad, last grey hairs,
Where youth grows pale and spectre thin and dies,
Where but to think is to be full of sorrow.鈥�

Real devotion, limitless zeal and absolute faith in the Divinity of human soul can sustain such institutions and nothing else can. Only highly motivated Mahatmas and Mothers can rise to such great heights of selfless service. There can be no excuse if half-hearted efforts in this direction should create conditions which render euthanesia more acceptable.

The needs of the second category, those comparatively healthy and economi颅cally sound, are mainly 鈥渟ociety, friendship and love Divinely bestowed on man鈥� but denied to them by fellow men. 鈥淩emote, unfriended, melancholy, slow鈥� they go about aimlessly. To provide for such groups is not a major problem. Special clubs, meeting places with facilities for games, library, canteen, comfortable resting lounges and similar facilities can all be organised on a cooperative basis. The members would gladly contribute liberally for their maintenance. Group leaders must identify like-minded men and women and bring them together. A happy and friendly atmosphere should be encouraged.

Old men and women should never be looked upon as unwanted, unproductive and a burden on the society. On the other hand, here is a huge reservoir of mature experi颅ence, wisdom and example only to be prop颅erly tapped for the benefit of their fellow beings. Persons interested in teaching can engage themselves in special coaching programmes for ward students and improve their performance in their schools. Medical doctors can run free out-patient poly-clinics for the poor. Engineers can help the poorer families in planning and constructing residential houses for them.

Hitherto, they have been getting something out of their professions and now the time has come when they should give something to their professions; free and willing service to the needy. There can be nothing more noble than service to their fellow men. It is only thus one can give life to years and experience the joy and ageing.