Old age, ageing, elderly care…

don’t wait for old age to prepare for old age. Better start to plan early 

By Dr R Neerunjun Gopee

Thanks to the understanding brought about by the specialty of Public Health such as the importance of hygiene and sanitation, and of the availability of potable water and clean air, as well as the prevention of the killer infectious diseases (typhoid, TB, gastroenteritis in children, etc.) by means of vaccines and the advances in medical science and treatment, the average human lifespan has been extended throughout the world where these measures and facilities are available. People, in other words, are living longer. And a majority of countries are now faced with a growing proportion of elderly people, many of them empty-nesters as children move out to live on their own as nuclear families. Coping with old age has now become a public health problem, especially in industrialized countries.

As a senior citizen myself, besides having an existential concern, my interest is both professional and social, as in the course of my occupation as a medical and health professional I have elderly patients to deal with. But I also come across much published material on this issue, and the associated ones of well-being and happiness. In fact, in recent years there has been an explosion of writing on these subjects, often repetitious and clearly with a commercial focus, and a proliferation of books has accompanied this growing and rather sudden interest.

From the medical angle, we have long been aware about the phenomenon of ageing. It is common knowledge too that ageing is accompanied by a diminution of physical abilities such as hearing and seeing, weakness, slowness in walking and so on. As an article put it, ‘as people move towards old age, they lose things they treasure – vitality, mental sharpness and looks.’ Needless to say, the attempt to correct these has resulted in lucrative businesses of supplements for old age and cosmetic surgery to improve looks (but what changes internally??) – all aggressively marketed, involving great cost to the consumer and of doubtful benefit in the long run.

What is more important is that there are known and identified medical problems of ageing, such as arthritis which results in pain, and difficulty in walking if the lower limbs are affected, mental conditions some of which can be more serious such as extreme forms of impairment of memory (dementia, Alzheimer’s), and diminishing function of vital organs such as the heart, the kidneys, the digestive system. Much is already being done in terms of treatment and rehabilitation of many of these conditions, and there is ongoing research about the known issues to gain new understanding that may lead to better treatment options and thus improve the quality of life.

The good news is that most of these conditions are preventable: barring inherited abnormalities or unavoidable incidents (such as accidents), neither physical nor mental decline is inevitable as one advances in age. Solid evidence derived from an increasing number of valid scientific and medical studies indicate that a combination of by now very familiar lifestyle factors can allow anyone to reach old age in a pretty good state of health, what is called healthy ageing. They are: attention to diet, regular exercise – which has benefits across the board, on all the organs of the body – avoidance of tobacco and refraining from alcohol abuse. Obviously, an early start is likely to give us a significant advantage, although it is also documented that reversal of some damaging changes (for example, in arteries of the heart or in tissues of the lungs) with improvement in one’s general state of health can occur if one takes the necessary corrective steps later in life, such as starting exercise or stopping smoking.

But why wait? Isn’t it better to prevent than to treat? Prevention is eminently possible and cheaper than treatment which is, besides, very costly nowadays. Imagine how much healthier the world’s population would be if more people followed the simple maxim ‘prevention is better than cure,’ and more prosperous too because of the savings on health costs that would be the natural consequence of this state of better health all around.

However, does ‘successful ageing’ – a term that has become fashionable – equate to only physical good health and mental alertness? No – for they are necessary but not sufficient conditions. Because we are social animals, and we like company, and again studies have demonstrated that old people who have strong family support and stable friendships do better than others who don’t have them. Unless one deliberately chose to live like a recluse, what good would it be to be physically and mentally healthy and yet be lonely, bereft of family or friends, or have no other social interactions or similar occupations which alone give at least some meaning to life? This is captured in WHO’s definition of health: ‘Health is not merely the absence of disease, but a complete state of physical, mental and social wellbeing.’

But there is more than just successful ageing: as one ages, one must also gain in maturity, develop greater understanding of people and their behaviour, have less tendency to be impulsive and choleric, be able to cope better with adversity, learn to be forgiving, be willing to extend help when and where possible and have an overall balanced approach to life with selflessness predominating over selfishness.

In other words, become wiser, and this is what adds grace to one’s life and personality. This is graceful ageing, and the wisdom dimension that brings with it serenity, which in turn allows one to discover the happiness within. The elements of wisdom include: rational decision making based on general knowledge of life; prosocial behaviours involving empathy, compassion, and altruism; emotional stability; insight or self-reflection; decisiveness in the face of uncertainty; and tolerance of divergent value systems.

Nurturing these elements would allow one to truly mellow gracefully into old age, and like a ripe fruit which is loved and relished, so too those who have achieved such a state receive respect and affection in equal measure.

Unfortunately, increasingly nowadays in our own country, many empty-nesters find themselves living alone and in isolation, and not all are in the best state of health. For such people, assisted living in homes for the elderly becomes a necessity, or at least availability of and access to carers trained to look after this age group. Both of these are costly, and any planning for our old age must make allowance for this contingency. Governments can only go so far, through legislation to regulate the minimum standards of infrastructure and of professional care required, as well as providing oversight.

At the end of the day, perhaps the take-home message is: don’t wait for old age to prepare for old age. Better start to plan early.

Mauritius Times ePaper Friday 22 March 2024