Winter blossoms

Visa Ravindran

"An old man loved is winter with flowers" says a German proverb. Rare and wonderful, its rarity lying in numerous socio-economic causes recognised and unrecognised, its wonder to be attained through understanding. Care of the elderly, as a complete science, is yet to emerge in our country. Rapidly rising numbers of the 60-plus age group in demographic surveys, the increasing complexity of life, pressure on family and social relations, the mental problems that adjusting to change brings with it and all the other obvious limitations in finance, mobility and health often add to functional disability and not only require support systems on a planned basis but rethinking on the whole subject of ageing.

Since illness poses a deep threat to the well-being and independence of the elderly the resources required and public policy framing and personal education for adjustment to change depend largely on health assessments of the ageing. Sociologists view health in three major ways: as being free from disease, the strength to resist illness or the capacity to function in everyday life. While the first two are ideals to work towards, quite often, in later years it is the third objective that is often aimed at and if achieved, can lead towards the others. Standardised Assessment Scales for Elderly People, the Royal College of Physicians and the British Geriatric Society identify suitable domains for assessment of elderly people: Activities of daily living (ADL) - maintaining basic self-care, mobility, instrumental activities of ADL i.e. being a functioning member of society and coping with domestic tasks; Mental health functioning - cognitive, presence of psychiatric symptoms; Psycho-social functioning - emotional well-being in a social and cultural context; Physical health functioning - self-perceived health status, physical symptoms and diagnosed conditions, health service utilisation, activity levels and measures of incapacity; social resources - accessibility of family, friends and a familiar/professional voluntary helper; availability of these resources where needed; Economic resources - income as compared to an external standard; Environmental resources - adequate and affordable housing, siting of housing in relation to transport, shopping and public services. (From "Health in Old Age - Myth, Mystery and Management" by Moyra Sidell.) These scales provide the broad parameters of assessment of the elderly and with suitable adjustments to Indian conditions, can identify the directions that public and personal provision for old age ought to take.

Rethinking ageing involves moving away from the myths about it - medical, cultural and sociological. The doctor who washes his hands off a problem saying a particular condition is due to old age and therefore one should grin and bear it, the young and middle-aged who tend to see the elderly as different from and "other' than themselves, and the elderly themselves who refuse to deal with problems because they are too old to cope are all guilty of succumbing to popular myths which condition them to grouping all old people in the same slot and deal with them in the same unimaginative way. The elderly belong to a heterogenous group different in health, ability, socio-economic and cultural background and obviously their different needs must be met in varying ways.

Geriatric care as a useful science should be part of the medical curriculum and also an element in the training of paramedics and nurses aides and students of social work. Retirement homes that welcome inmates with imaginative provision for their emotional and social well-being, day care centres where those living alone or those living with family but are alone and lonely during working hours can meet other people (not necessarily old), discussion groups, craft classes, information on alternate methods of healing, yoga and meditation therapy, stress management courses are some of the ways in which social interaction can be developed along with coping skills.

For the healthier, more energetic elders training and placement in second careers, organisational work in voluntary agencies working in areas of interest to them or areas in which their previous work and training have given them expertise or special knowledge can be ways in which they can spend their time and remain useful to society. While the destitute need government and philanthropic institutions to lay out all the finances and organise shelter, food and income for them the other groups can be guided to help themselves with some supplementary aid or concessions from the state. This would not only reduce pressure on limited resources but also benefit the elderly by making them proud of being able to tackle their problems themselves and with dignity. Those who are fit can be encouraged to travel in groups and trained personnel could take care of arrangements. Even those older members of society who do not live in institutions or communities of old people (formed by themselves) would be thankful if running around for investment and banking purposes, mechanical repairs, sometimes even nutritious food (imagine a couple living by themselves and both falling ill at the same time) could be minimised if dependable services were available and could be reached on the telephone.

An article on financial planning for retirement (Jagdish Gulrajani, Economic Times July 5, '98) paints a grim picture of the erosion of actual value of savings and computes the enormous amounts of extra capital that would have to be invested for a person surviving 15 to 25 years after retirement to be able to sustain present scales of spending. This is an area where expert advice is necessary from auditors, portfolio managers and HRD professionals for working executives to plan for the future while still employed.

Yet another area where future planning is required is in the cultivation of hobbies and the development of interests outside one's job. In these days of punishing workstyles this is easier said than done and often difficult to find time for even when the inclination is there, and so next to impossible for those who do not understand its importance. But one sees too many retired persons completely going to pieces because they have not cultivated alternative interests to occupy their spare time. A wide circle of like-minded friends, by creating a social group with similar inclinations and needs can fill the vacuum and keep one mentally stimulated - an absolute must if one is to avoid getting isolated. As Ogden Nash says, "Senescence begins/ And middle age ends/ The day your descendents/ Outnumber your friends."

Deepak Chopra, the New Age guru, gives a different shift to the perspective on old age. One has a fixed chronological age, he argues, but biological age in terms of critical life signs and cellular processes and psychological age which is how old you feel you are can be "reprogrammed," and as such the quantum world view that he presents in his "Ageless Body, Timeless Mind" is that we are not inevitable victims of sickness, old age and death. The body seems to age beyond our control only because we are collectively conditioned to believe so, he says and affirms confidently: "Because the mind influences every cell in the body, human ageing is fluid and changeable; it can speed up, slow down, stop for a time, and even reverse itself... Ageing is much more dependent on the individual than was dreamt of in the past." An idea that philosophy endorses, albeit in different terms, and holistic systems of medicine also draw on.

Adding years to life as they say, is meaningless if we cannot add life to our years. This issue discusses perceptions of old age, its sociology, the empty-nest syndrome, ageing and health, couples ageing together, ageing alone (without the spouse), shows how old age homes are places of exile to some and a welcome option to others and addresses questions such as whether the quality of life has improved for older people and whether creativity declines with age. If we are to celebrate longevity it must be accompanied by improvements in the quality of life and the development of efficient and imaginatively-designed support systems that turn the post retirement years into a period of rest, comparative security and contentment. Winters then would truly blossom into second summers.

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