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Alone at the end

By Dinesh M. Varma

The Hindu Times, May 12, 2002

THE 62-YEAR-OLD woman who was rushed to the Medical College with intra-cerebral bleeding had three `home nurses' but no relatives at her bedside. The following day, her U.K.-settled daughter managed a two-day leave to fly down, and was told about the dim prospects of her mother's survival.

The daughter returned to Britain the very next day after telling the doctors about her inability to stay back any longer. Probably to assuage her guilt, she assigned two more `home nurses' for her mother, who was subsequently shifted to a private hospital where she died within a month.

For scores of elderly men and women, life, and often death, happen in isolation, away from their near and dear.

The twilight years of the elderly are turning to be traumatic — ridden with a sense of neglect and loneliness. And, in an era of nuclear families and working couples, increasing numbers of the aged are desperately reaching out for surrogate support systems.

NGO activists say the elderly often become victims of insult, neglect and sometimes even physical assault at home. "We receive queries almost every day about old age homes from old people, including many from those who have severe adjustment problems with their children," says Aliamma Thampy of HelpAge India.

Instances are legion of parents who, having bequeathed their property to their children, find themselves literally on the streets. "We tell parents lavishing love on their children to spare enough for themselves as well," says Radhakrishna Menon, president of the Senior Citizen's Association.

Among the worst-hit are those below the poverty line. Even the lowly old age pension seldom reaches beneficiaries on a regular basis. In Thiruvananthapuram, with a substantial fisherfolk population, over a thousand old persons are now solely dependent on HelpAge India's "Adopt-A-Gran" community-based scheme of providing essentials to the weaker segments.

"Whether it is physical disability or old age, women are the worst sufferers whose security concerns and needs for support are unique", says Vimala Menon, secretary, Cheshire Homes.

Meanwhile, old age homes, once thought of solely as a refuge of the destitute, are increasingly becoming the dwelling of even the well-to-do. Many of these homes have run up wait-lists as they come under pressure for accommodation.

The State already has the highest number of old age homes (over 200) in the country. Activists say old age homes are fast becoming the first, instead of the last resort.

And, reflecting the changing times, in many households where couples leave for work the chronically ill are being managed by `home nurses'. The Indian Red Cross Society, for instance, has assigned more than 20,000 nurses to take care of "laid-up" patients. The largest concentration of the "home nurses" is in the State's central districts which have a large expatriate population.

"From a medical perspective, the lack of specialised geriatric management has reached crisis levels," says Jothy Dev of the Thiruvananthapuram Medical College and member of a WHO expert committee on geriatric medicine.

The atypical presentation of a typical illness can mislead clinicians into adopting wrong treatment modes. For instance, a fracture sustained in a fall is routinely referred to orthopaedics though the fall itself could have a neurological basis. However, awareness on geriatric protocols is lacking among physicians and missing from the medical curriculum, he adds.

According to estimates, the elderly constitute between 10 and 11 per cent of Kerala's population and their numbers are ever increasing. It is also projected that by the year 2025, one in every five persons would be a senior citizen.

Experts feel the Government should urgently draw up economic and social security mechanisms for the elderly. Though several proposals have been mooted since 1997, the State is yet to frame a comprehensive policy that would address the varying needs of different segments of the elderly.