The United Nations Population Fund's recently-released report: 'State of World Population 2007' alerts governments of developing countries to the increasing number of old people living in urban areas and stresses the need to facilitate the provision of health and other social services for them.
According to the Confederation of Indian Organizations for Service and Advocacy, Chennai, while only 19 million people in India were over the age of 60 in 1947, the figure has now expanded to nearly 80 million - a stunning increase of 285 per cent.
Professor V.S. Natarajan, retired Head of the Department of Geriatrics, Madras Medical College and General Hospital (GH) and the man who set up the country's only geriatric ward, at the GH, attributes the burgeoning number of aged people to the rising life expectancy - a consequence of the general awareness of health issues and the easy availability of medical facilities.
However, there is a pressing need for institutions that can provide specialized geriatric care. Geriatrics is a multi-disciplinary field. A number of conditions, such as vision loss, Alzheimer's and Parkinson's diseases, occur commonly among the elderly and can't be tackled in isolation. A comprehensive treatment plan thus has to be developed. In such situations, specialist geriatricians are invaluable. Propelled by a staggering increase in the geriatric population in Tamil Nadu, currently stated to be 36,00,000, the Central government, state machinery and voluntary organizations have proposed to set up a National Institute of Ageing to provide specialized geriatric-related care under one roof. Under review by the Planning Commission, the proposal for the institute was presented to the Ministry of Health and Family Welfare in 2005 by Professor Natarajan and Dr B Krishnaswamy, Head of the Department of Geriatrics, GH. The doctors assure that if the project is sanctioned, they would go all out to set up the institute - in Chennai and Delhi (a different group would set it up in Delhi)- within a year.
Sweta (name changed) has welcomed the move to set up a single multi-disciplinary hospital. She accompanies her 70-year-old grandmother, who suffers from a heart condition, to various hospitals for tests and feels that elderly people are unable to cope with the rigors of medical treatment - undergoing three to four tests a day can tire them out. Also, the costs of an ambulance (to take them to various hospitals) are substantial, and not all can afford the expense. The United Nations Population Fund (UNFPA) 2007 report states that while in theory urban areas could provide a greater number of facilities for the aged, such as better health facilities, home-nursing and community-based forums, old people actually require economic security and strong social support systems to benefit from such facilities. According to organizations such as HelpAge India and Agewell Foundation, nearly 90 per cent of the elderly have no form of official social security and over 40 per cent live below the poverty line.
Says Prof Natarajan, "The break-down of the joint family has compounded the problem. Today, we have the old facing insecurity, dependency and poverty. While a section gets meager pensions, the majority is unable to support itself, leave alone afford good medical care. They are also affected by deep loneliness and emotional insecurity. The consequent dependence on neighbors, unwilling relatives and ill-equipped old-age homes makes their condition pathetic."
Till a few years back, Dhanam (72), a poor widow, had no one to take care of her in her old age. Circumstances forced her daughter and grandchildren to abandon her on the streets. With no one to turn to, she took refuge in an old-age home in Ayanavaram, Chennai, run by ARUWE, a non-profit, social welfare organization. Dhanam feels she is better of at the home, as she "at least gets three meals and a place to sleep".
Clearly, the elderly are among the most vulnerable in society. Therefore, it is absolutely necessary to ensure that there are specific schemes to help alleviate their situation. And Chennai has taken the lead in providing the best of care and facilities for the elderly. Besides day hospitals, old-age homes and the lone specialized geriatric ward in GH, the elderly in the city also have organizations such as the Dignity Foundation, and individuals like Professor Natarajan and Savitri Vaithi, rooting for their cause.
As the chairman of Chennai's Senior Citizens Bureau, Professor Natarajan helps tackle the health, economic, sociological and psychological problems of the aged. The bureau runs a clinic for geriatric medicine and has treated over 200 people in the past year alone. Besides, it also conducts free counseling sessions.
Seventy-six-year-old Savitri Vaithi is committed to taking care of the elderly. She set up her first old-age home, a free one, in 1978, and now lives in one - Vishranthi, a refuge for elderly and destitute women. This home is unique as it not only gives shelter, food and medical care but also encourages the occupants to participate in income-generating activities, such as catering, thus doing wonders to their self-worth. Admission to the home involves an in-depth interview of the prospective resident and family members in addition to a complete and thorough medical check-up. Vaithi says Chennai is unique, as it has 132 old-age homes.
Dignity Foundation's Chennai chapter also chips in to make the lives of senior citizens of the city just a bit easier by conducting a number of recreational activities and other programmes. In addition, it operates a helpline, which provides support to senior citizens subjected to elder abuse. Once it gets a distress call, the foundation sends a volunteer to assess the situation and counsel the perpetrators of the abuse. At times, professional legal advice as well as police assistance is sought. Throwing light on the foundation's future plans, Rosy Thomas, a social worker with the foundation, says, "We are shortly going to start a dementia day-care centre for elders suffering from dementia and Alzheimer's disease, as it is difficult for care-givers to take care of them round-the-clock. Patients can be dropped off in the morning at this centre and picked up in the evening."
With the 'State of World Population 2007' report stating that urban centers will be the preferred locations for setting up facilities for the aged, it appears that Chennai is set to become a model for geriatric care in the country.