Care and Respect for the Elderly: Health Aspect

Due to development in public health and medicine in the recent past, there is an increase in human life expectancy resulting in a significant increase in the elderly population. Dr Zubair Saleem, noted Geriatrician and Gerontologist and the pioneer of advancement of geriatrics in Kashmir highlights the importance of overall health of elderly people in an interview with GK Health Desk
Aged people sitting at dinning table inside an Old Age Home in Jammu on 13 September 2018. [image for representational purpose only]
Aged people sitting at dinning table inside an Old Age Home in Jammu on 13 September 2018. [image for representational purpose only]File: Haseeb Ibn Hameed for Greater Kashmir

What is Geriatrics and Gerontology?

Elderly people are very special and have special needs and requirements for their overall wellbeing. A branch of medicine that focuses on the unique needs of the ageing population is called as Geriatric Medicine or Geriatrics.

Just as the way pediatricians specialize in the health needs of children, geriatricians specialize in the health needs of elderly.

As far as Gerontology is concerned, it is the study of the process of ageing that includes the study of physical, mental, and social changes in humans as they age.

You said ageing, what is it all about?

Ageing is a continuous and gradual natural process of becoming older. With the passage of time there is a gradual decline in normal body functions until death.

Different people age differently and there are several undesired changes that are considered normal and are unavoidable.

For example, eyes can’t focus well on near objects, hair becomes grey or muscles become weaker.Experts divide the ageing process in older people in 5 stages.

Stage 1: Independence, this is an early stage of the ageing process and most of the elderly people will experience some decline in mental and physical ability, however, not enough to have an impact on their life.

Stage 2: Interdependence: Here the elderly people will do their daily chores with more difficulty and a significant decline in mental and physical activity is observed and they begin to forget things. In this stage they require assistance for doing certain things.

Stage 3: Dependency: here age-related changes become more noticeable, and elderly people experience difficulty in doing many things. The quality of life gets affected and the person becomes dependent on the caregiver for most of the things. A caregiver/son/daughter may have to manage the medication and monitor the health status of their parents.

Stage 4 & 5: are Crisis Management and End of Life: in these stages elderly people are required to be monitored round the clock and should have access to hospital.

What is the relation between ageing and illness?

It is essential to differentiate between the process of ageing and the course of illness. Process of ageing is a normal phenomenon, while as, the course of illness is not. There needs to be awareness about the normal inevitable ageing process among masses. And here comes the role of Geriatric Medicine.

It not only provides awareness about the normal changes during ageing but also helps elderly in living a better life by decelerating and delaying the ageing process by giving age specific treatment. The peaceful and least dependent life is important for ageing gracefully.

Ageing is a risk factor for various illnesses and keeping in view the decline in physiological functioning of various organ systems in elderly, the drug-drug interactions and drug dosage has to be used and monitored carefully among them and Exclusive Geriatric Treatment Protocol (EGTP) takes care of it.

What is an Exclusive Geriatric Treatment Protocol?

From diabetes, high blood pressure, urinary, thyroid, gastrointestinal, neurological to orthopaedic diseases, the EGTP includes a holistic treatment approach for treating all medical diseases in elderly patients. Besides, it also includes health promotion, preventive services, diagnosis and management of geriatric medical problems.

EGTP involves both non-pharmacological and pharmacological interventions in treating elderly patients. Non-pharmacological intervention includes life-style modification, age specific dietary advice and physical activities whereas pharmacological intervention includes medicines that need to have very less unwanted effects on kidneys, liver and other organ systems. Polypharmacy is a big challenge in elderly and EGTP tends to minimise it.

Can you elaborate on Polypharmacy?

Well, polypharmacy is simultaneous and daily use of many medicines and is common in elderly people as they have multiple medical conditions treated by multiple subspecialist doctors. Polypharmacy increases the risk of drug-drug interaction and adverse effects of medicines.

Nowadays we see diminishing values and respect towards elderly. What is your take on that?

I agree to this completely. We are witnessing the negative attitudes, beliefs, and behaviours toward the elderly in our society .When young people feel that the elderly people are no longer capable of doing things and discriminate with them on the basis of their age, it is called ageism. We cannot fight ageing, it is inevitable and normal.

However, we can fight ageism. In order to combat ageism we should treat our elders with the respect that we will want when we attain their age. It is high time to prevent mental trauma in our elders (parents). We need to deal with them with patience, love, care and compassion, the same way they dealt with us when we were children. elder abuse is on rise and that is the grim reality.

When it is abuse, we usually think of child or women abuse. How do we explain elder abuse?

Well, elder abuse is a term referring to any knowing, intentional, or negligent act by a caregiver or any other person that causes mental harm or a serious risk of harm to an older vulnerable adult. Saying a word of contempt or just raising your voice to your parents amounts to elder abuse. The failure by the children to provide food, shelter, health care, protection, mental peace to their parents is elder abuse. The major types of elder abuse are,

Emotional Abuse: Inflicting mental pain, anguish, or distress on an elder person or parent through verbal or nonverbal acts

Physical Abuse: Inflicting, or threatening to inflict, physical pain or injury on elderly or parent, or depriving them of basic needs like medication, proper food etc

Exploitation: Misuse, or concealment of funds, property, or assets of an elderly person or parent

Neglect: Refusal or failure by children or caregivers to provide food, shelter, health care or protection for a parent or elderly

Abandonment: The desertion of aged parents by their children.

I believe that elder abuse is an existing grim reality that pervades our homes and an issue we should not shy away from talking about or acknowledging that it exists. Over the past few years HelpAge India conducted many surveys to understand the extent of elder abuse by getting the perspective, understanding and experiences of elderly. Shockingly, in 2014, half of India’s elderly (50%) surveyed reported experiencing abuse from which 77% lived with their families indicating that elder abuse is a family issue

How do you see elder abuse in Kashmir?

I have an elderly widow patient whose husband had died after the 2014 floods. She has two sons and a daughter. She marries her two sons. They influenced her emotionally and took her thumb impression on a stamp paper.

She told me that how could have she doubted the intentions of her own blood? One fine day she realises that her sons have sold the house, distributed the money among themselves, and built their separate houses.

She along with her unmarried daughter could not get some space in their houses and they are now putting up in a rented room and are surviving on the alms given to them. She has multiple health problems.

These cases of suffering of elderly parents are not uncommon in Kashmir and as a practising geriatrician, I encounter such stories frequently and this is just a tip of the iceberg.

An elderly widower, one of my patients, had gone outside Kashmir to spend winter at his daughter’s place.

On his return he finds that his sons have somehow managed to procure his fake death certificate, forged the signatures of their sisters and had sold the whole property.

This is shocking. Who are mostly the perpetrators of this abuse in Kashmir?

This is a tough question. I have been treating elderly patients for eleven years now. Not all but a significant number of elderly patients are victims of elder abuse here. In one way or the other it affects both marginalised and privileged elderly parents of any background or social status and can affect both men and women.

A study that I did at JLNM Hospital and Ahata Waqar, Chanapora in 2019 included 2377 elderly patients. Besides studying about their various physical and mental conditions, I studied about if they are victims of elder abuse.

Though many of the respondents did not divulge much details about behaviour of their children with them, however, among the studied elderly patients around 45% said that they were not been taken care of their emotional and health needs by their children.

You will be astonished to know that more than 50% of elderly experienced disrespect and emotional abuse, whilst 33% experienced neglect. Coming to your question, the main perpetrators or abusers were sons (around 55%), daughter-in-laws 25% and daughters and spouses around 15%.

How big is the problem of elder abuse in Kashmir?

Elder abuse is like a fast spreading malignant cancer that erodes our elderly parents of their dignity, self respect and security. As in Kashmir elder abuse is primarily a family issue and keeping in view the reputation of the family, most of the cases remain under- reported or unreported. elder abuse imparts many emotional and physical effects on an elderly parent who look fearful and anxious.

They may be depressed, have loss of appetite and have insomnia. The agony and mental stress given by their own blood accelerates their process of ageing and predisposes them to various debilitating chronic diseases. Their existing health issues may worsen because of emotional trauma inflicted by their near ones.

Unfortunately, in Kashmir elderly people often get abused by the ones who actually should be their caregiver and protector. Not caring for your parents is neglecting them. I have observed that both elderly men and women are at risk of abuse, though the majority of victims are mothers over the age of 70 years.

Most common cause of elder abuse in Kashmir is psychological abuse by neglecting and abandoning our parents and by not talking to them properly. Emotional abuse can cause psychosocial consequences such as mental stress, feeling of worthlessness, embarrassment, depression, shame, self-neglect and social isolation.

Financial abuse is also common in Kashmir among the elderly parents who are financially dependent on their children. These parents are made to feel that they are a burden on their children.

They don’t enjoy any kind of financial freedom and are at risk of cognitive impairment and dementia. I have also witnessed that single elderly persons are easily targeted for financial frauds and stealing by their caretakers.

Physical abuse in the form of force-feeding, hitting, pushing, kicking, etc, is not uncommon but remains unreported.

Why is elder abuse an Invisible Problem?

This is like other forms of interpersonal abuse. This abuse also occurs behind closed doors. Many parents are reluctant to report abuse because they feel ashamed and embarrassed, particularly if their son is an abuser. Even at the cost of being abused, some parents don’t want their children to be recognised as disobedient and abusers.

In some cases I have also seen that parents are afraid of being victimised if they reveal that they are being abused. They feel insecure that the abuse may get worse and they may be abandoned.

Some elderly parents are also in the state of denial or are unaware that what they are experiencing is actually elder abuse or mistreatment.

Some elderly patients are even unable to speak because of dementia or other mental impairments, or may not be believed when they do.

How can we prevent this menace?

Caretakers of elderly, who are in most cases their children, should be kind and give respect to their parents. I request each one of you that all religions teach us to be respectful to our parents.

Make your parents feel important. Talk kindly with them. Don't isolate them. Give time to them. Your words of love and kindness towards them are more important than anything else for them.

What is the status of geriatric care in Kashmir hospitals?Recently, under the patronage of Dr. Mushtaq A Rather, Director Health Services Kashmir, Geriatric, Pain and Palliative Care Centres were established in all district hospitals of Kashmir. Elderly people can avail treatment in these centres.

In Srinagar, elderly people can avail this facility at SKIMS, JLNM Hospital and Ahata Waqar (Govt day care centre for senior citizens) Chanapora.

What is your take on Jan Ashudi medicines?

I always recommend patients to buy their medicines from Jan Ashudi drug stores at affordable prices. We have a record number of 8566 elderly patients being treated at JLNM Hospital and Ahata Waqar, a government daycare centre for senior citizens who exclusively buy their medicines from the Jan Ashudi drug stores since April, 2019. The efficacy of these medicines is at par with the medicines available in markets under popular brand names. These medicines are very cost effective and efficient as well.

What is World Elder Abuse Awareness Day?

The World Elder Abuse Awareness Day (WEAAD), designated as 15 June, was initiated by the International Network for the Prevention of Elder Abuse (INPEA) in 2006, and recognized as a United Nations Day by the General Assembly in its resolution adopted in 2011.

Theme for 2022 is Combating Elder Abuse: What’s next? Five priorities for the Decade. I would like to add here that Dr. Mustaq A Rather, Director Health Services Kashmir has directed all the hospitals of DHSK to observe this day in order to sensitise the younger generations about the importance of elderly people in our homes and in our society.

What is your takeaway message?

I do realise that some people do experience several challenges while taking care of their ailing parents. Sometimes, because of aging, some parents also tend to act unexpectedly. However, on the face of earth, nothing can justify being unfair to your parents.

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