During my fellowship at the Seoul National University Bundang Hospital, I was amazed at the involvement of the health professionals with the geriatric population. The Seoul National University Bundang Hospital consists of eight centres, including the Geriatric Medicine Centre. There is a department on geriatric medicine equipped with the highest level of Korean medical technology available, achieving the function of a national medical centre for the elderly.
Geriatric healthcare is unique in the sense that it creates the perfect digital medical treatment system available to the attending physicians on smartphones and tablets as opposed to the traditional paper chart treatment. The necessity for such a state-of-the-art geriatric centre arose with the realization that South Korea is experiencing a rapid rise in the number of elderly people and that portion of the population now represents 10.7 percent of the Korean nation. In South Korea, as in other countries, geriatric care is not a profitable venture. To bridge the gap in treatment of the elderly, Seoul National University’s Bundang Hospital established an innovative national medical centre for the elderly.
It is a commonly-held view that an extended family support system is enough to cater to the needs of the elderly in Pakistan
The Japan Geriatrics Society has proposed that the definition of the elderly be extended to individuals aged 75 or older on the rationale that they are comparatively mentally and physically in a better health than those in the same age bracket a decade earlier. The number of Japanese aged 90 or older is currently 2.06 million. The underlying cause is attributable to vastly improved geriatric health care.
Health care delivery in Pakistan is not oriented towards rehabilitation of the elderly population. The absence of rehabilitation facilities for individuals aged more than 65 years is perceived to be adequately met by the extended family system in Pakistan where family members traditionally act as care givers to elderly.
On account of present-day financial constraints and the shift towards nuclear family arrangements, this is becoming increasingly difficult. Moreover, caregivers are not trained to rehabilitate the elderly, further complicating their plight. The care is confined to giving company to the elderly, accompanied trips to washrooms and an occasional medical check-up. In some families the patriarchs, despite controlling the purse strings, are in misery as they remain deprived of an extended quality of life in their later years and adopt compensatory mechanisms whenever any ailment afflicts them and complain that the new generation has no reverence left.
Government agencies and philanthropic organisations providing rehabilitative services to elderly populations to enhance their quality of life are almost non-existent
The World Health Organization (WHO) defines active ageing as the “process of optimizing opportunities for health, participation and security in order to enhance quality of life as people age”.
The census of 1998 reports a 28 percent disability rate of people above the age of 60. Disability was defined as being in a crippled state, such as deafness, blindness and mental retardation. In Pakistan, the total number of persons above 60 years is expected to increase from 7.3 million in 1998 to 26.84 million in 2025 and this phenomenon is termed as “graying of nations.”
According to a United Nations projection, the proportion of population 60 years and above in Pakistan will increase to 12.4 percent of the total population by 2050. The offspring have abandoned their frail and ageing parents for better employment or business prospects abroad, leaving their parents at the mercy of domestic help or a sibling. Migration requires tremendous adjustments to a new lifestyle, which is emotionally trying for elders. Nowadays, in Pakistan, the diverse yet legitimate expectations of the elderly promote social isolation and disengagement from the mainstream community. Individuals aged 60 years and above are stereotyped to be inactive in comparison to the active life they led prior to crossing the magical line of 60.
Government agencies and philanthropic organisations providing rehabilitative services to elderly populations to enhance their quality of life are almost non-existent. The current scenario calls for those likely to soon join the elderly to themselves establish a curative and rehabilitative healthcare system in a holistic manner to cater to their future needs through cost-effective and innovative methods of healthcare delivery. This can be done while they are still the decision makers.
Making financial plans such as pension benefits and insurance will not by itself provide them a sustainable health profile. The elderly are affected by health challenges and the spectrum extends from urinary incontinence, dyspnea, fatigue, visual impairment, hypertension and diabetes and arthritis being chronic ailments. Falls are a widely-feared issue for the elderly. Recognizing the fact that healthcare for the ageing population requires specialized training, two private hospitals in Karachi and in Islamabad have initiated nursing courses geared to train students in geriatric care. Short courses in geriatrics do not figure in the curriculum of universities.
Geriatric care involves as a primary aim conservation of function and improving quality of life rather than treating and curing certain diseases. Sensorial limitation attributing to impairment of hearing results in social isolation of the elderly.
One school of thought is that infirmities in old age are the result of a sedentary life, eating habits, lack of regular exercise and exposure to smoking. According to the data of Pakistan Medical Association and National Health Survey 2011, nearly 200,000 individuals die each year from coronary heart disease and annual incidence of strokes are nearly 350,000 for which timely intervention and a multi-disciplinary approach for rehabilitative services should be made available as the severity of disease increases with age.
Rehabilitative services for the elderly are restricted to physiotherapists in general hospitals. Speech therapy for the elderly catering to their communication disorders and hearing impairment is almost non-existent. Geriatrics is not practiced as a specialty in Pakistan yet each one of us is next in line for geriatric care.
