Raging through 2020 and continuing in the new year as well, the COVID-19 pandemic brought into sharp focus the state of health infrastructure in the country. The scramble for hospital beds across cities, oxygen scarcity and medicine shortage, the helplessness of patients suffering from other chronic or terminal illnesses highlighted the wide gaps in our public healthcare system.
But apart from that, another issue that came into sharp public focus, after years of neglect, is the plight of senior citizens in our urban settlements. Unable to step out of the house as they came under the vulnerable category, and often with their children living away, they faced serious problems accessing medical care, medicines and sometimes, even essentials.
The inadequacy of the system led many to take some tough decisions. Take the case of 86-year-old Nalini Karandikar, a Thane resident, who decided to move to Suhruday Geri Care, a facility in Pune district, offering palliative care to those who require assisted living.
“I had been operated on both my legs and needed medical attendants to take care of me. But during the COVID-19 induced lockdown, the housing society I stayed in with my daughter and her family, did not permit attendants to enter. The entire responsibility of looking after me fell on my daughter. Coupled with her other responsibilities and household chores, it would be too much for her, I felt, and therefore, I began suggesting old age homes where I could stay comfortably,” says Karandikar.
In June 2020, the octogenarian finally moved to Suhruday Geri Care in Chikhalgaon, Mulshi taluka in Pune district. Today, she feels completely at home there, following a routine which takes care of her medical and recreational needs.
What ails the elderly?
The decision to start Suhruday Geri Care by a doctor couple, Dr Vaidehi and Dr Sachin Nagarkar, stemmed from personal reasons, but addressed universal concerns about the availability of care for elderly family members.
“My mother-in-law was bed-ridden with Parkinson’s disease for three and a half years. My mother too underwent multiple surgeries and has been bed-ridden for 13 years. It was a little easier for us, we being doctors, to take care of our parents,” says Dr Vaidehi; “Yet, there are several people who need medical and other care in their advanced years, but cannot access it.”
The concerns she raises ring a bell with most people living in nuclear family setups, who lack the man-power resource required to ensure fast and continuous responses to the needs of these elders. “In such situations, it’s the children of the senior citizens who have to juggle their jobs, their parents’ healthcare needs, their children’s and their own personal lives. That’s the reason we started Suhruday Geri Care a little over two years ago,” said the doctor.
Longevity and loneliness go hand in hand and currently, about 8-9% of the total national population is above the age of 60, falling under the geriatric group. This number is likely to grow to about 12% or so in the next few years, observes Dr Sandeep P Tamane, consultant physician and geriatrician. He says, “As a result of advances in medical treatment, we are leading longer lives. But it doesn’t necessarily mean that we are leading healthy lives.” That is where the focus must lie.
We need to take note of the fact that the needs of one senior citizen might be different from another. In geriatrics, the elderly population is broadly divided into three groups, as Dr Sandeep explains.
The first group consists of ‘young old’ i.e those who are between the ages of 60-70 years. They are mostly healthy and often still engaged in some kind of work.
The second group is categorised ‘old’ which has people in the age group of 70-80 years. Some are healthy, but some need help or support within and outside their homes.
The third group is of ‘very old’ people, above the age group of 80. Most of them are immobile and dependent on others.
“Dividing geriatric patients into these three groups can give us a better idea of their requirements and the services they need to be provided with,” he adds.
A good life for seniors
Over the years, most senior citizens residing in urban areas have come to live independently. Their children may be working in other cities/countries or in some cases, the elders are just comfortable in their own space. In either case, certain precautionary measures need to be adopted by everybody.
Dr Sandeep, who is chairman of the Pune chapter of the Geriatric Society of India, suggests anti-skid tiles and good lighting as the first steps to make the home stay safe and comfortable for the aged. “The biggest health/safety concern among seniors is injuries resulting from falls. Therefore, you need to have good lighting at home, no loose rugs or carpets, anti-skid tiles. You should also keep the lights in toilets and bathrooms switched on at night.”
As far as hospitals are concerned, there should be wheelchairs for the use of senior citizens right at the entrance. There should be ramps, the consultation rooms should be on the ground floor, so they don’t have to climb stairs or take elevators. All these factors should be implemented with the help of a geriatrician or a physiotherapist.
Like all medical professionals, Dr Sandeep also underlines the importance of staying as healthy and fit as possible. In fact, individuals should start early and not wait for old age to catch up before they make healthy changes to their lifestyle.
Shailaja Bapat, a patient of Dr Sandeep, testifies to this. “We have been consulting Dr Tamane for 15 years now. We first visited him when my husband, who was then 50, experienced a spell of giddiness. Dr Tamane asked my husband to undergo a few tests and he was diagnosed with diabetes. After a few years, I was diagnosed with mild thyroid and later with mild diabetes. The doctor has prescribed regular monitoring and also medication for thyroid, diabetes and vitamin intake. He has also asked me to exercise, have a proper diet and be occupied with something. Today, at 62, I keep myself busy looking after my granddaughter, practising yoga and trying to stay fit,” says Shailaja.
Advances in medical sciences have significantly reduced the suffering of elderly patients and made many conditions treatable/manageable:
There is a misconception that if you are old, you are bound to lose your vision. Many older patients develop cataract, glaucoma, diabetic retinopathy which are completely treatable.
Knee replacements, spine surgeries have become common and help senior citizens overcome orthopaedic challenges/conditions.
Dr Sandeep also mentions certain vaccines that elderly people should take, as has been recommended by the Geriatric Society of India: “One is the influenza vaccine which is to be taken once a year. At the age of 60, an individual should take the pneumococcal vaccine, to prevent pneumonia.
The shingles (herpes zoster) vaccine is given as a single dose at the age of 60. It is not readily available with the chemists/pharmacist as the other three are and has to be requested. It can be taken even by those who had shingles in the past.
The fourth is the tetanus vaccine, which actually protects against three conditions: diphtheria, tetanus and pertussis. The DPT vaccine is usually given to kids. For adults there are two vaccines called Tdap and Td. Even if you have taken the DPT vaccine as a kid, it is recommended that you take the Tdap shot as an adult, once in 10 years.
The need for homes away from home
What also goes a long way in boosting the physical and psychological health of the aged population is bonding with people of the same age group. A sense of purpose, derived from a well-planned day gives meaning to their life. Working towards this goal are some groups and daycare centres which work to ensure good health, happiness and dignity for senior citizens in their care.
Suhruday Geri Care, which germinated from personal concerns as we have seen above, is one such. It is a home equipped with all medical facilities and a palliative care centre for terminally ill patients. ‘Death with Dignity’ is at the core of their belief system.
“We are using the premises of Sadhana Village, which is a centre for specially-challenged adults. We have rented one bungalow on its premises. Since it is situated amidst nature, but not too far away from the city, our residents like it,” says Dr Vaidehi.
At the moment, there are 12 patients staying at the facility and they all need assistance. They are suffering from dementia, paralysis, cancer, some with psychiatric illnesses. The centre has its own nursing home at a short distance, with nurses, attendants, resident doctors and visiting specialists.
Apart from medical attention,however, the patients also require recreational activities, to prevent them from brooding or feeling depressed because they are away from their families. “We do not put any restrictions on the visits or telephone/video calls of family members. One of our residents is nonagenarian Leela Soman, lovingly called Soman Ajji, who has reduced vision. She was initially reluctant and found it difficult to adjust, but now she has settled down,” says Dr Vaidehi.
Relative Manjusha Vaidya explains that Soman Ajji had been living independently with attendants since her husband passed away, but curbs on movement during the lockdown made it difficult, especially given her failing vision. “It was a good decision to admit her at Suhruday Geri Care; two doctors are heading this facility and that’s a relief. Ajji suffered from a fall there, but the doctors immediately took over and treated her. She is fit now,” said Manjusha.
Leela Soman’s roommate, Nalini Karandikar, lists the various activities at the centre, such as painting, music, yoga, book reading and even birthday celebrations, that keep all the residents in good spirits. “I like watching TV, so the doctors ensured that I could watch the serials here. The staff here ensures that my routine remains unchanged,” she adds.
Another centre which brings the best of both worlds — family life and meaningful engagement with people of the same age group — is Rainbow Day Care Centre started by Anuradha Karkare.
Located in Left Bhusari Colony, the Rainbow Day Care Centre was started with an intention to provide senior citizens a safe space with meaningful engagements, quality time, and stress free atmosphere during the day. “I thought the idea of starting a palnaghar (daycare centre) is better than starting an old age home, because in this kind of setup ajji-ajobas will get best of both the worlds i.e. their family as well as friends of the same age group,” says Anuradha.
The Centre, that has trained professionals as staff on roll, provides pick-up and drop facility for the senior members, if they stay within a radius of five kms. “We decided on a space that was easily reachable, with a hospital nearby. The centre can accommodate up to 30 elderlies with space for group activities, kitchen and dining facility. There are also arrangements for them to take a nap or rest whenever they feel like it,” shares Anuradha.
A practising psychotherapist herself, she and her team see to it that the emotional needs of the residents during the day are taken care of. “The seniors need acknowledgement, a sense of safety and togetherness, an empathetic ear, individual attention, and of course timely, nutritious meals and medicines. We have a range of creative and cognitive activities especially designed by our counsellor for them,” adds Anuradha.
Another group which provides senior citizens with opportunities for socialising and fun is Dignity Foundation. Founded by Dr Sheilu Sreenivasan, Dignity Foundation has several chapters, including one in Pune. Gopal Asthana, Chief Dignitarian of Pune Chapter says that the Foundation’s mission is to provide a fulfilling, happy and meaningful life for seniors. Started in Pune about 13 years ago, it has 150 members, who enjoyed at the chapter every evening from 4 to 6 pm, attending various sessions on health, dance and music till COVID-19 hit them.
“We used to meet every evening at our Lullanagar centre. There were people from different backgrounds mingling with each other, becoming close friends and providing support for each other. During the lockdown we started meeting on Zoom and are continuing with that even now,” says Asthana.
A few members of the Foundation have volunteered to be Steering Committee members at respective chapters. During the lockdown, they took to calling senior people in the group and keeping tabs on their health and disposition. The foundation also has a helpline for members.
Preparing for the future
With COVID incidence on the rise again, especially in Maharashtra, doctors are suggesting tele-consultations wherever necessary.
“In the early days of the pandemic, when the elderly couldn’t step out for exercise during the lockdown, it affected their medical conditions like blood pressure, diabetes etc. Initially, they also faced problems in procuring medicines, especially those they couldn’t get without a doctor’s prescription. But later, as restrictions were eased, doctors started sending prescriptions on WhatsApp and they were accepted by chemists as well. This may have to be worked out again. Of course, whenever possible, doctors and patients must try to meet in person,” says Dr Sandeep.
Geriatrics is a multidisciplinary subject and there is an urgent need for doctors, nurses, physiotherapists, occupational therapists, psychologists, pharmacists, nutritionist, family physicians, care-givers working together. As Dr Sandeep puts it, “It is teamwork”.