Evening of Life: Act while the sun is still bright

Those who are in the evening of their lives are often called old, senior citizens respectfully by the society and are often attributed to have some of the following:

Candles cost more than the cake on their birthday; their investments in insurance are paid off; they wish their easy chairs have more options than their car; their arms are too short to read a newspaper; their mind makes contracts, which their body cannot keep; they cannot remember when they are absent minded; the colour of their hair is grey unless they dyed it; they have less hair on the head than on the ears and nose or on other parts; they have wrinkles where smiles have been earlier; selective deafness to spouse is replaced by actual deafness; cannot distinguish between spouse or a young pretty person at a distance; has a third leg in the shape of walking stick; One does not sleep with their teeth; they have urgency and cannot hold and wet their pants like a four year old; one knows everything but cannot remember it; one is stiff everywhere except where he wants it to be etc.

In the evening of life, the diseases one may suffer are high blood pressure, diabetes, hypothyroidism, degenerative disorders, auto immune diseases, failing hearing, eye sight, painful stiff joints (arthritis), difficulty in breathing (COPD), cancer, dementia, and senility etc. In addition, the proneness to accident and resultant fractures and disabilities add to the discomfort.

Earlier most of these lifelong ailments were seen in the age group of 60 years. Now the ages at which they have become prevalent are lowered. Does this mean that the definition of old has to be redefined? Would the duration of evening of life increase?

Gadgets like fans and air-conditioners have eliminated human's normal sweating which is a process of elimination of unwanted products from body. Ever increasing dependence on automobiles for travel reduced walking and affected fitness and mobility and exposed to pollutants. Disuse of human physical capability and misuse of comfort gadgets affected the health of people.

While the modern medical and health care has prolonged the life span of individuals, have cures and controls and corrections for many diseases it is yet to reduce the disabilities occurring in the evening of life.

Thus, it makes the living more frightful and painful in the evening of life. The modern health care enabled more and more to survive and to live to old age with disabilities, and diseases, for longer periods.

Modern medical care also made it possible for the world to control and limit families to one or two children. The first two born are the selected. They may not be the fittest to survive but they are made to survive. Small family norms have changed the dependency ratios of young and old and there are less numbers of young now to support the increased number of aged.

The great scientific inventions in the last few decades especially in the areas of transport and communications and IT have greatly changed life styles of populations. Huge demand is created for white collar jobs which promoted migration and emergence of nuclear families. It resulted in breakage of joint families which was a safety net. It worsened the dependency ratios. Physical distances with kith and kin widened.

In a child there are uniform growth and development markers like crawling, sitting, walking, speaking, and feeding etc. All these are generally determined and marked at which age generally all children would acquire them and perform. In children they are not deficiencies or disabilities but are part of growing up and learning. It is not so in the old age.

Different people acquire the so-called disabilities or deficiencies at different ages in the evening of life. As there is no uniformity there cannot be a uniform solution. It is highly individualistic. The needs may be physical assistance in routine chores, communication and companionship, assistance to manage property and allied things, home nursing, assistance in travel, entertainment, nursing of bedridden etc.

The senior citizens used to play a useful role in the joint family and community earlier. They were transferring the knowledge on many issues settling differences, and were able to imbibe values amongst juniors.

This was possible as most of the time the successors in the family were also adopting the same profession, artisan work, or avocation and were living at the same place. Currently various members of the family practice different avocations and the seniors may not have any knowledge of the same to contribute.

Currently the contribution of the seniors to the family structure is vague. They are not able to continue to earn anything with their physical labor and get retired reaching the age of superannuation. There is only minuscule percentage that gets a pension.

Few lucky professionals like lawyers, doctors, politicians and businessmen who are physically and mentally fit may continue to earn and be independent. All seniors are in search of a solution. They all require a new "Safety Net" for their old age.

Rich weave alternate safety nets to take care of their health and physical existence with their wealth including getting remarried at late in age to address the problem of companionship to overcome loneliness. They can engage services of others for their needs at huge costs, and overcome disabilities through advanced medical procedures if necessary, in other countries. The poorer senior citizens may be getting some subsidy from the Governments for food.

However, seniors in the middle-income groups are more. Their aspirations are high. They have not yet found a solution and are still in search of new Safety net. They sulk in themselves, curse at their fate, muse at their helplessness, and blame others for their current status. They spend their life savings or the contributions from their children abroad on medical procedures to give relief for a while.

They spend their remaining period of life in and out from hospitals even for some incurable and irreversible ailments like final stages of cancer etc instead of seeking relief from pain in palliative care. They live in false hopes.

It is time for them to get united and organise integrated, comprehensive services they require for assisted living through one window call centre. However, before they do anything, they must remember the famous and wise advice of Bernard Shaw in the book Doctor's Dilemma that, "Do not try to live forever. You will not succeed".

Death is certain and accept it. Persons who cannot keep themselves alive by their own activities, cannot, beyond reason, expect to be kept alive for ever by the activity of others. Let us use our health, even to the point of wearing it out totally. That is what it is for. Spend all energy that one has before they die as one cannot carry it with him or her.

Let us not outlive ourselves. Let us be realistic. The period of Joint family as a safety net is over. Let us Join with peer groups and build safety nets for the Evening of Life. Better act while the sun is still bright.

(Late Dr AP Ranga Rao was a United Kingdom returned medical doctor by profession and was chief architect of FDHS, 108, 104 Ambulances and Telemedicine Services)