At 80, Hansraj Tagra needs four shots of insulin daily, a regimen that also requires him to stick to two rotis and a sabji (vegetable) for lunch and dinner every day. For someone who loves his food, Tagra finds this forced discipline irksome. Only his 26-year-old granddaughter Kishi Arora can get him to comply. She also ensures that he gets 30 minutes of physical activity every day to help keep his diabetes and hernia problems in check.
Tagra lives with his son’s family in Delhi and is especially close to Arora, his sole caregiver when the rest of the family lived overseas for eight years—until the domestic help attacked Tagra, wounding him grievously, and the family returned to India. “We looked out for each other during those years and it has proved habit-forming. Even now Dada waits up for me at night and expects me to settle the spats he has with the rest of the family over his food and exercise regimen,” says Arora.
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As more urban Indians move to nuclear family systems, caring for the elderly at home is proving difficult for many. In 10 years, the number of the aged in urban India may double (see ‘Know’, below left). “Earlier, my oldest patients would be in the age group of 65-75 years, now a majority of them are between 75 and 90. Lifespans are increasing and along with it come the attendant problems of caring for the elderly,” says Radha Murthy, a Bangalore-based doctor who focuses on geriatric care.
“The mistake in dealing with the ailments of the old is that physicians treat them on par with other adults, while the truth is that the body of an older person reacts differently from that of a normal adult,” says Kushagra Katariya, CEO, Artemis Health Institute, Gurgaon.
In 1996, Murthy launched Nightingales Home Health Services, a mobile medical service catering to approximately 3,000 families. The geriatric care on offer ranges from routine diabetes and blood pressure monitoring to nasal-tube feeding, respiratory support and physiotherapy for recovery from accidents or strokes. But, she says, “We can only support patients within a 7-8km radius as we focus on personalized attention and long-term care.”
Access to convenient medical care and rising medical costs are key issues. K. Venkataraman, 72, and his wife Jayalakshmi, 66, live with their son and his family in suburban Bangalore. A diabetic for the last 20 years, Venkataraman relied on a mediclaim policy to meet periodic medical costs. Last year, however, the insurance company refused to renew his policy, citing ineligibility, upsetting him greatly. ”Some time back, we realized he needed to get a hearing aid to help him combat a growing problem of hearing loss. He refused, fearing that it would prove to be too expensive,” says his son V. Krishnamurthy. He finally relented when he realized that loss of hearing was actually shutting him out of normal interaction.
“Older people need reassurance that they are not a financial burden for their families. That is a critical aspect of elder care,” says Murthy, who is campaigning for the extension of medical insurance cover to health services provided at a patient’s home. Her patients pay a registration fee of Rs2,000 that covers three family members for four years (each family gets a monthly bill detailing services availed).
Combining medical and physical care with emotional support is critical to fashioning an optimum environment for seniors, according to most physicians—a fact Bangalore-based couple Amarnath T.S. and Lakshmi are keenly aware of. Their four-member family includes his 84-year-old mother Annapurnamma. “Emotional counselling is a must while living with the elderly. Just normal ageing or sometimes the onset of age-related conditions (such as blood pressure, diabetes or cardiac problems) can result in mild depression,” he says. Unless treated promptly, it can lead to rapid deterioration of health and self-esteem. “Elders must have access to counselling at home or, if required, by a qualified counsellor,” he says. In the Amarnath household, the way to peaceful coexistence is involving Annapurnamma in family outings and planning weekend activities that cater to her tastes and endurance. “We also ensure that our son Rohith, 10, interacts with and defers to his grandmother. This interaction goes a long way in keeping homes happy and healthy,” Amarnath says.
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