Guidelines for Ageing with Health, Grace and Dignity SM Tuli, Neena Bhasin, Punya Bhasin
Page numbers followed by f refer to figure.
Affordable houses 17
Alcohol and drug abuse 70
Alcoholic drinks 37
Allergy 58
due to
drug 58
food 58
Alzheimer's disease 25, 65, 78
American Association of Retired Persons 27
Anxiety 63
Appetite, loss of 65
Arthritis 57
Assisted living 20
services 16
Atal Pension Yojana 32
Attack of confusion, sudden 58
Attention disorders 63
Ayushman Bharat Scheme 62
Bariatric surgery 42
Beans 38
Bladder and bowel functions, poor control of 65
Blindness 51
pressure 2, 49, 55
high 35, 42, 56, 70
low 58
sugar levels 52
vomiting, sudden 58
immunity of 33
tissues 4
fragility of 4
mass 4
Book reading 26
Brain cells 5, 33
Breakfast, suggested 35
Breathing, sudden difficulty in 58
Cancer 49, 56
of mouth-throat 53
save yourself from 53
Cardiovascular system 4
Cataract 2, 4
Cell mediated immunity 55
Chest discomfort, defused 58
Chicken 38
Cholera 72
Cholesterol, levels of bad 42
Comfortable death, assisting for 76
Communicable diseases 72
Communication skills 4
Constipation 4
Coronary artery disease 56, 70
Cortex, grey matter in 5
café sessions 74
common cause of 3
doctor-assisted 84
sudden 73
Deep sleep, induction of 82
Delhi Development Authority 19
Dementia 25, 65, 78
Dental problems 2
Depression 63, 64
Depressive disorders 63
De-stress 70
techniques 50
yourself 50
Diabetes 2, 49, 56, 70
product of 51
save yourself from 51, 50
Dialysis 52
Diarrhea 55, 58
Digestive system, slowing of 4
Diminished hearing 4
Dinner 35
Disease, global burden of 3
Drink sufficient water 36
Egg 38
for health 38
Elderly abuse 11
Employee Provident Fund 31
End of life 74
Euthanasia 77, 81
subject of 82
Evening tea 36
active 46f, 47f, 49f
physical 43
Eye-ailments 59
Family for hire 29
Family physician 61
Family support network 5
Fat, small amount of 38
Feeling lonely 27
Fish 38
free 36
pyramids 34f
Foot paths 18
Fruit 36
Gene dependent 7
Glaucoma 59
Good food in younger age, invest for 38
Good-food pyramid to ensure health 34f
Government effort to prevent elderly abuse 11
Guru Vishram Ashram 13
Hand fullness 23
Happy hormones 56
Happy living 25
insurance 32
is wealth 48
maintenance practices 3
life, long-term 35
persons 2
Heart 78
disease 2, 56
Hepatitis 55
Heredity from parents 54
Hippocratic oath 81
HIV-AIDS, infected with 40
Home for seniors 15
Homo sapiens 5
Hormonal changes 4
Hospice movement 79
HPV virus 54
Human animals 5, 67
Human body 54, 69
systems of 51
Hyper-aged-societies 1
Immune system 54
Immunity, acquired 55
Infection 72
Intensive care units
multiple tubes in 76f
plugs in 76f
Japanese encephalitis 55
Japanese tea ceremony 25
desiccation of cushions of 4
pains 2
Kala azar 72
Kidney 78
disease 51
function of 4
transplant 52
Lens of eyes, opacity of 4
Libido 4
Life 76f
Life Insurance Corporation of India 32
Lifestyle ageing and death 72
Lifestyle-related disorders, common 56
Liver 78
function of 4
Living animals, biological system of 67
Living-will 72, 83
Loneliness 23
Lunch 35
Lung 78
air sacs 56
conditions 49
Maintenance and Welfare of Parents 18
and Senior Citizens Act 19
Malaria 72
Measles 55
Medical attention in seniors, immediate 58
Medical disorders 44
Medical doctors, learning from journey of 10
Memory loss 4
Meningitis 55
Mercy killing 72, 82
Middle-age, expectations at 8
Milk product 38
Mindfulness 23
Ministry of Loneliness 26
Model Building Bye Laws 17
Modern nuclear family 17
Monetary investment for sunset years 31
Mood swings 63
Muscle mass, start losing bulk of 4
National Crime Record Bureau 12
National Pension Scheme 31, 32
National Policy on Senior Citizens 11
Nerves, disease of 52
Neurons, reduction of active 4
Neuropathy 52
Neuropsychiatric disorders 63
Non-Government Organisations 23
Bharti Foundation 24
Cure International India 24
Equitas Development Initiative Trust 24
HelpAge-India 12
Ipas Development Foundation 24
Make A Difference 24
Parinaam Foundation 24
Quality Education and Skills Training QUEST Alliance 24
Room to Read India Trust 24
SEWA Rural 24
SOS Children's Villages of India 24
Nurture and nature 6
Nutrition, eat food for 33
Obesity 44, 49, 56, 70
Obstructive disease 56
Oils for cooking, preferred 38
Old age
homes 19
pension 32
Oral cavity 53
Oregon's physician-assisted suicide 81
Organ 4
failures, progressive 78
Oro-dental health 60
Orphanages 18
Osteoarthrosis 2
Osteoporosis 2, 57
Palliative medical care 79
Paralysis 52, 65
Parkinsonism 66, 78
Peripheral vascular disease 52
Physical strength, diminution of 4
Pneumococcal influenza 55
Polio 55
Pradhan Mantri Awas Yojana 32
Pradhan Mantri Jan Awas Yojana 17
Prohibited for seniors 45f49f
Prostatism 2
Psychoneurological disorders, age-related 63
Psychosocial stressors 50
Public Provident Fund 31, 71
Residential areas, libraries in 26
Residents Welfare Associations 25
Rubella 55
Seizures 65
Senior age, less dependant at 38
Senior Citizens Act 18
Senior citizens
balanced diet for 35
food for health for 33
generation of 23
Sensations, loss of 52
Service apartments 16
Severe giddiness 58
Sexual activities 4
Shift workers 67
Shifting onus 78
rashes, sudden development of 58
wrinkling, extrinsic 4
Sleep, biological clock for 67
Sleeplessness 65
Sleep-wakeup rhythm 69
Smallpox 55
Social functions 6
disturbance 65
sudden changes in 58
Spiritual care 80
Starch-rich foods 37
Stress 70
post-traumatic 63
psychological 68
Stroke 49, 56, 70
Sugar rich fruits 37
Sun-set years, walking during 9f
Sweating, unexplained severe 58
Tension 44, 70
Terminally-ill patients 82
Tetanus 55
Tobacco 52
Trans fats 38
Traumatic brain 82
Tuberculosis 55, 72
Unhealthy lifestyles 3
Unit Trust of India 31
Vegetative stage 77
Viral infections 72
Vomiting 58
Wellness centres 62
Whooping cough 55
World Health Organisation 1
Yoga 44, 70
Youth-full years, during 5
Chapter Notes

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Realisationchapter 1

Indian-sub continent is a home for 100 million elderly people above 60 years at present. There is a dramatic change in demographic profile of our country, this number is likely to increase three fold in the next three decades. Broadly speaking 20 percent of people would be above the age of 65 years by the year 2050. Like China and many other countries, we would be like “hyper-aged-societies”; the word coined by World Health Organisation (WHO) for countries with 20 percent of their population above the age of 65 years.
For descriptive purposes in this write-up, we would describe growing age “up to 30 years”, “Young-age” from 31 to 60 years, “Senior-age” from 61 onwards.
People are living longer and couples are raising fewer children. The result is that small number of “young-age group“ have to be responsible for the care of many more years of senior age people. The young couples have to look after their own life, 2the care of growing age, school-going children and the burden of senior-aged parents. As the bodies and minds of ageing parents, dwindle somewhere along the journey, relationships within the families can come under great strain. Joint family system was earlier a popular normal affair. However in the fast changing world today, it is no longer common. Among the middle class families in our country nearly one-fourth of the senior parents live independently so long as the spouse is alive, one-fourth are left alone to live a lonely life and nearly half of the senior parents are still living with their children.
Not many senior people are covered by health insurance or by social security. The young working couple has to spend the money not only for his family and needs of children but also for the care of the senior parents. After the age of 60 years, some of the common medical conditions that require to be taken care off (even in otherwise healthy persons) are cataract, blood pressure, diabetes, heart disease, prostatism, dental problems, osteoporosis, osteoarthrosis, joint pains, and frequent falls.
Nearly 15 percent of all deaths in future will be due to cancer (the commonest in women from breast, and lungs in men. You need to reach the hospitals, spend time and money to take care. To reach such facilities may be relatively easier 3in cities however in the villages, the old parents are left alone to fend for themselves, as in most of the households the younger people migrate to cities for work for livelihood.
It is easier to recognize problems than to accept responsibilities to find solutions for management and prevention of problems. All this must start during growing age. In addition to the emphasis on reading, writing and arithmetic and development of work skills, the growing generations must be informed and trained in good health-maintenance practices. The school education must also inform the growing age not to be swayed away by artfully persuasive mass advertisements related to food commercials.
Common cause of death and disability in the India-subcontinent are heart diseases, respiratory problems, stroke, tuberculosis, birth-related complications, road traffic accidents and suicides (self-harm), these figures are from Global Burden of Disease. Unhealthy lifestyles and unhealthy diets are responsible for most of the above diseases. With changing demographics, 20 percent of population in India would be living beyond 60 years. Roughly 15 percent of people would be dying of cancer.
Old age is much “more than numbers”: A few of the common changes that are apparent to 4almost all of us are listed as follows. This is the phase of life when we start losing bulk of muscle mass (diminution of physical strength), decrease in bone mass (fragility of bone), reduction of active neurons (memory loss, diminished hearing and communication skills), hormonal changes (sexual activities and libido), diminution or weakening of power of repair of all body tissues and organs (cardiovascular system, function of liver and kidneys, extrinsic skin wrinkling), opacity of lens of eyes (cataract), slowing of digestive system (constipation), desiccation of cushions of joints (decrease of height 2 to 3 cm, and joint pains). To compensate for such changes a senior citizen on an average consumes four medications daily to carry out all activities.
We spend more time in doing our daily routines, we need to take care of your dentures, eye drops are needed for dry-eyes, we need glasses for reading or writing. We need extra-effort to reach our toes for cleaning or even wearing socks, more light for reading a newspaper, more time and attention to cross a road/street or cover a distance, more time to eat food or drink fluids, learn to eat slowly and small potions (to avoid food entering into air-passages), eat food that is easy to digest and helps in bowel movements, speak louder for communication and a stick for walking outdoor safely.5
All the above listed changes occur even in persons who are apparently healthy. However, there are many examples almost in all countries where certain people beyond 80 have memory and attention almost at par with healthy 25 years olds. Such elite elder have been addressed as “superagers” by neurologist Marsel Mesulam. Scientists have observed that outer layer of their brain (grey matter in the cortex) retains its thickness for a longer time and there is better communication between brain cells; probably inheritance and environments have a role to play.
Family support network
Growing consumerism, shrinking support networks, expectations from families, friends and society have led to increased stress levels. Getting stuck with trivia; expecting “perfection” at every stage of life can also add to stress. One should understand nothing is perfect in life, nor are we as human-animals (homo sapiens); do seek and try for perfection however achieving it is an illusion. There is a close link between one's mind and body and it includes neurochemicals, hormones and even the immune system.
During youth-full years (say 25 to 45) develop relations with your brothers, sisters, cousins and friends, learn to give and take. Do not hesitate 6seeking help from this group but also support and empathise each other when needed. This is the group that is going to be your company when the social circle gets markedly shrunk and we need it the most.
During the same youthful years, take care of your children, daughters, sons, nieces and nephews. These children would be adult and young when you reach the old age; they are the ones who will take you to the hospitals, or for shopping or for social functions, and they would hopefully volunteer to bring medicines and food for you. Let us nurture the next generations by self-examples because they are the ones who can take care of the seniors the best.
Approximately, half of senior citizens in India are still living with children as a joint family or as families staying in adjacent flats or homes. The “young generation” has to be the role model for the “growing generations”; it is their behaviour that they will reap or receive from their children when the young generation becomes the senior citizens. A parental and social effort must be sustained even if some of us are not disciplined enough to make it.
Nurture and nature: It is the behaviour of young generation that determine the nurturing or behaviour of the growing generation. The 7literate section of society (educated class) keep on discussing about nature (i.e. gene dependent) and the nurture (i.e. influence of environment) and their influence on the family or societal behaviour or response. We as humans may not have much control on the genes (more than twenty one thousand exist in human being), however, the nurturing or environments have a much bigger role to play on the growing generation. The “next generations” are not influenced by rhetoric's or sermons, however, they can be induced to some influence by looking at the practical examples conducted/practised by the generations senior to them.
Many people at young age do not realise that someday they too shall be old. They live by the words of English author Francis Bacon—“I'll’ never be an old man, for me old age is always 15 years older than I am”.
Our children learn from us, of how kind and respectful we are towards older people. Most of the old persons are marginalised at home—beset with multiple problems like reduced physical strength, decreased immunity and onset of sensory-motor disabilities, fading memory, etc. They need care, love, emotional and physical support, but they must never feel humiliated. In our country, 25 percent elderly do not know 8who will take care of them in case they meet an accident or they fall ill. Most of seniors would need help of people for day-to-day living like getting medicines, rations, fruits and vegetables, repairing of things like fixing a broken bolt, changing a light tube or bulb, repairing a broken water heater, operating their banks accounts, paying their utility bills for electricity, water, gas, telephones and property.
Aged women if left alone, are more prone to isolations, dependence and humiliation, because they have a longer life span as widowhood, and most of them have no source of income as traditionally most of them have been home makers.
Expectations at middle-age:
Passing through different phases of life: Generally, after the age of 40 when your children are grown up and able to look after themselves one may have to become “carers” again. This time not generally for your children, but mostly for your parents and parents-in-law. Their illnesses may not be life-threatening, however the parents may need hospital or medical attention for a broken leg, a heart episode, a brain stroke, or diabetes. With care, medications and rehabilitation they may recover, however the life for you never will be like that earlier than forties. There would be demands on your time and energy for parenting the parents and taking care of your bodies 9manifesting the signs of middle age. You may start feeling a creaking noise and pain in the knees, low backache, and necessity to loose your weight and control your eating habits to reduce your weight, control your cholesterol, blood pressure and diabetes.
This is also the decade or phase of life when you will be presenting your families for functions or bereavements. You begin to experience the loss of near and dear ones, parents, parents-in-law, dear friends. Some losses would be expected through a slow process but other may drop in like bolt from the blue. All these do leave you gasping with shock and horror but also educating you about the power of God and destiny—and the expectations with advancing age—the life however has to go on, there are limitations that cannot be simply wished away.
zoom view
Fig. 1: Continue walking during sun-set years.
10Learning from the journey of medical doctors: Eighty-five doctors graduated (MBBS) in 1955 from Amritsar; glimpse of their life as observed up to 2015 may provide us an insight what can one expect under the best of circumstances regarding the health information and medical facilities. By the year 1980, seven died because of road-accidents (two), cardio-vascular accident (CVA-one), heart attack (two), militancy (two). By the year 2005, sixteen more died because of CV accident (seven), heart attack (five) and malignancy (three), murder (one). Between 2005 to 2015, forty-six people died of CV accidents, heat attack, malignancy. Twenty-three are still living beyond 80 years, walking around and capable of looking after their activities of daily living. This example seems to be the best one can expect in life (collated by Dr Hardas Singh and Dr Radhey Sham).