Ageing in an unprepared society

WITH EYES WIDE OPEN

D. N. Bezboruah

If I remember correctly, it was Maurice Chevalier who said, "Growing old is inevitable for all of us. The clever thing is to accept it and always plan your next move in advance." As we all know, old age is a revealing time, when the best and worst in us stand out in bold relief. It is one thing to be prepared individually for old age and quite another for a society to be prepared to treat its senior citizens with the respect due to them by demonstrating that our society as a whole is prepared for the needs of older people with their physical infirmities coupled with forgetfulness and more serious problems of dementia et al. I have come across a whole lot of educated people in their 80s and 90s who are well prepared to cope with the problems they are beginning to face on account of ageing. Unfortutely, I cannot say the same thing about my State or even the city I live in being honestly prepared to take care of old people who are in need of assistance. One very visible example of this is the lack of facilities for people in wheelchairs to get into buildings without any help from total strangers.

The problems of ageing in India are somewhat different from those that are faced by senior citizens in other countries. This is because in addition to the universal problems of ageing that have been extensively researched and written about, old people in India have certain emotiol problems that are linked with social changes and changes in attitudes to life. One of the saddest experiences for senior citizens in India is the shift from the joint family pattern to nuclear families that seldom have any room for old people. Even so, old people’s homes seem to have come up in most Indian cities, and one finds a lot of lonely old people—widows and widowers included—adjusting very well to the needs of spending their last days with others like them in old-age homes. They have adjusted splendidly to a completely different mode of living away from their near and dear ones.

Some of our problems of coping with ageing arise from our tendency to overlook the fact that the ageing of the human brain starts much earlier than the visible signs of ageing. It has been established that performance of many types of tasks studied in the laboratory rises to a peak somewhere between the late teens and late thirties, and then gradually declines into old age. It used to be assumed that the declines were due either to the effects of age in sense organs, muscles, and joints, or to older people being uninterested in, or out of practice at, the kinds of tasks set by laboratory experiments. Research since the 1940s has shown that, while peripheral changes may be important in later old age, central brain functions account for the main trends of performance in middle and early old age. The trends are by no means all adverse: certain kinds of ‘mental agility’, such as indicated by scores in untypical intelligence tests, decline from the early twenties—it has been estimated that by the age of 60 they have returned to their level at the age of 10—but the decline is offset, at least partly and sometimes more than fully, by increased knowledge gained in the course of experience. The age of peak performance is thus usually in the thirties, forties, or fifties rather than in the 20, and varies with the balance between demand for ‘mental agility’ and for knowledge: for example, it comes relatively early among mathematicians and relatively late among historians and philosophers. What needs to be emphasized, of course, is that the statements are of average trends and that some individuals achieve their peak performance much earlier or later than the majority. Unfortutely, what happens for a lot of people is that the principle of atrophy begins to work as soon as one gives up the business of learning on the pretext of being too old “to learn new tricks”. What works quite expectedly is the principle of “use it, or lose it”.

In talking of ageing in an unprepared society, it is possible to explore the entire gamut of problems that come with old age especially to people who are all by themselves. But we are limited by the constraints of space. Apart from the economic problems of having to live on one’s pension at a time when the retail inflation is over five per cent or on no pension at all if one belongs to the unorganized sector, there are problems of health care that our society has not bothered look into for the benefit of senior citizens without economic support. There are many senior citizens plagued by diabetes, blood pressure, arthritis, etc., sometimes brought on early due to lack of exercise or neglect of wise food habits and so on. There are also common complaints of forgetfulness that begin with our ibility to recall where we left the bunch of keys or the glasses or the dentures. Old people also tend to forget faces and mes or the dates on which certain social events have to be attended. These are relatively negligible acts of forgetfulness that are common to all people and accepted as such by their families. I have come across quite a few old people too who are able to laugh at their own lapses of memory over everyday matters. But we cannot ignore other more serious memory lapses that may have tragic consequences. I am referring to one of the manifestations of dementia that strikes very hard in old age.

In his book Organic Psychiatry (Oxford, 1978), W.A.Lishman defines dementia as “an acquired global impairment of intellect, memory and persolity but without impairment of consciousness”. Although dementia is often considered to be an irreversible condition, recent studies have shown that about 10 per cent of patients with dementia have conditions for which treatment can reverse the otherwise inexorable decline of mental function. The progressive dementias are most often diagnosed in the elderly under the headings of senile dementia of the Alzheimer type and multi-infarct dementia. The former is caused by widespread degeneration of nerve cells in the brain and their replacement by elements known as plaques and neurofibrillary tangles. Post-mortem studies of the brains of patients who have died as a consequence of senile dementia have ebled correlation of the numbers of these elements with the degree of mental impairment shown by psychometric testing during life. Multi-infarct dementia, which is not as common as senile dementia, is caused by loss of brain substance following repeated closure of small or large blood vessels, incidents which cause minor or major strokes.

Think of the tragedy of a person who is travelling all alone to another city and has the onset of dementia there. He may have forgotten where he came from, he may not remember who to contact in the event of such a crisis, he may be totally devastated in some other city or country among total strangers who might be more inclined to take advantage of his loss of memory to exploit him and deprive him of his belongings. This is a common trend in India, as is evident from what has happened to senior citizens who have forgotten the PIN codes of their credit cards or debit cards and are coaxed by strangers pretending to be helpers who are actually out to loot them. What happens when dementia strikes someone in his own city and he does not know where he has to go back to get some sleep. The pity of it all is that one cannot predict what abilities are lost in a person struck with dementia and what abilities are intact but may also suffer losses. Degeneration of the brain might be widespread and scattered or concentrated in some areas of the brain. For instance, the person may lose his speech (developing aphasia) but not his memory or vice versa. Mercifully, one of the last things to be affected is one’s persolity, and some of the last skills to be lost are the social ones. Since the person also remains conscious, there may be ways of combining his social skills and his consciousness to arrive at some means of helping him out. Obviously, even these possibilities have been researched in other countries, giving people the means to help victims of dementia and to get them reunited with their families. I am not aware of any positive measures to help old people struck by dementia or Alzheimer’s disease being codified and shared with others by any organization in Assam. Until we can do something on these lines, all our talk about honouring senior citizens, all our initiatives to honour them with awards will remain meaningless unless we can help them in their most critical moments. We need a city and a State administration that can stretch out a helping hand to old people when they are at their vulnerable worst.