By Zubeida Mustafa

THE world population is aging. So is Pakistan’s. In 1947, nearly four per cent of the population (1.8 million) was above sixty years of age. In the 1981 census, this percentage had risen to 6.9 (5.8 million). Life expectancy has also risen from 43 years in 1960 to 62 years today. This is not just due to the failing infant mortality rate. The fact is that people are living longer.

This longevity has far-reaching economic, social, health, employment and even political implications for the country. The dependency ratio has grown which is affecting the economy. The health delivery system is being called upon to cater more and more to geriatric patients, without this discipline even being recognized as such in our medical colleges. In elections, the voters who are 60 plus constitute a sizeable number and their views count for whatever they are worth.

Most palpable of all is the human dimension of the aging of populations. There are more octogenarians around today than ever before. But this has basically been a case of adding years to life and not necessarily that of adding life to those extra years. In other words, longevity has not always been accompanied with good health. With no doctors trained specifically to examine and treat the elderly, the health care they receive is not always of the best kind.

Traditionally, the care of the aged has been the responsibility of the family. But new trends have emerged to transform family structures which have reduced the capacity of this institution to serve as the safety net for the less privileged. The old and the young, the sick and the unemployed have conventionally found sanctuary in the extended family. In days of yore, old people – even childless widows /widowers – could expect to be provided shelter by nephews and nieces in a household comprising as many as three generations.

The emergence of the nuclear family has changed the pattern of life enormously. Only elderly parents are now readily accommodated by their offspring. One of the sons – the eldest, the favourite or the one with the most cooperative wife – usually takes the responsibility of the aged parents. There are still cases where the generation gap is so wide that interpersonal conflicts makes it impossible  for aged parents to be accommodated under the same roof as any of their children.

The institution of the family as the shelter for the aging is gradually being eroded by several, not necessarily related factors. First is the small size of the modern family which is the desirable norm today and is a direct offshoot of socio-economic, health and demographic compulsions. With fewer children, who were once regarded as old age insurance, the elderly have limited options.

There are further restrictions by the migration phenomenon which has resulted in many young people leaving the country. Sons go abroad in search of greener pastures. Daughters are wedded to the green card holder. The empty nest has left the parents with no source of support. The choice of migration is not always available to them. Visas are not readily granted. Many of those who are allowed to settle with their children in foreign climes find it impossible to adjust to the strange lifestyle of an alien society.

Others are fortunate to have a child or two who have stayed back in the country and welcome their aged parents in their homes. But as more and more women go out to work, many aged people are left at home to fend for themselves in the day. This has not been without its problems especially when age and illness have made them feeble and dependent on younger persons.

Women, who have conventionally been the care givers in the home for the young and the old alike, are facing a new challenge. Whether they are daughters or daughters-in-law, women are the ones who have looked after the aging, tending to their needs for food, nursing and emotional support. Previously they shared this responsibility with other female members in a joint family. Those who are working women and have coped with the dual demands of motherhood and a career in their younger days, are now being called upon to adjust to the multiple roles demanded by their career and care givers for elderly parents. In many cases they additionally have to cope with their own advancing age and that of their spouse.

With longevity now quite a common phenomenon, the care of the elderly has emerged as a major issue in our society. Given our socio-cultural values which hold the elderly in great veneration, it is difficult for people to admit openly that there is a problem here which is being shoved under the carpet.

There is a need to address it pragmatically and dispassionately if a solution is to be found. By refusing to admit it, we are simply making life difficult for the elderly and their care givers. Just a few true cases should provide an occasion for soul searching:

An old lady who is 90, stays with her son and daughter-in-law who are themselves in their sixties. She requires round-the-clock care. There is no one else to provide it. As a result the daughter-in-law, who does not enjoy very sound health herself, is literally house-bound which creates human problems of a serious nature.

An elderly widower has both his children, a son and a daughter, living abroad. He was refused a visa by the British – even a vistor’s visa – and now he moves around from one relative’s place to another. In his old age he cannot enjoy the security and stability of having a place he can call his permanent home.

*An elderly incapacitated widow whose children are abroad depends on the attendants provided by some of the agencies operating in Karachi. For a few days, the attendants did not turn up and there was no one to look after her and she was rescued when the neighbours finding no signs of life broke into the apartment. The daughter had to rush back to attend to the emergency.

*One old widower, who was not keeping good health and was lying alone, died suddenly and his body was discovered a day later when a daughter who would phone him every morning to keep in touch got no response and rushed to his house to check on her father.

These cases focus on only one dimension of aging, namely, the problem of boarding and care giving to the geriatrics. There are other issues as well. The health problems of the aged are no less serious and the medical profession in Pakistan has so far not focused on them. There are no nursing homes/wards in hospitals specially for them and nurses are not trained to take care of elderly patients.

There are also the problems which only an aged person knows, namely, those of acute loneliness and lack of recreation and company of the people of their own age. How can their lives be made more meaningful? Not much has been done in this regard. Maybe Leon Trotsky was right when he wrote, “Old age is the most unexpected of all things that happen to a man.” We are still unprepared for it.

Source: Dawn 22 Oct 1998

Dawn 22 Oct 1998