Recently I had the opportunity in listen to a lecture on Alzheimer’s disease, a condition causing memory loss. The lecturer was Prof. Christopher Butler, a neurologist from the University of Oxford. He highlighted some of the biggest issues we will face globally with the rapidly expanding elderly population. And problems pertaining to memory loss. Petrified by what he presented, I was keen to study some numerical data on how Sri Lankan elderly population would expand.
We now have close to 821,000 people aged 75 and above. Which will exceed 1.4 million by 2030. There will be more than 3.5 million people who are more than 65 years of age by then. (Source: US Dept. of Census – International data base) 65 is the age limit we consider when defining the geriatric population. So as a nation, are we prepared to handle health care and related needs of the elderly?
Imagine the workforce we require to provide the comforts to the geriatric population? One to one care wouldn’t be a possibility at all as Sri Lanka will require 3.5 million caregivers to look after the same number of elderly people. Unlike some of the developed countries we do not have a government sponsored support system to look after the aged persons. Even certain elderly care homes are facing numerous administration problems. I witness the “dropouts” who did not meet the “entry criteria” on the streets – slow diseased and aged men or women begging for survival.
In Sri Lanka, the extended family concept, which is still preserved in the rural areas might mimic an enriched environment. Sadly the large families that once were, are slowly fragmenting into small units, because of the “global trends in independent living”
Some of you who are reading my article will be entering the geriatric age group within the next decade. Certain issues that the old aged population will face are cognitive health problems (memory and thinking), mental health conditions (loneliness, depression, suicidal thoughts etc), physical injuries, malnutrition, substance abuse and poor housing. As a country we need to anticipate all these complications.
Advances in health care is a key reason for longevity. Unlike medieval times all the scientific knowledge is dissipated globally within a matter of a few days thanks to information technology. Some say that access to better health care, the latest trends and knowledge is just a few seconds away because of smart devices. Healthy trendy habits are being promoted by media. In the state sector where I am an employee, we make use of this knowledge to provide the best of evidence based treatment to the elderly.
Nevertheless there are certain controversial arguments on whether prolonging lives of the elderly is worthwhile, as they are the group that contributes the least to the society. And also on the costs involved in advanced health care. Some expostulate that the lifespan shouldn’t be extended through artificial means. As medical professionals what we try to achieve is the minimum amounts of disability so that the aged population can take good care of themselves. Without depending on a caregiver.
- We now have close to 821,000 people aged 75 and above
- SL needs 3.5 million caregivers to look after same number of elders
Further talking about elderly care and technology, I saw a video of how Japan is attempting to experiment with robots capable of looking in to the needs of the old. In a developing country using technology to this degree might be too costly. Therefore using the existing “extended family” concept and “enriched environment” might be a better solution.
What is an enriched environment? This is a situation where the brain is stimulated through social and physical surroundings. Especially after strokes, an enriched environment is proven to be very effective in bringing back the previous functions/ memory. In Sri Lanka, the extended family concept, which is still preserved in the rural areas might mimic an enriched environment. Sadly the large families that once were, are slowly fragmenting into small units, because of the “global trends in independent living”.
Being a rheumatologist/ rehabilitation specialist, I am keen to enhance the quality of life of my geriatric patients. If the elderly are treated in such a way that mobility related pain becomes ignorable, they usually recommence their previous activities. By avoiding falls, a huge cost and a burden to the family is prevented. In the absence of memory loss (dementia) component, some veteran professionals can contribute a lot to the society using their vast experience. I have witnessed volunteer schemes in the UK where starting from hospital reception help desks, most tasks are done by the elderly. The sense of importance gifted to them through these schemes, is important in enhancing self-esteem.
Sri Lanka has to prepare for the elderly population expansion. Screening for future health needs, correcting all disabilities, promoting self-care and increasing self-esteem of the geriatric population should be our aims
My suggestion is commencing screening programmes exclusively for the elderly in Sri Lanka. This should be a free access facility in all State hospitals. So far we do not have such an established countrywide scheme of screening. One might wonder why we should waste medical resources on such a programme when the hospitals are already overburdened with work. Assessing their health risks years ahead of catastrophic events might save billions of rupees. As falls/ fractures, heart attacks, cancer, blindness, strokes and other related conditions are time consuming and costly to treat.
Unfortunately to this date we do not have a single consultant geriatrician specialized in Sri Lanka to commence such a herculean task. I remember listening to discussions on starting geriatrics as early as my Medical Officer days. Even as I write this article a group of clever specialists are attempting their level best to start this specialty in Sri Lanka. Even if we commence producing several geriatricians this year itself, the rate of production might not meet the enormous demand for geriatricians by the year 2030.
As a concluding remark, I would like to state that Sri Lanka has to prepare for the elderly population expansion. Screening for future health needs, correcting all disabilities, promoting self-care and increasing self-esteem of the geriatric population should be our aims. So when it comes to elderly care and geriatrics I could say -It’s been a long time coming but better late than never!
The author is a Consultant in Rheumatology and Rehabilitation
