The United Nations has dedicated this decade to healthy ageing – one billion of us are over the age of 60. According to the World Bank collection of development indicators (2020), persons aged 65 and above are 4.3 percent of Pakistan’s population. The fraction is expected to continue to grow.

Older people have different health issues and needs compared to the rest of the population. The field of geriatric medicine is established in most of the world. However, in Pakistan it is neither recognised as a specialty nor taught in medical universities.

Even primary care is a rather new concept here and most people seek care only when problems arise. We know that preventive care is crucial for our health. This becomes essential as we age. If we don’t focus on preventive care, then we will be ridden with disease burden for older adults, and the burden of disability will be tremendous.

Dementia is a disease of ageing (prevalence: 12 percent among the 65 - 74 age bracket; 20 - 25 percent among the 75 - 84 age bracket; and 45 percent for age 85 and above). It is important to recognise the burden on patient and caregivers for the course of this disease. Stroke is another disease common among older adults and can lead to significant disability and requirement of specialised care. Dementia caused by Alzheimer’s disease may not be curable, but stroke can be prevented by treating its causes like hypertension and diabetes early in the course of disease.

Burden to caregivers for persons with dementia and disability caused by stroke is significant, leading to caregiver stress and can be detrimental to their health. While families with means can afford homecare, poor families cannot, which can lead to loss of income for these families.

Consider another element: there is no system in place for the support of psychosocial needs of older people dealing with disease burden and their caregivers.

Countless families across socioeconomic strata are dealing with this burden, and there is no formal support from healthcare. While there are a few geriatric centres in Karachi and Lahore, there is no formal structure of geriatrics training in Pakistan. It is important for us to advocate for post graduate training of doctors in the field of geriatrics. And not just doctors, we also need to train nurses, homecare workers, rehab therapists and psychologists to provide care for an ageing population across the continuum of care.

It is also important to increase awareness among general population regarding healthcare needs of older people and focus more on prevention. Only one third of dysfunction for ageing persons is caused by pure physiological changes, e.g., hearing impairment, and vision impairment etc. One third are diseases of ageing like diabetes, high blood pressure, stroke, osteoporosis, osteoarthritis, certain cancers etc. One third are due to misuse or disuse – we lose around 40 percent muscle mass between the ages 40 - 60. Diseases like hypertension, diabetes, osteoarthritis, and osteoporosis can also be better managed with modification in lifestyle. In essence, two thirds of health-related problems can be prevented or delayed with focus on prevention measures.

We also need to implement programmes where focus is on awareness and provision of resources for caregivers, so they don’t end up seeing their elders as a burden. Public health measures like ad campaigns in print, electronic and social media will help families deal with healthcare issues and make life easier.

Falls are a problem faced more by the elderly and can lead to further disability and impaired mobility. Most falls take place at home. The focus should be on making home environment senior-friendly by having non-slippery floors, special equipment in bathrooms (raised toilet seats, grab bars).

Depression and social isolation are other major healthcare related issues faced by older persons. Serotonin depletion leads to higher depression prevalence among older populations and lack of resources like social support of peers leads to downward spiralling. Families need to understand that social activities with peers and friends are a key to functional and healthy ageing.

While no formal support exists, several groups of individuals are creating support groups like senior citizen clubs and gatherings for older persons, where they engage in social activities with one another. My mother lived till the age of 86, and I used to beg her to live with me abroad. She wouldn’t because of her friends and companions. Her neighbour ladies were younger than her, and they had created this system where they all looked after one another and went to social gatherings together. She had fallen and broken her hip at the age of 83. She had become bedbound for the last few years of her life. Her friends and neighbours created a roster by which they visited her and brought her food. During that time, I moved back to Lahore and noticed that she was depressed. My mother loved to sing; so I started signing with her, and arranged social gatherings for her where we engaged in activities she liked. She became happier.

Many years later, my older sister and her group of friends are continuing in this neighbourhood club where they take gardening lessons, and pool resources for transportation and take part in social welfare activities together, where they look after one another as well as older ladies. They sometimes ask me talk to them about preventive measures for successful ageing. During the pandemic lockdowns, they went on walks together in the park, and created a social network to make sure everyone was supported. They are a vibrant group of their community.

I recently discovered a group of men of various ages, who were all part of political activism during the 1980s. Most of them are seniors now, and are fondly called “leftovers”. They meet every week at one of the local clubs and no formal membership is required. Newcomers are welcome. They have tea and biscuits and talk about current affairs. An hour is dedicated to poetry recitation. They, too, pool resources like transportation etc. I attended a few of these meetings recently (women are welcome too), and it was such a pleasure to hear their stories. One of them told me that he had had a stroke a few years ago and had become depressed but coming to these meetings had improved his health.

These informal support groups are a perfect example of community support for ageing populations. We need to encourage more of such gatherings and programmes. Senior centres in the US are a great resource for socialisation of older adults. Mostly such centres are supported by community groups and foundation grants, and have some formal structure like social workers, lunch programmes and social activities. Community and academic physicians, geriatricians and other professionals volunteer their time at these centres to provide educational awareness talks and health screenings for older adults. In most metropolitan cities in the US, there are groups of volunteers who are young professionals, and they engage with vulnerable homebound seniors and do their chores for them. Some just provide socialisation like reading the newspaper for them or playing card games etc. We could create such programmes in Pakistan and reach out to academic institutions to create awareness campaigns.

Senior citizens helped build foundations of the society, and their continued presence leads to robust younger generations. Healthy ageing is possible by implementing better healthcare programmes and providing better resources for patients and caregivers.

The writer is a US-based geriatrician who has held positions at University of Michigan, Indiana University, University of Wisconsin and New York University. She can be reached at amnabuttar@gmail.com, and on Twitter @dramnabuttar