he population of the world is ageing at a substantial rate. The developed countries have been dealing with the phenomenon for decades. Programmes and networks have been set up to support the elderly population in the community in those countries. On the other hand, the Global South used to have strong family networks. These included extended families, village communities and mohalla communities in the cities. These support systems have deteriorated due to urbanisation, and mass movement of the youth to cities and abroad. This has led to the disintegration of extended families and mohalla communities, leading to social isolation among the elderly.

While governments of developed countries have provided support networks and community programmes, governments in the Global South, especially Pakistan, have limited or no programmes to support the elderly in the community.

When I was a child, my maternal grandmother lived with my uncle, and visited us frequently. She was disabled, but was revered and respected by everyone, and was surrounded by loved ones. My paternal grandmother lived in the village with my uncle, and had access to social support through friends and extended family.

Older adults today are facing social isolation, as many families are spread across the globe and many of them are forced to move out of their neighbourhoods, villages, mohallas, cities or countries. If they move, they face the prospect of being in a place where they have no support outside of their family. This can lead to exhaustion and caregiver stress for children. This can also put the elderly in a situation where they will feel like a burden, leading to depression and feelings of helplessness and despair. If they choose not to move, then they are dealing with social isolation again, as there are no “elderly friendly” services like special transportation, senior citizen centres and specialised meal delivery programmes, like the ones in developed countries.

Most of the adults in their seventies start losing friends due to severe disabling illness or death. If they move abroad, they have to deal with the cultural shock and language barriers.

We used to have a culture, where older adults were considered a source of wisdom, and would be treated as matriarch or patriarch of the family. Due to our longing for and fascination with Westernised ways of life, we have lost our family bonds, and have made many a buzurg feel like a burden.

Some young families expect their mothers to help out with babysitting or cooking, overlooking the fact that they have already done this while raising their children. They should now be living a life of comfort and enjoying their old life. Most middle-class people don’t save enough for old age, as they have to deal with demands of raising their families.

Social isolation leads to depression, worsens cognitive impairment and increases disease burden, as many choose not to go see their doctor due to lack of elderly friendly transportation services. Malnutrition is prevalent among the elderly due to multiple factors including, changes in appetite and taste due to ageing, dental problems and lack of access to food due to social isolation.

Social isolation also puts the elderly at risk for elder abuse and fraud. There have been incidents of persons or groups having some older person hand over their house or substantial amounts of funds to people who have no interest in their personal well-being. There would be little likelihood of this previously due to constant family oversight.

Geriatrics is not a recognised specialty in Pakistan. This leaves a void where there are no advocates for demanding better services for older adults. Geriatricians are healthcare providers trained to not only focus on diseases, but a person as a whole, and their psychosocial health, and community needs for their healthy independent living in the community.

Geriatrics Centres not only provide geriatricians, they offer multi-disciplinary experts, including social workers, physical therapists, psychologists, gerontologists, nutrition specialists; and offer a comprehensive service. Once these are in place, we will have a multitude of services to improve quality of life and promote healthy ageing. Once geriatrics is established as a specialty, the government should fund geriatrics centres in all districts across the country.

The government should also implement programmes where accommodation should be made to support older adults, e.g., specialised on demand transportation, subsidised food and groceries delivery programmes, special crime divisions for elder fraud and elder abuse and subsidised home care.

In an earlier article in these pages, I had mentioned several informal social support programmes. It is essential that we continue to support the existing groups and encourage the formation of new support groups. The government can start programmes that support these informal groups.

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