February 1, 2010

Geriatrics: Boon or Curse?

A very well known English proverb goes like “Knowledge is Power.” The knowledge of aging empowers us to provide for a better quality of life for the aged. It’s a well-known fact that ageing is universal and an irreversible process. If we try to look to the age old traditions of Indian Culture, old age is considered as one of the stages of human development wherein an individual attains wisdom, maturity, social & economic security, with social recognition and emotional fulfillment, leading to the last phase of life, which is considered to be of spiritual salvation. This process of aging & old age has been considered as an integral part of the process of development of the life course, set against the backdrop of births & rebirths. In ancient times the elderly occupied a position of prestige, power & privilege. The Varna Ashrama dharma scheme of life also associated honour and respect to the aged. With the advent of modern medical science & health care service, life expectancy/longevity got increased considerably. The rapid and faster technological growth in medical science has considerably controlled the fertility & mortality rate and relatively large population of elderly persons.

India is in the throes of a temporary compacted demographic transition. Thus, India, being a country with a tradition of good elder care, is facing many affronts that seem to threaten the status of the elderly. Like many other developing countries in the world, India is presently witnessing rapid ageing of its population. Urbanization, modernization and globalization have led to changes in economic structure, erosion of societal values and the weakening of social institutions such as the joint family. In this changing economic and social milieu, the younger generation is searching for new identities encompassing economic independence and redefined social roles within, as well as outside the family. The changing economic structure has reduced the dependence of families on land, which had provided strength to bonds between generations. The traditional sense of duty and obligation of the younger generation towards their older generation is being eroded. The older generation is caught between the decline in traditional values on the one hand and the absence of an adequate social security system, on the other. This breakdown of traditional kinship and family organizations leaves the elderly helpless, isolated, and economically dependent. The mental health of older persons is influenced not just by ageing changes in the body and brain, but also by socio-economic and psychological factors. Growing old can also be agonizing for the ageing. Then there are things to consider such as the very volatile emotional state of the elderly, their loss of self-esteem and the accompanying feeling of uselessness, and the loneliness they have to deal with when they realize that all their friends have already gone ahead of them!

In the present scenario the traditional family is fast disappearing. With urbanization, families are becoming nuclear, smaller and are not always capable of caring for older relatives. Increasingly, older people may be perceived as burdens due to their disability or dependence. Rapid changes in the family system are reducing the availability of kin support. With modernization, older values are being replaced by ‘individualism’. The family’s capacity to provide quality care to older people is decreasing. In non-agrarian societies older persons who are ‘economically unproductive’ do not have the same authority and prestige that they used to enjoy in extended families where they had greater control over family resources. The unconditional respect, power and authority that older people used to enjoy in extended traditional family are being gradually eroded in recent years. The social and economic pressures are impinging on intergenerational relationships. Efforts are being made to revive cultural values and reinforce the traditional practice of interdependence among generations.

India is geographically vast and culturally heterogeneous country and the Indian subcontinent is physically and culturally diverse. Though Hindus are the majority, secular India is home to different religions. Different parts of the country are experiencing varying degrees of socio-economic change. Literacy, employment, health and morbidity rates vary from region to region. Urban and rural environments present contrasting pictures with respect to quality of life at any age. Population ageing is the most significant result of the process known as demographic transition and India is undergoing such a demographic transition.

In ancient India, life span was divided into four stages: life of a student, householder, forest dweller and ascetic. There was a gradual move from personal, social to spiritual preoccupations with age. In most gerontological literature, people above 60 years of age are considered as ‘old’ and as constituting the ‘elderly’ segment of the population. Manu, the ancient lawgiver, in his Dharmasastra divided this span of life into four ‘Ashramas’ or life stages. The first, ‘Brahmacharya’ (life of a student) was to be spent at the teacher’s (guru) house. This is the life of a celibate, to be spent in education and training. Once education was complete, the boy (grown into adulthood by now) would be ready to enter the ‘Grihasta’ ashram. This was the life of a householder. A man was to marry, have children, and shoulder the responsibilities of an average citizen in the society. He was to discharge the debts he owed to the parents (Pitru Rina) by begetting sons and to the gods (Deva Rina) by performing Yajnas (rituals). This was the stage when a man would fulfill his basic desires, for love, marriage, for parenthood, for status, wealth, prestige and other such physical and social needs. When a man’s head turned grey and wrinkles appeared, he was to give up this life of householder and turn to ‘Vanaprastha’, which literally means ‘moving to the forest’. A mature and ageing man would gradually give up his worldly pursuits, move away from the mundane routine of householder and turn inward in search of spiritual growth. Finally, when he was spiritually ready, he would renounce the world completely and enter the stage of ‘Sannyasa’ or asceticism.

Indian culture, like many other Asian cultures, emphasized filial piety. Parents were to be honoured as gods. It was considered the duty of a son to respect and care for his parents. Indian society is patriarchal and after marriage sons bring their wives to the parental household to live. This tradition assured that old people would have younger in-laws and grandchildren to care for them. Also, caste and kin group exerted pressure on younger members to obey and respect elders. Apart from these the old people played the most significant part in the socialization of young by transmitting their knowledge. As a result of recent induced and spontaneous social change, the traditional social structure based on ascriptive criteria is crumbling down and gradually yielding to a new system based achievement criteria. As the traditional bonds are weakening, the extended family system is being gradually replaced with nuclear family system.

In modern India, for all practical purposes people above 60 are considered to be ‘senior citizens’. How elderly people are regarded in society varies from culture to culture and country to country and affects their care, independence, and participation. A culture's high regard for elderly people can be estimated by the extent to which societal values support positive self-esteem and status of elderly people. In industrialized societies older people are not critical to the functioning of the nuclear family, and extended care of dependent elderly people is often assumed by formal systems of long-term care. As nations become more industrialized, there appears to be a trend toward loss of role and status for elderly people, with an accompanying move toward a more nuclear family structure that minimizes the contributions of elderly people.

It is inevitable for a human being to undergo this phase of life, i.e. old age. In our Hindu scriptures it is clearly mentioned that there are six stages of human life viz. “Jayate, Vardhate, Asti, Parinamayate, Apakshiyate and Mriyate.” This “Parinamayate” i.e. transformation of human body is inevitable whether one is rich or poor, educated or uneducated, weak or strong, whether one is Muslim, Christian or a Hindu, this old age is bound to come to one and all with its varied complications. It is impossible to think that one will remain evergreen forever. In this connection a very significant event happened in the life of Gautama Buddha when he was Prince Siddhartha. He was born as a son of king Suddhodhana and was raised carefully by his father with luxuries so that he would not be tempted to abandon his destiny as the ruler of Sakhyan kingdom, for the prophecies were uncertain concerning whether he would succeed his father as king or leave the palace to become a spiritual master. In spite of his father’s protection, Siddhartha came to know old age, disease and death as unavoidable sufferings of all human beings. His encounter with these existential questions finally led him to forsake his royal environment to seek liberation from sufferings in an ascetic life. He devoted six years to his ascetic exercise before his great enlightenment took place. At the age of 35, Gautama attained a complete awakening and became the Buddha, or the Awakened One. On the morning of the enlightenment, the Buddha apprehended the truth that all things and all beings are interconnected and mutually dependent in time and space. The spiritual journey of a man is a continual exploration of the truth of interdependence, which Siddhartha Gautama realized to become the Buddha, “the Enlightened One.”

1 comment:

  1. Very thought provoking. The title raises an apt question and here in what you have depicted is actually a very scary picture of our society. Hope this reading helps people realize their odds...

    Great blog...!!

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