A FRIEND’S mother has full-blown and advanced Alzheimer’s and another friend’s father has advanced dementia. Both of them are old and have a number of other ailments as well.

Both require specialised care and significant attention all the time even when no medical emergency exists. At times of medical emergencies they require specialised hospital care. Both these friends tell me they cannot find doctors who specialise in geriatric care in their respective cities. They have problems getting round-the-clock help for the care of their loved ones and they also have trouble finding specialised geriatric care at hospitals when it is needed.

Geriatric care is a specialisation. When people get older their systems slow down and decline, organs don’t work as well as before, the immune system gets weaker, the likelihood of having ailments like diabetes, arthritis, heart disease, prostate and gynaecological issues, incontinence, hearing and sight problems, etc increase significantly.

At the same time, since the person is also weaker on the whole, doctors cannot treat any issue in isolation and need to know the individual’s medical history in order to gauge how the various medicines they want to prescribe will interact with each other. The cardiologist needs to know what the orthopaedist is doing and vice versa. An older body cannot take the burden of mistakes and lack of knowledge.

This is exactly why geriatric care has developed as a separate specialty in many countries. The geriatric expert has to be an excellent general physician who knows how to care for an older body that might have a number of ailments and where the mind of the person might also be not as sharp as it once was. This specialisation is missing, almost completely, in Pakistan.

Caring for older people, even at home, requires a certain amount of effort and understanding. Even when an older person is mentally fine and has a good memory, multiple ailments can require a delicate balance in terms

of their diet, the amount of physical activity they should do and so on. But when the memory is affected and the mind is not what it was before, requirements for the care of the elderly increase substantially.

Caregivers of such elderly people need to get a certain type of training to care for the old if they want to do this well. Or, they need to get specialised help. Such quality care appears to be unavailable in society, and where hired caregivers are concerned, is also expensive.

Caring for people with advanced Alzheimer’s and/or other ailments that affect the mind, or even people with other serious diseases is not an easy task. It takes a huge toll on the caregiver

and the family. This should not be underestimated. To expect a spouse and/or sibling to be able to provide this care is quite unrealistic. To expect even children to provide this care is asking for a lot.

This is especially true if younger members of the family are also working and/or studying. Some specialised help/care, especially nursing care, might still be needed. But this does not seem to be widely available. More importantly, what is available is also very expensive and even middle class households would find it prohibitive to have such care regularly for their loved ones.

Most elderly people in our society live with their families and/or have people around them who can take care of them. But this is not universally true and so we should definitely have nursing homes and old age homes that are equipped to handle either very serious patients, advanced cases of mental degeneration and/or people who do not have family members/others who can take care of them.

As average age in our society increases, the proportion of older people in our society will also increase. Many countries have already been through the demographic transition and are dealing with much larger proportions of their populations being older.

We still have to make the transition. But there is already a certain percentage of older people in our population and they need specialised care; their numbers are likely to increase as life expectancy rises and we go through the demographic transition.

A friend’s aunt was ill for almost the last 10 years of her life. For the last five, her mental state was not good either and she could not recognise even her siblings and/or her children. She was not able to remember or perform the simplest of tasks, even ones we do not normally think about and consider them to be habitual (remembering to eat, to chew, knowing where one’s bed is).

Her care took its toll on the entire family. They got some nursing care too, but the bulk of care-giving fell on the female members of the family and they, especially the ones who worked as well, were run ragged trying to manage the care of their beloved aunt.

Even if specialised care is available the emotional toll will still be there. But the physical effort would be much less. And the emotional toll might also be less as the comfort of having specialised care would at least be there.

There is definitely some responsibility on the state. It needs to provide geriatric units in some of the leading hospitals of the country. This will set some incentives for doctors to start looking into this specialisation as well. But the bulk of the incentives for doctors and other medical specialists come from market dynamics (demand/supply). One hopes doctors see the need for this care and a sufficient number can see returns in the specialisation to adopt it. Any which way, we have to address this important need. n

The writer is senior adviser, Pakistan, at Open Society Foundations, associate professor of economics, LUMS, and a visiting fellow at IDEAS, Lahore.