There is no escaping the age issue. The life expectancy of an average Nepali rose from 27 years in 1954 to 67 years in 2014. In fact, the past few decades have seen unprecedented growth in the elderly population and dependency rates. While the elderly population grows globally, there is a disproportionate number of geriatricians (physicians specialised in the care of the elderly) even in developed countries. Nepal is no exception; projections indicate that the issue is likely to impact the nation’s health care system and economy heavily.

Among the factors contributing to an upsurge in the elderly population include accessible and affordable medical care, widespread health care education and improvement in dietary habits and lifestyle. The traditional Nepali culture of living as a joint or extended family has been instrumental in the welfare of the elderly. However, as young adults in families migrate from the villages to the cities, and from cities to developed countries, the elderly suffer from inactivity and malnutrition, often leading to a deterioration of their physical and emotional health.

Setting the stage

Aging can be depressing as one loses one’s job, health, independence, spouse and family. For instance, as people age, they tend to develop dementia, making them more dependent on caregivers. When life expectancy was low, say 30 years ago, this subject was irrelevant, but now the issue of aging looms large. The media, public and policymakers should shed light on the concern in order to draw the attention of private and public stakeholders. Meanwhile, the lag in medical insurance policy, lack of awareness about the growing demand for a geriatrics workforce, political turmoil and inadequate

government intervention portend tough times ahead.

The bulk of geriatrics care (for those over 60) in Nepal is currently being provided by general internists, neurologists and psychiatrists. However, the physiology of diseases, social, psychological and emotional intricacies can be entirely different and complicated in older adults. These aspects can impact the outcome of medical treatment and can only be explored and addressed by a dedicated team of multidisciplinary professionals. Unfortunately, Nepal has only a handful of physicians trained in geriatrics. What makes things worse is that most of them live abroad.

Acts and guidelines are in place in Nepal to ensure health care rights and subsidised treatment to senior citizens. The formulation of Senior Citizens Treatment Guidelines (2061 BS) and the establishment of Senior Citizens Health Facilities Fund to ensure discounted medicine and treatment fees to the elderly poor in each district are steps in the right direction. Nevertheless, a provision to establish a health centre for the elderly in all the five development regions is yet to see the light of day. Meanwhile, although the provision of free health service for heart and kidney patients older than 75 is available, it is ineffective. Old age homes such as Pashupati Briddhashram and Devghat have been serving impoverished elderly citizens. In spite of this, the homes are ill-equipped in terms of the workforce and technology to provide advanced care. More than 80 charity organisations have been working to improve elderly care, although their services are fragmented.

Improving lives

Shunning responsibility by blaming the government for its inefficacy may be the easy way out, but each of us has the obligation to realise better care for vulnerable seniors. Geriatricians need to design pragmatic and affordable health care models for senior citizens. These health care providers can play a pivotal role in honing the geriatric skills of home health aides, nurse aides and personal care aides. Geriatricians also hold the key to developing content for patient education and care coordination and to fashioning an interdisciplinary care model through their collaboration with policy-makers. Frequent discussions among health care providers in and outside the country can ensure high-quality and cost-effective medical services for elderly Nepali citizens.

Many developed countries have started integrating geriatrics curricula in medical schools and residency programmes to partially offset the demand for geriatricians. This approach is likely to produce specialty doctors with geriatrics knowledge who can integrate their patients’ social, emotional, physical and spiritual aspects in providing holistic care. Establishing geriatric units in major academic hospitals can pave the way for the development of a geriatric-focused workforce. Palliative care and prototypes of long-term care facilities, such as Bindhyabasini, can foster age-friendly recreational activities, sports, and entertainment programmes to keep residents socially and cognitively active.

NGOs and INGOs can lend a hand by partnering with the private sector to establish rehabilitation centres, elderly homes, daycare centres, assisted living facilities, nursing homes and palliative care/hospice facilities. They can also train geriatricians, geriatric-focused nurses, physical and occupational therapists, psychotherapists, case managers and social workers who love interacting with the elderly. Such actions would foster good health, nutrition, social welfare and security to this vulnerable population.

A brave new world

Software engineers in Nepal also have a responsibility to advance health information technologies. Many countries, including China, have launched mHealth, a platform that utilises mobile phones, tablets and computers to deliver medical services and information. Such technology is integral to patient care through telemedicine, accessing patient records, appointment reminders, assessing treatment compliance and raising health awareness. Patients can connect with their health care providers anytime, while providers can make precise decisions based on realtime evaluation of collected information without on-site patient revisits. This lowers health care costs, and improves quality of care and treatment outcomes. As such, there is a need to raise awareness about assistive technologies and remote monitoring technologies to improve safety and communication.

Ultimately, the buck stops with the government, whose role includes enhancing countrywide networking at grassroots level, designing performance indicators and integrating different health care settings and providers. The state should promote and

oversee the implementation of policies aimed at easing the lives of the elderly, such as laws ensuring barrier-free access to buildings and transport.

Such steps would help the older

population uphold its autonomy and dignity. Furthermore, by facilitating inter-regional workshops and collaboration with international organisations for interval training of the health care workforce, the government can help hone much-needed skills.

One thing is certain: age will soon creep up on most of us. Safeguarding today’s elderly population means protecting them from exploitation, neglect, destitution and poor health. Serving seniors also means offering them a buffer against loneliness and helping them maintain their purpose. By remaining proactive and realigning our resources towards helping the elderly, we will be safeguarding their future, and in turn, our own.

Bhattarai is a practicing

nephrologist in West Palm Beach, Florida, USA; he is also a geriatrician