Longevity: a boon or a curse?

TeaThere’s something so seductive about the jagged smiles of old people. It is like children. Whenever I used to talk to Lakshmi, her smile and relentless voice would fascinate me. She was a breast cancer survivor, and bravely endured eight years of major surgery, chemotherapy, periodic scans, and numerous doctor visits.

When I first met her at the clinic a year ago, she had back pain that turned out to be a recurrence of breast cancer with spread to the spine. She went through a major spine surgery and recovered. But the wound ruptured as a result of mandatory post-surgical radiotherapy to the spine. She was now in her eighties and diabetes and cardiac problems were serious challenges for her wound to heal. But whenever I met her, she never shied away from sporting her smile.

Finally, he was discharged after a month-long stay. Like in a haunting movie, just when we thought she had come out of our hell, she returned to the hospital six months later with a clot in her lung. Now she had lost her smile. The long hospitalization, the prospect of multiple tubes being inserted, a battery of tests and the prospect of another surgery weighed on him. I was pretty sure that with intensive care and high-end medications, we could prolong her survival but she had lost her will.

The life expectancy of an average human being at the beginning of the 20th century was about 40. Due to dramatic improvements in modern medicine and public health initiatives, life expectancy has now risen to 75 worldwide (the global population aged 60 and older has doubled in 1980 by 2017). In particular, humans have lived longer than their ancestors because of vaccines to reduce the incidence of communicable diseases, early diagnosis and treatment of non-communicable diseases, effective surgical treatment, and handling of complex injuries. Although many lifestyle diseases such as diabetes, high blood pressure and heart disease are affecting people more than ever before, there are a plethora of medicines to keep these diseases under control. Many people take these drugs for 20 to 30 years, which reduces the risk of early death. Modern cancer chemotherapy, precision surgery and focused radiotherapy have made the survival of cancer patients much longer than before. All of them have delayed death, but are at risk of disability. Elderly people living with colostomy bags, indwelling urinary catheters, thrice a week dialysis, tracheostomy tubes, multiple surgeries, oxygen cylinders and respiratory supports have become relatively common, especially in developed societies. It presents philosophical questions of long-term disability due to aging.

As we age, neurological diseases such as Alzheimer’s and Parkinson’s diseases, and musculo-skeletal diseases such as osteoporosis, sarcopenia, and arthritis are natural accompaniments, making the mobility of elderly people difficult and painful. In developed societies where adequate social health care systems exist, the lives of the elderly are reasonably well supported. Social discussion groups, home care nurses, delivery of essential items and recreation centers help them deal with the disability with proper rest. All government and private places are equipped with ramps, easy access to toilets, lifts and comfortable parking spaces, helping the elderly to lead a better life.

little support

However, in developing countries like India, the increasing life expectancy of the elderly seems to be a curse for many. The shattered joint family system and the lack of government social support have a double whammy on the plight of the elderly. With many children working abroad or having odd working hours, older people are left to take care of their disabilities. Many of them find it difficult to walk on our potholed roads, unable to get even basic groceries. They rely on online delivery agents and Good Samaritan neighbors and auto drivers. The problems are further exacerbated by the psychological effects of “empty-nest syndrome”, leading to increased physical impairment.

Unlike other animals and plants, whose life expectancy has been the same for millions of years, humans have tricked nature and prolong their lives, albeit with the bad stuff. Modern science is developing every day in leaps and bounds, finding cures for many diseases and postponing the inevitable. I am not arguing that science should not be developed and diseases should not be cured. But the way we move into old age and the way we are supporting the elderly must simultaneously change. Similar to retirement financial plans, the focus should be on physical fitness to reduce future musculoskeletal disability, at least from mid-life. Sedentary lifestyle, job stress and obesity are fodder for disability in old age. The physical infrastructure, and social systems of offices, buildings and recreation areas must be significantly improved so that senior citizens can be comfortably enclosed rather than locked inside the home.

rishiortho@gmail.com