Home >

Overdue acceptance?

Accessibility of geriatric medicine, linked to its broader acceptability in healthcare, remains a challenge

October 01, 2023


here are many challenges to healthcare accessibility for elderly people in Pakistan. Worsening economic conditions, unfavourable government policies and an eroding sense of social responsibility have only exacerbated the issue. While this year’s International Day of Older Persons emphasises “fulfilling the promises of the Universal Declaration of Human Rights for Older Persons”, the right to healthcare for older persons in Pakistan relies mainly on the family rather than a coherent government policy ensuring inclusive healthcare for the elderly.

“The absence of elderly people’s well-being in the government’s priority list and the gradual disintegration of the family as a societal institution has put senior citizens in a difficult position, at a time they need love and care the most,” says Prof Dr Shahid Shaukat Malik, general secretary of the Pakistan Medical Association, Lahore.

Speaking to The News on Sunday, Dr Malik says that geriatric medicine is not taught as a discipline in medical education and there are no geriatric departments/ clinics at hospitals. This, he says, speaks volumes about the government’s lack of priority to the well-being of the elderly.

Caretaker Punjab Minister for Specialised Healthcare and Medical Education as well as Social Welfare Prof Javed Akram, claims on the other hand, that geriatric hospital wards are a need in Western countries, which lack family bonding. In Pakistan, he says, family ties are strong so that the relatives ensure proper love and care for the elderly.

But what about economic constraints and the resulting friction within families? As far as healthcare is concerned, Dr Akram says, there is no great challenge to accessibility for the elderly. He says that all kinds of treatments are available free of cost in public sector hospitals. He advises the elderly to get regular medical check-ups and necessary screening as advised by their physicians. “There’s no need to launch residency programmes for geriatric medicine,” he says, adding that the strong family structures in Pakistan compliment internal medicine services in hospitals.

Prof Khalid Masood Gondal, president of the College of Physicians and Surgeons-Pakistan, says however, that the CPSP plans to launch a residency programme in geriatric medicine.

Dr Shahid Malik says that the challenges that elderly people deal with include chronic illnesses, sensory impairments (vision and hearing), risk of falls causing fractures and immobility and cognitive decline. “The weakening self-control over urinary and bowel habits make elderly people dependent on others. Dementia or Alzheimer’s is not even considered a disease in Pakistan,” he says. Dr Malik says that domestic isolation and loneliness are pushing many elderly people into depression.

He says while ramps have been provided in most hospitals, the governments must make it mandatory for all public and private buildings meant for public use to ensure the availability of ramps and elevators to facilitate the elderly. “Separate counters should be set up in all public and private institutions to deal with them,” he adds.

Dr Malik says that elderly people should be encouraged to visit parks so that they breathe fresh air and walk. “The government should provide for their free entry in parks, make sitting arrangements and separate walking/ running tracks for them,” he says. He says free transportation can also help improve accessibility to health services and opportunities for a healthy life.

Dr Salman Kazmi, general secretary of the Young Doctors’ Association-Pakistan and a medical officer at Mayo Hospital, Lahore, says that while elderly people are treated in general wards in government hospitals, there is no special supportive care for them. At best, the terminally-ill patients are kept in hospice care available at some hospitals. This allows the elderly patients to spend their last days peacefully. “Many families and children leave their elderly parents at the Punjab Institute of Mental Health or psychiatry wards of other hospitals and seldom return,” he says. He says too often, elderly people are seen spending nights out in the open in the city’s main thoroughfares.

Dr Kazmi says that old age homes are cropping up in every city but appear to be insufficient and unwilling to accommodate the elderly people for as long as is necessary – in some cases, for a lifetime. The Musafir Khana initiative of the previous government was irrelevant in this regard as strict procedures at these shelters did not allow one to stay for more than two days.

He says that the Health and Social Welfare Departments need to collaborate to ensure proper treatment and supportive care for the elderly people to enable them to live healthy lives. He suggests setting up counselling centres for the elderly at public hospitals. “Some of the private hospitals are minting money in the name of geriatric care,” he says, adding that the Punjab Healthcare Commission has hardly done anything to facilitate the elderly patients in public and private hospitals.

Dr Muhammad Maqsood, an assistant professor of medicine at the Lahore General Hospital, suggests that elderly men and women should increase their intake of calcium or milk, depending on their physician’s advice, to prevent osteoarthritis and bone weakness that may lead to fractures. He advises against poly pharmacy, self-medication or visiting quacks, which may cause more harm than good.

Medical experts say that despite physiological changes and other limitations, evidence suggests that older adults can age successfully. To promote healthy ageing, optimum healthcare is important.

The writer is an investigative journalist associated with The News International. An EWC and GIJN fellow, he also contributes to various international media outlets. His X handle: AmerMalik3