Building more nursing homes or putting the elderly in the existing ones is not the right thing to do. We essentially need a system that addresses their medical and social needs, and helps families take care of their elderly.

Afew days ago, a 76-year-old woman visited my clinic. She had fallen down on the bathroom floor one night and was unable to get up. She lay on the floor till her maid came and helped her the next morning.

My patient was a widow who lived alone in an apartment while her three children lived abroad. Sadly, there was no one to help her when she needed people most.

Doctors are coming across such cases more and more frequently in their medical practices; these not only reflect the increasing number of elderly in our population but also give us a glimpse of the changing social structure of our society.

A look at worldwide figures well illustrates the rise in elderly population. According to a 2005 UN report 20 per cent of the population in the developed countries is 60 and older. By 2050 this will grow to 50 per cent. In the developing world eight per cent of the people are 60 and older and by 2050 this number will increase to 20 per cent.

These growing numbers require the presence of a proper social and medical infrastructure to adequately fulfill the needs of our elderly.

When doctors look at health of the elderly, they find that the elderly are more prone to succumbing to various illnesses and diseases as compared to an average adult. They are also more at risk for certain unique conditions like memory loss, osteoporosis and falls. These conditions then are often complicated by atypical symptoms making diagnosis and care more difficult.

Older individuals may also experience a decline in their socioeconomic status. They may have retired from active workforce; they may have suffered losses (loved ones, friends) through their lifetime which makes them vulnerable to depression and social isolation.

In the West, the concept of independent living and nuclear family system has long been in place and acceptable and nursing home care has become a satisfactory option for a lot of older people.

Though far from perfect, such homes do provide some structure and protection to the most frail and old. Nursing homes also play a role in housing certain elderly patients with illnesses such as advanced dementia where home care is next to impossible due to need for skilled labour.

Our society historically has maintained a strong family structure in which elders have held positions of respect and been given reverence. Unfortunately this structure is now rapidly crumbling, giving way to western trends. The increasing pace of life and decreasing tolerance of joint family systems has led to nuclear families. Many of our elders have thus been sidelined and marginalised.

The brain drain our country has faced for the past so many years has also affected our elderly since children who leave for better jobs or education often prefer to stay back, leaving parents behind. Things get worse when one spouse in that aging couple dies leaving the other to live alone.

Similar changes are also being seen in India. According to the Help Age Society of India (a non-profit organisation) 11 per cent of their elderly either live alone or with unrelated people. These numbers will more than double by 2025.

Today organisations exist and operate in India that work with or for the elderly. Most of these are private and provide both social and medical support. The government also has in place a ‘social pension plan’ which targets the poor elderly and provides some financial aid. Geriatrics (elderly care medicine) as a separate and specialised field is also recognised in India.

In our country so far only one organisation is dedicated to serving the elderly. The government has recently addressed the issue of caring for the elderly but so far nothing concrete has materialised.

Some nursing homes do exist and are administered by private or religious organisations. Though serving a very valid purpose, such homes are only a part of the solution. Building more nursing home or placing our elderly in the existing ones is not what is needed.

Rather, we essentially need a system that addresses their medical and social needs, and helps families take care of their sick elderly.

Programmes like subsidised medical plans, prescription plans, transportation, etc., would help our elderly maintain their health and have better access to their health care providers. Doctors who specialise in geriatric care and can work in partnership with specialists in order to maintain the health of the elderly also need to be encouraged.

Other options include a social framework for the elderly where their communal needs may be met and issues like isolation from society might be addressed.