Is this the silver lining we were waiting for?

From afar, Tara Vaidya (name changed on request) can be seen approaching the wide gates of Saptasopan, the week-old geriatric day care centre at Thane mental hospital. The 61 year-old resolutely looks at her feet throughout the full minute it takes to reach the facility, which has open spaces lined with trees and roofed cottages under construction. Children of the hospital’s workers squeal during their morning bath outside their quarters, but that means nothing to Vaidya. She hastily adjusts her dupatta, picks up pace just outside the centre and calls out to Dr Rupa Kinkar, the centre’s occupational therapist.

Dr Sanjay Kumavat with Tara Vaidya (name changed to protect identity) at Saptasopan, a dementia centre and day care centre at Thane mental hospital. Pic/AtulKamble

“Nine,” she says, and holds out nine fingers in the air for Dr Kinkar to see. “I made nine rotis today.” Dr Kinkar raises her eyebrows in surprise, pats Vaidya on the shoulder and laughs. “Four would have been good enough, really. But, well, I am glad. Rolling rotis isn’t that scary anymore, is it?” asks Dr Kinkar.

Vaidya, says Dr Kinkar, suffers from dementia and, until three days ago, her biggest fear was rolling rotis at home — something she had done uncomplainingly since her marriage 35 years ago but recently dreaded because the condition has affected her cognitive capacity to complete the act. When Vaidya first came to Saptasopan, her wispy hair had long escaped her bun and no amount of coaxing, remembers Dr Kinkar, would convince her to comb. Now, however, it is apparent that Vaidya has taken care to groom herself before stepping out of home.

Lavanya Bachwal and Swati Pal Biswas at IIT, Powai. Bachwal has co-authored a book with IIT professor, Gaur Ray, on designing safer and better spaces for the Indian elderly. Pic/ Rane Ashish

Saptasopan, a dementia care centre and day care facility, is the first government initiative of its kind aimed at the geriatric population in the country. The project was envisaged by Dr Sanjay Kumavat, superintendent of the Thane mental hospital and funded by the National Rural Health Mission, Maharashtra. Saptasopan, run by 21 doctors, psychologists, occupational therapists and volunteers, is spread over 10,000 sq ft. Charming cottages, all painted yellow, house a TV-computer centre to help seniors access technology-aided therapy, a playroom for games designed to aid memory and neuro-psycho-social rehabilitation, and an exercise room.

MR Sridhar (centre) at the country’s first senior-run BPO at Jobs60+ by Nightingale Trust at Bangalore. Pic Coutesy/Nightingale Trust

Apart from this, under the National Programme For the Health Care Of The Elderly (NPHCE), hospitals in six districts — Wardha, Amravati, Pandhare, Chandrapur, Gadchiroli and Washim — will establish centres with 10 beds for senior citizens and palliative care centres. “We will send the plans to the Public Works Department in a month and the facilities will be ready by December,” says Dr Satish Pawar, joint director, non-communicable disorders, NPHCE.

Slow but steady
The silver lining is slowly showing up, says Sailesh Mishra, founder president of the Silver Innings Foundation, a non-profit organisation working with senior citizens and their families, and grins at the intended pun. During our hour-long chat at a Charni Road café, Mishra’s phone rings frequently (he ignores all calls). He apologises and explains that he is busy arranging activities for the upcoming commemoration of the World Elder Abuse Awareness Day (June 15). Awareness campaigns, workshops and even a football match between teenagers from the Mira-Bhayander area will be organised to sensitise them to issues pertaining to seniors early in life. “In India, culturally, we claim we revere elders, but let’s be realistic — most people don’t give a damn about their seniors at home,” he says.

It also offers suggestions such as pasting glow-in-the-dark markers on water bottles and sharp surfaces in case a senior has to move around his/ her home in the dark. Pics Courtesy/ Lavanya Bachwal

If one takes account of the glaring lack of senior citizen-friendly spaces, policies and social and healthcare set-ups in the country, you’d know Mishra is right — in spite of the fact that the senior population in India is only set to rise. According to the United Nations Population Division (UN 2011) India’s population aged 60 and older will climb from eight per cent in 2010 to 19 per cent in 2050. By mid-century, population of 60 year-olds and above is expected to encompass 323 million people, a number greater than the total US population in 2012. Between 2010 and 2050, the share in the oldest age group (80 and older) will triple from one per cent to three per cent. Care for the elderly in India, however, is not equipped to deal with these figures.  “Elderly care in India has been the stuff of NGO meets and academic conferences — the government was barely involved. The geriatric centre at Thane mental hospital is the first effort of its kind, and I hope this sets the ball rolling,” says Mishra. 

Book of care
At this time of the year, during summer vacations, it seems the only things moving at the Indian Institute of Technology (IIT) in Powai are the eyes of bored watchmen following the traffic outside the gates. But inside, at the Ergonomics lab of the Industrial Design Centre (IDC), things are a tad different.
It is difficult to see why Lavanya Bachwal, a 26 year-old research associate at IIT, is so excited as she sits down in a cabin and fiddles with an air conditioner which doesn’t seem to work. She then hands me a draft of the book she has been working on for almost two years — Residential Interior Design for The Elderly and Physically Challenged — the reason for her cheer.

Illustrations from the forthcoming book, Residential Interior Design for The Elderly and Physically Challenged, authored by Prof Gaur Ray and Lavanya Bachwal. The book specifies different, ideal heights of the platform in kitchens for seniors who knead dough and wash dishes

For the first three days of the week, Bachwal works with the Head of Ergonomics at the centre, Professor Gaur Ray. For the other three days in the week, she is a clinical nutritionist. Since November 2008, she has been researching the book which, she hopes, will make people realise that the care of the elderly begins with their safety at homes, care centres and hospitals, and design has everything to do with it. Residential Interior Design…is the first book which takes the anthrometry (measurement of human beings) of Indians into account and is about designing spaces and homes for the elderly. “There are some books on designing spaces for the elderly, but all dimensions and facilities keep the European and American ageing population in mind. You won’t find any chapters on how to design a pooja room for seniors, for instance, or the ideal kitchen platform for an elderly lady in India who kneads dough for chapattis every day,” explains Bachwal.

The book, published by Shroff Publications, is aimed at architects, builders, interior designers, and most importantly, senior citizens, their families and caregivers. Each design specification comes with easy-to-understand illustrated sketches. Bachwal points out that, as family members age, the way they access their homes and spaces changes. Their grip, for instance, naturally loosens and simple tasks like opening doors and turning knobs become difficult.

“So many seniors fall in bathrooms and cannot peep through keyholes because they lose height with age. We change, but homes don’t.” Last month, when Bachwal’s home underwent renovation, she asked the carpenter to fit door locks at a height higher than usual, so her 60 year-old father could see it clearly. She has also installed railings in the bathroom for support.

Every year, Ray makes sure that one of the projects given to the students at IDC concerns designing senior citizen-friendly products. “We are also working on a project on the prototype of the lid and bottle that seniors will find easiest to open, which industries can use to design better products for the elderly. It is funded by the Department of Science and Technology,” says Swati Pal Biswas, a senior research assistant at the IDC.

Senior-run BPO
Two months ago, in Bangalore, a computer teacher at Jobs60+, a centre which is a part of the NGO, Nightingale Trust, asked a class of 30 senior citizens whether they would like to take up jobs after retirement. MR Sridhar was part of the class and thought the idea was downright preposterous. He didn’t raise his hand. Today, however, the 60 year-old is part of a group of 20 seniors who run a BPO, the first of its kind in the country. It will start operations this month. Throughout our conversation over the telephone, ‘loneliness’ is the word Sridhar uses most often when asked about his life post-retirement. The engineer retired in 2009 and thought he would sit back with his wife and attend social functions “like most retired seniors do”. 

“But I felt so pointless all along. I was lonely even amid my wife and children,” he admits. He applied to companies for consultation projects and was sure his age and experience would help. “But everyone said only two things — that I am too old and lacked any knowledge of computers,” says Sridhar. The experience made him aggressive at job interviews, and he decided to address the root cause of it all. Now, as he gears up to work in the country’s only senior-run BPO in the country, Sridhar says he has left his underconfident self behind. “I was the first one to raise my hand when I was asked about working in an elderly-run BPO,” he smiles. The Nightingale Trust also started its Tele Dementia treatment services last June, wherein volunteers and counsellors, armed with a laptop, visit homes of seniors suffering from dementia. The senior’s consulting psychiatrist speaks to him/her over Skype, suggests lifestyle changes and adjusts medicine doses. 

It is the advice on seemingly trivial matters that helps 22 year-old Archana Iyer. Iyer stays with her parents and 77 year-old grandfather, Ramakrishna Iyer, in Malleshwaram in Bangalore, and has been availing of the Tele Dementia service since last year. Ramakrishna’s diagnosis, in itself, was painful for the family. “He is not my old grandfather anymore — he doesn’t enjoy the walks he so loved, he mistrusts my father and believes that his friends mock him,” she says over the telephone. Soon, he refused to get into the car to go see the doctor, too. That was when volunteers from Nightingale visited the Iyers’ home and Ramakrishna’s psychiatrist spoke to him over Skype.

“He thoroughly enjoyed speaking to his doctor over Skype and even showed her our home. Then, when I offered him some tea, he got agitated and the doctor noticed it. She immediately suggested some changes in his medication,” says Archana.  Thanks to the exercise, the doctor also picked up how Ramakrishna hated being served dinner on the dining table because the array of dishes confused him, and avoided going to the washroom all day. “The doctor offered alternatives to these issues, and suggested small changes we can make in our home — like placing the TV set close to the sofa and asking our grandfather to sit there. It seems irrelevant, but to a family taking care of a senior, these things take up all day,” explains Archana, who pays Rs 800 per visit, which is cheaper than ferrying him to doctors in multi-speciality hospitals.  “My grandfather does not recognise me anymore, but it thrills me to see him smile when I approach him with a laptop,” says Archana. 

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