Srinagar: Early this year, as the second wave of the COVID-19 pandemic raged on, the family of 70-year-old Mehraj-ud-Din* found themselves at loss trying to gauge what ailed their father. His behaviour had suddenly altered to such a degree – he had become violent and abusive – that the family feared for his safety and sanity.
“His son called me in a panic-driven state. The patient was diagnosed with bi-polar disorder and sought treatment at the government psychiatry hospital, Srinagar. As the family was not well off financially, he used to procure free medicines from the hospital. The pandemic-induced lockdown left them in a fix as he could not visit the doctor for check-ups. Eventually, he stopped taking medicines and that worsened his mental health,” said Ajaz Ahmad Khan, senior clinical psychologist from the Institute of Mental Health and Neurosciences (IMHANS).
Similarly, 68-year-old Shameema’s*, who hails from a poor family background, availed treatment from the government facility for elderly at Jawaharlal Nehru Memorial (JLMN) hospital, Rainawari, for her heart blockage and hypertension.
“Due to the lockdown, she could not come for the follow ups. Moreover, she could not find the medicine prescribed for her ailment and ended up buying a simple anti-hypertensive medicine rather than the combination prescribed from a local chemist. Consequently, she landed in a heart failure and died,” the doctor treating her said.
The two cases are only the tip of the iceberg when it comes to the problems faced by the elderly persons in the Valley when the second wave of COVID-19 hit us in April. While all age groups suffered in the face of a crumbling healthcare infrastructure, the elderly in particular were affected the most.
Dr Zubair Saleem, geriatric consultant, JLMN hospital, Rainawari said that the elderly who are already predisposed to various co-morbidities faced various challenges in the second wave. This severely affected their physical well-being as they could not come for the follow ups and consultations.
“For the elderly, tele-medical advice is simply not sustainable for a majority of them as they are unfamiliar with digital devices. As a result, their routine tests were not conducted and dosage of medicines remain unaltered in absence of follow ups. This affected the kidneys and other vital organs of the patient,” he said.
Emphasising on the economic aspect, the doctor said that a large section of elderly people in the unorganised sector lost their limited autonomy and mobility in the pandemic.
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“Subsequently, they became directly dependent on the families who may be themselves bearing the onslaught of the virus. In this situation, caregiving becomes difficult and the geriatric person could well be considered a burden on resources,” Dr Zubair said.
Besides physical health, the mental health of elderly patients also took a hit due to the pandemic.
“Talking of mental health, in the first wave of pandemic, the elderly persons were confined to homes. The sense of deprivation had already set in, and the second wave exacerbated it which increased the frequency of anxiety and panic attacks, depressive episodes and insomnia in them,” he said.
Besides the general anxiety and depression during lockdown, many elderly persons were suddenly thrown into maelstroms of trauma and grief.
“A lot of them also prematurely lost their children or younger family members. Moreover, due to the lockdown neither they could attend funerals, nor relatives could come to comfort and console them. Since social rituals provide a means to share grief and gain support from friends and families during death, the inability to attend these rituals resulted in a greater lack of closure, adding multifold to their grief and pain,” noted Dr Zubair.
The collapse of geriatric healthcare, and the compounding of their problems brings to fore the lack of policymaking and engagement with regards to this section of population.
Despite a sizeable ageing population, Kashmir has only a skeletal geriatric healthcare system in place. Besides, the geriatric OPD at JLNM Hospital, Rainawari and Sher-I-Kashmir Institute of Medical Sciences; ‘Ahata-e-Waqar’ – a daycare recreation center for senior citizens – has been set up in Chanapora, Srinagar.
Moreover, a geriatric OPD has been established at a public library at Bag-i-Mehtab, Srinagar. While Srinagar can at least boast of this skeletal network, the other districts of the Valley have been left to fend for themselves as no geriatric care facility exists there.
Consultant psychiatrist at IMHANS, Dr Junaid Nabi said that elderly people need easy access to home healthcare, access to essentials preferably through home delivery, and above all compassion and care from their families and state systems.
“This is the right time to engage stakeholders, including elderly men and women themselves, to frame more equitable policies for a more active, empowered and productive old age,” Dr Junaid said.
*Name changed to protect the person’s identity
Hirra Azmat is a journalist based in Srinagar, Kashmir, who covers human interest stories with a special emphasis on health and environment.