Book Review – Medicine of the Elderly / Vol I and II By Kusal Perera What is “geriatrics”? This was one word that I was not much familiar with, till I read through two volumes titled “Medicine in the Elderly”, co – edited by Professor Colvin Goonaratna, the eminent Physiologist who was Head of the [...]

The Sundaytimes Sri Lanka

Business of Growing Old


Book Review – Medicine of the Elderly / Vol I and II By Kusal Perera

What is “geriatrics”? This was one word that I was not much familiar with, till I read through two volumes titled “Medicine in the Elderly”, co – edited by Professor Colvin Goonaratna, the eminent Physiologist who was Head of the Department of Physiology, Medical Faculty, University of Colombo, one time President of the Sri Lanka Medical Association, Chairman, Pharmaceuticals Corporation and one who held and holds many prestigious positions too, along with Dr. Achala Balasuriya, a Consultant Physician and Dr. Piyusha Atapattu, a Senior Lecturer in Physiology at the Medical Faculty, Colombo University.

The title of the two volumes itself is an explanation of the noun “geriatrics”, while dictionaries from Collins to Webster, from American Heritage to Cambridge say in common, that “geriatrics” is “the medical study, treatment, and care of old people and their diseases”. The important question and what is being raised by the three compilers of these two volumes is, how important is it for us in Sri Lanka to pay reasonable and adequate attention to this section of the population that is fast growing in numbers?

Often people don’t want to accept they grow old and wish to present themselves as still “young enough” for the occasion. Hair dyes and “make up” paraphernalia would not otherwise have a thriving market in our society. Yet the fact is, we cannot avoid or give “ageing” a pass. The latest numbers and percentages available with the Census and Statistics Department from their second preliminary report of 2011 shows an increase in female population with 51.5 per cent out of 20.27 million individuals. Females would therefore have the larger share in old age. This also says, “old age” calculated as above 60 years of age and technically non-productive, shows a very significant growth or an increase from 9.3 per cent in 2000 to 12.2 per cent of the total population in 2011 and another 25.8 per cent below 15 years of age, who are also dependants. This means, a visibly shrinking percentage of 62 for now between 15 and 59 years of age, has to take care of the rest of the population.

The two volumes “Medicine in the Elderly” are therefore important to a discourse in readjusting and including elderly healthcare in our health service and also on social security networks for the elderly, especially the poor. The three medical professionals take us on a journey that one would not expect to have any relevance to old age. I wonder who is aware that there is an Act No. 09 made into law by parliament in year 2000, short titled as “Protection of the Rights of Elders” and provides for the establishment of a “National Council of Elders” (NCE). This Act had been amended as Act No. 05 of 2011. Under this, the President appoints four members from among professionals, corporate and public sectors to the Board of the NCE. The Act provides for elders as parents to have a monthly payment or a lump sum from their children, if they are unable to maintain their old age lives with basic necessities. The Act clearly says, basic necessities “will not be limited to shelter, food and clothing” (Section 25-3). That thus makes health and medical care an important factor too, in old age.

While the compilers of these two volumes have thought it necessary to include the first Act No. 09 and then its Amended Act No. 05, in Volume II of their publication, they have also brought in very important essays from very competent and qualified persons to cover areas that would provide extremely good information and knowledge to any reader, young or old. The essay on “Some relevant legal issues; the prevention and resolution of disputes” by Yasantha Kodagoda in Volume I is certainly a new insight for those who are responsible in care giving to the aged. He touches upon issues like the “Last Will” and the role of a medical doctor in disputes that may arise before and after a “Last Will” is signed by an elderly. The essay co-authored by Dr. Achala Balasuriya and Prof. Goonaratna on “Sleep Problems” was another very interesting chapter in Volume I. Periodic Limb Movements in Sleep (PLMS) the two professionals say, is an old age disorder and often has Insomnia as a complaint. So is the last essay on “Care of the Elderly in General Practise (GP)” by Dr. Ruvaiz Haniffa. The essay has very revealing information on GP. It says in Sri Lanka, annually estimated family practice consultations are estimated to be 12.7 million and 32 to 50 per cent of our elderly, use them. The best is that Dr. Haniffa believes, the elderly needs “home visits” and says, it is “a key component of the overall assessment of elderly patients.”

Volume II has other important topics. Chapter 3, “Sexuality in the Elderly” written by Dr. Lasantha Malavige, that begins with a poem written by Bertrand Russell at his ripe old age of 80 years to Edith, his fourth wife, which provokes much interest beyond often heard private whisperings. Essays like, “Dental and Oral Health” and “A Good Death” are essentially very useful reading. There are more essays for those with a better understanding of medical terms and concepts that could enrich a much neglected dialogue on elderly healthcare.

The two Volumes by these three eminent medical persons, beyond their educational and informative value for dialogue, raise one very pertinent question responsible authorities and organisations in society including the corporate sector should pay attention to. Can all these very apt and necessary conditions for good, old age living be satisfied within our social structures and with the new law “For Protection of Elderly Rights”? Perhaps the urban middle class and the affluent would manage. But the majority is not them. Often conflicts between parents in old age and their offspring are not due to children consciously neglecting their responsibilities in taking care of the aged parents, but because of their inability to provide care.

Poverty in ability fashions thinking and decides life values and social responsibilities. Inability tends to make persons, unwillingly selfish.

Though on an individual, personal level that seems so, there is a social responsibility in taking care of elders in society. They are people who have been adding their labour and skills to social life according to opportunities they were afforded by society. In old age, they have to be taken care of by society. This needs a viable social security network and the Employees’ Provident Fund (EPF), wholly underutilised to date, can be one major source for such service and instead of questioning values and attitudes, also help out “children” who are themselves struggling to have a decent life.

EPF is a trillion rupee social fund, owned by contributors, who are all private sector and state corporation employees. The EPF has 2.3 million active members. That would be a million households at a minimum. Leaving aside all allegations and accusations on corruption, waste and mismanagement of EPF monies, here is a social security fund with Rs. 409.6 million (by 2008) in the unclaimed account. Here is a fund that has more annual contributions than retirement claims. In 2010, the total contribution to the EPF was Rs. 54,800 million. Total claims paid out of the fund were only Rs.35 billion, leaving a profit margin of almost Rs.20 billion. It is a growing fund that would not feel a pinch, if used for employee and old age healthcare provisions.

To give due credit and importance to this much needed discourse the three eminent medical professionals have helped create, let me conclude this by quoting from the Resolutions adopted at this 2013 May Day rally, by members of a private sector trade union, Free Trade Zone & General Services Employees’ Union: “Resolution 06 – Elders’ Social Security- As the demography of Sri Lanka shows a fast growing elderly percentage, we note that it is the responsibility of society to take care of the retiring elders through social security schemes, but regrets there is no such scheme to date. We therefore resolve this day to propose a social security scheme using the EPF to put in place a medical and health service scheme for all members of the EPF and their dependants and also for all employees who were in the EPF as its members and retired during the past decade and for their spouses also.”

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