Do not forget the elderly

Dr. Daniel Tumwine

An interesting oddity that many visitors upon arrival in any African city tend to comment on is the striking lack of elderly people in the public.

In the past, the African village square was the nucleus of wisdom acquired from centuries of reverence for the elderly advice.

The elderly were always visible in times of crises or conflict, and tended to bring stability and cohesion to African societies. Their roles down the centuries has diminished vastly, and are frequently referred to as a forgotten generation.
About 4% of Uganda’s population is aged 60 and above, which roughly translates into 1.3 million people. This is the same number as those who need ARVs in Uganda.

This invisible minority (the elderly) is rarely seen in public, nor spoken of. Many of them lack food, money, clean water and health care. Most older persons have sold all their assets and struggle for a regular income. The social pension is limited to only those who have worked in the Government sector.

However, many older persons’ organisations have noted that accessing their pension can be difficult or unpredictable, even for those who are eligible.

Because of poverty, poor mobility — coupled with long distances — as well as negative attitudes towards older persons, the elderly rarely access healthcare.

This is despite the fact that many conditions, such as stroke, heart disease, pneumonia, diabetes and high blood pressure — as well as HIV/AIDS and malaria, afflict elderly persons. Cancers, cataracts and other visual problems, hearing impairments, arthritis and other orthopaedic conditions, as well as dementia, become much more common as one ages. If the elderly do seek care, many turn to traditional healers as an alternative.

In addition, Uganda has limited geriatric expertise. Many health professionals do not find the specialty financially attractive. Geriatric medicine is as different from routine medicine as, say, paediatrics is. Older patients often present symptoms differently, absorb drugs more slowly, respond differently to certain protocols and usually have multiple chronic conditions that overlap.

Many health workers, lacking the information and training necessary to recognise the special needs of elderly patients, simply dismiss their deepening confusion, unsteadiness, muscle weakness or odd gait as normal signs of aging. Without formal and reinforced training, these professionals will be unaware that such behaviours in the elderly could be signs of, in order of the above symptoms, depression, poorly maintained feet and toenails, low caloric intake or a urinary tract infection. These problems are readily treatable. But, as a result of misdiagnosis, the elderly patient continues to live a lowered quality of life.

In rural areas, where people must move long distances to access safe water, the elderly may resort to consuming contaminated water. Even where pit-latrines are available, they require agility to squat. More so, many elderly people are depressed and isolated. Therefore, those who need assistance with personal care, but are isolated, can suffer from poor personal hygiene and its effects.

Our Constitution recognises the unique place held by the elderly. It calls for the ‘reasonable provision for the welfare and maintenance of the aged’. In addition, an act of Parliament allows for the election of older people into local government and issues affecting older people have been included in the Poverty Eradication Action Plan and strategic plans on agriculture, health and HIV/AIDS. There is also a national policy for older people.

In addition, Uganda is also a signatory to the Madrid International Plan of Action on Ageing, which calls for the poverty of older people to be halved in line with the Millennium Development Goal (MDG) to halve world poverty by 2015. But there is only so much a government can do. Granted, it can make it easier for the elderly to access its services, by transforming health centres into elderly-friendly zones, emphasise geriatric care in health care training, as well as provide certain benefits to vulnerable elderly.

However, the vast majority of the effort in improving elderly lives should be from ourselves. We need to appreciate the fact that we will be elderly sooner than we imagine, and, therefore, preparing for it through lifestyles that promote a culture of saving and health living can go a long way. Providing a voice for those who are already elderly and making them more visible is another key intervention.

Despite Uganda having one of the world’s youngest populations in the world, I find it imperative that placing our elders at the centre of, not just our lives, but our national conscious will leave an important golden generation living a fruitful and quality life.

The writer is the director of The Children’s Clinic, Kansanga and excutive dierector of the Uganda Paediatric Association

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