As someone who travels frequently to Pakistan and England, I can’t help but be made aware of the stark difference in the care provided for the geriatric population between the two countries. This is most likely due to how the eastern mindset varies from the western in caring for the older generation.
I had the opportunity to intern for a British nursing home, which made me realise that there may be ways that a developing country could implement improvements in geriatric care without having to completely give up their traditional norms.
In England, it is common and acceptable to place family members in nursing or residential care with there being more than 11,300 care homes in the UK; This ensures a range in price, services and quality, thus providing care for over 400,000 residents at any given time.
In stark contrast, despite all my efforts to find something resembling a care facility in Pakistan, I came up empty handed. This is probably because people are more worried about “log kya kahein gai?,” if they outsource care, instead of prioritising optimal care for their dependants. Or perhaps they just don’t understand the enormity of the care and skills professionals can provide, which is why an aspect of homecare employees’ job in Pakistan is to guide their clients to acquire the proper mindset for outsourcing care.
This could be why currently there is only homecare available, rather than nursing or care homes, as the community may be opened to the idea of their family staying at home but with the accompaniment of a nurse. It is important that we normalise the idea of external and raise awareness, perhaps through physicians advising patients and their families, about the benefits of geriatric care, primarily homecare, as it sustains traditional and family values while providing a high-calibre of care.
For instance, my Tayajaan (mother’s uncle) was part of an affluent family. Having had a Pakistani upbringing, he later lived in England. When Tayajaan became sick, he was not admitted into a rest home, despite the western culture. Rather his son administered assistant care, which supplied an at-home nurse to monitor and support their health. Even though he had spent most of his life in England, his cultural values restricted him from being in a care home, yet, in this case, enough geriatric care was provided in a different way. Geriatric home care services need to be provided at a larger scale in Pakistan, to be able to cater to a wider audience.
With an increasing number of 11.3 million senior citizens making up 5.7% of Pakistan’s population, it is imperative for the government to allocate resources to provide and improve geriatric care, and that families are made aware of the benefits of outsourcing care. As life expectancy rises and birth rates fall, this number is expected to rise to 43.3 million by 2050, according to Punjab University, which stresses the urgency of having a higher provision of services for the estimated 15.8% of our population over the next 3 decades.
While 70% of the elderly population in the UK receives some form of care, only 30% of the elderly population in Pakistan are cared for by trained practitioners, and it is time to see that number rise and for us to care for our growing population properly.
Something else that I have come to notice is how the perception of nurses differ between the two countries, which could be due to cultural differences. On one hand, although most nurses are immigrants and tend to be on low wages in England, they are extremely respected, and their role is appreciated and applauded. Contrary to this, the geriatric population in Pakistan struggle to grip the concept of employing nurses to purely facilitate with the upkeep of health, instead these nurses are often mistaken for domestic help, being expected to assist with other tasks around the house. I believe that this is the result of different upbringings in separate environments and cultures.
I find it unfortunate that due to people being raised in a different environment or country to others, their mindset towards caring for their elders restricts the possibility of them providing maximum care for their family members, and doing what is best for their elders rather their reputation. They should realise that as much as we care about our parents, we are not geriatric specialists and to be able to provide appropriate care when an elder needs help, they should be taken to the hospital without any thought.
Before the government issues any policies towards geriatric care, it is critical, especially with the rising older population of Pakistan, to tackle the taboo of care and nursing homes in Pakistan. Like centres already established by Edhi, the government should sponsor old-age homes to cater for the population as it ages. Apart from this, the state can allocate resources to train and recruit specialist doctors in the public sector for geriatric diseases as Alzheimer’s disease and memory dysfunction.
Finally, we can learn from the West and create community centres with day-care facilities where trained workers can also provide counselling to those in need. All of this shows that it is possible to ameliorate and refine geriatric care in Pakistan, if the right steps are taken by the government and physicians.
After doing further research into geriatric care, I have come to realise that it differs substantially, due to contrasting mindsets and cultures. This is in the aspect of not only who can afford this type of geriatric care, but also the government aiding these payments, which I have seen impact the elders in my family – only the affluent are able to provide enough care.
However, both countries have started to advance by using technology; Although at different standards and in different ways, this shows that it is possible to provide and improve geriatric care in a developing country.
I have seen first-hand the impact that finances can have on providing care for elders in one’s family. For instance, my Bari Ami (father’s grandmother) was an integral part of an affluent family and once she became wheelchair bound, she had a dedicated carer and a nurse to take care of all her needs and requirements. On the contrary, my Amijaan (mother’s grandmother), who does not come from as affluent of a household, did not have access to dedicated help or even a wheelchair – the only form of assistance she had was a bell at her bedside, which was used to call her grandkids when she needed something. Needless to say Bari Ami lived a longer and healthier life than Amijaan.
In England, the government is prominently involved in geriatric care with the care home sector being worth around £15.9 billion. They provide a base fee for the resident and the family pays more on top of that if the home requires a higher fee. This reduces the financial strain on the family and allows them to access a range of homes, depending on how much they are willing to pay or what they can afford. On the other hand, in Pakistan there is no government involvement in this, and it is rather a hope for the future. Because of this, home care is privately funded resulting in only the upper class, or perhaps more wealthy people can afford this upcoming sector of care provision.
The ratio of private to public hospitals in Pakistan, currently being 3:10, shows the substantial lack in services and why most of the population would be unable to access geriatric care, as it is primarily provided by private hospitals. The government hospitals provide substantially cheaper service, making them more appealing, however the cheaper price results in a poor quality of service. Due to this, most patients would turn to private hospitals for better care and service, meaning they would be paying out of their pockets.
The elder population in Pakistan suffer from major challenges in geriatric care that must be addressed by the government. Mild cognitive decline is evident in 10-25% of 70-year-old people, with dementia affecting about 10% of the population. On top of this, 60% of the elder population are clinically diagnosed with depression every year; In Pakistan, studies conducted in different areas reported that 23% of elders in Karachi suffer from depression, with this number rising to 42% in Islamabad and Rawalpindi.
Along with this, 28% of people above the age of 60 have some kind of disability hindering their ADL (activities of daily living), while about 10 million elder people in Pakistan have osteoporosis. Taking this into account, it is imperative for the government to introduce policies and specialised geriatric care to be able to provide for the elder population properly.
On the other hand, care providers in both communities rely primarily on word of mouth and references to grow their business and gain clients. The companies also use their other services to promote their care provision, as well as using pamphlets and websites to provide information to the inquiring public. Although in different ways, England and Pakistan have both used technology as a principal way of improving the care provided.
In England, this being data recorded online instead of charts, making it more efficient and environmentally friendly, whereas in Pakistan, it being installing a digital monitor in the residents home to improve communication and efficiency between the nurses and clients at home and the doctors. In these ways both countries have implemented technological to further their care provision, demonstrating that it is possible for a developing country to improve its geriatric care using the resources available.
All things considered, I believe that, unfortunately, those with less disposable incomes are unable to sufficiently fund necessarily care for their elders. The government could play a major role in changing this, or at least providing more access to geriatric care to less affluent families. This could be done by either providing free or subsidised geriatric care, or in the same way as the western countries – by providing the resident or patient with a base fee that the family can then add on to. It would be great to see this implemented in a developing country; however, I think that it is a stretch to expect something of this sort in upcoming years.
A more realistic expectation would be to implement policies that have already been created. An example of this is the National Policy designed by the government in 1999 to promote better health of elderly people; it would implement the training of primary doctors in geriatric care and a health care system for the elderly including physical therapists and social workers.
Another example of a policy that would significantly benefit the geriatric population is the relief package approved by Prime Minister Chaudhry Shujaat Hussain in 2004, which would ensure that basic social and medical needs of the geriatric population are met, and educating young people to care for senior citizens, however this package was not enforced properly either.
Other policies that require correct implementation include the Social Security Act of 1965, Employees Old Age Benefit Act of 1976, Public Sector Development Programme and the Ten Years Perceptible Plan. Pakistan would benefit extremely with proper implementation of these policies and acts, as it would result in better quality of service with higher availability, through public hospitals, for the elderly, meaning that their families would no longer need to pay excessive amounts for geriatric care. By: Hasnah Peracha