– Mahima Devkota
Aging is definitely the success story of this century with Nepal’s elderly population enjoying an increased life expectancy of 70.8 years (WHO, 2018) and decreased mortality rate. This represents an increase from 53.99 years in 1990 to 70.88 years in 2020. Nepal’s formation, structure, culture, demography and policies are all based on the 20th century industrial era. In that scenario, work was rigorous and life expectancy was lower, hence people retired earlier and the focus of their latter days were on recreation, spirituality and other gentle pursuits. Now, in 21st century, while ageing is our everyday reality, there is disconnect between our increased longevity and the dearth of norms, polices and social structures within which we may be able to spend our added years of life.
The concept of Active and Healthy Aging (Robert Havighurst) offers a vision of old-age linked to the means to achieve quality of life. Our recent pandemic clearly shows the vulnerability of aged people facing ongoing migration, increasing placement in aged care facilities, the growth of cardio-vascular diseases, immobility, depression and even suicide. With our precious elderly at increased risk, it is high time for Nepal to adopt the principles of active and healthy aging.
Active Living is process of optimizing opportunities for health, participation and security, in order to enhance quality of life to people (WHO, 1999). Living is that combination of physical activity, social activity, functioning activity according to capability, and engagement in everyday life activities and with people. What we are and do today will continue in old-age. Our daily habits, coping mechanisms, economic resilience, behavioral habits, activities, inter and intro personal relationships will continue.
As a consequence, adoption of healthy living with physical activity, engagement with people, work, curiosity and positivity will enhance our self-worth, health, connections and value in old-age.
In Nepal, the 65 plus population comprises 5.34% of our total population (World Bank, 2018) – a figure which is growing as a result of advances in health care, education and service provision. However, the elderly are faced with numerous physical, psychological and social role changes which challenge their sense of identity and self-worth. Many people experience loneliness and depression in old age, either as a result of living alone or due to lack of close family ties and reduced connections with their culture of origin, which results in an inability to actively participate in community activities. This is now becoming a disturbing norm of society, with increased aged people living in old-aged homes and decreased connectivity between generations.
With advancing age, it is inevitable that people lose connection with their friendship networks and that they find it more difficult to initiate new friendships and belong to new networks. So, what can we do in Nepal to help our aged population to adopt healthy aging?
Conducting research in Devgaht in 2019, I came up close and personal with many aged people and was honored that many of them shared their life stories with me. This included sad details of the circumstances under which they were forced to leave their homes – the most prominent of which were family disputes, migration, poverty and foreign settlement. In Devghat, we can find aged people from a wide range of backgrounds – caste, creed, socio-economic status, etc. Devghat offers three main types of living arrangement: staying alone, staying in an old-aged home and staying with children. Despite the striking differences, one commonality I observed was engagement and active living in an enabling environment. Many actively engage themselves with God, religion, daily life, meditation and so on, and that engagement leads to healthy aging. Whilst facing medical conditions such as mental disorders, neurological problems, substance abuse issues, diabetes, hearing loss, osteoarthritis and so on (WHO, 2017), the difference here, is they live an active life, leading to healthy and active aging.
Healthy Ageing is about creating the environments and opportunities that enable people to be and do what they value throughout their lives (WHO, 2020).
Though many aged folk at Devgaht have faced a bitter past and have no family members in their present, they enjoy happiness and satisfaction due to their active life leading to healthy aging. While lacking material benefits their path is enriched by philosophy, religion, sagas, spirituality and a serene environment to heal, prosper and grow.
WHO stresses the point that environment plays a vital role in tge active and healthy aging of people. “Finally, I found God and I learnt that God is in our action.” said Maya, aged 72. I saw not only devotion to God, but the actions of kindness, understanding and engagement with each other, or, as one Devgaht resident put it, and “We are now a big family who lives differently, but follows same way of life.”
Another expressed the view that “Devghat makes me feel safe and free from emotional, mental and psychological upheavals.” I saw many aged people in Devghat, having a normal routine which included meditation, praying, listening to preachers from Mahatams, batti katnu, fetching religious water from Kaligandaki, and helping in the activities of the Ashram. Some even generate income by weaving threads.
I observed that having a normal routine, involvement with people and one-self, and being active in daily life gives these elderly residents a sense of fulfillment in life. Thus, freeing them from the emotional, mental and psychological diseases born of dissatisfaction, loneliness and the environment in which they live.
The recent lockdown made me think a lot about the aged people in Devghat, so I took the chance to reconnect with a few who are living alone, in Kutis and with their children – sparking these gems: “Here, engagement has made it relatively easy for aged people to become are self-sufficient and indulge themselves with activities of living.”, said Maya, aged 71. “God helps me to regain strength and positivity during this time.” said Dharani.
“I do not fear death, but I do fear the loneliness during death. There is no one to give me even water on my last breath and I do not have money to buy masks and sanitizers.” said Muna. “But, I believe I am more happy and engaged here than I was in my home,” she added.
From this, we can find that engagement and positive co-dependence leads to active and healthy aging where one is free from the turmoil’s and tensions causing depression, anxiety, and emotional breakdown. At Devghat this is further enhanced by the gathering of aged people during morning and evening Aarati, gardening and simply sitting with each other.
However, there are still areas of concern around the availability of necessities in Devghat like food, clothes, medicines and health check-ups. Meanwhile, age-friendly roads, stairs and homes need prioritization by the relevant local authorities. So, what can we learn from Devghat to bring change in the quality of aged people lives?
In Nepal we have a culture of altruism and inter-generational reciprocity, with family at the center of an individual’s life. However, this thread is weakening as many aged parents are seen in old-aged homes nowadays. Nonetheless, the recent lock-down, can open up ways to engage aged people in life, society and more with family.
The main step is to bring the connectivity back, which is only possible with engagement in each other’s lives. We can engage through decision making, cooking food and gardening together, sharing stories to grand-children, sharing knowledge and life lessons to children, participation in community building through clubs and memberships for active and healthy aging in the country. We can visit hospitals together for regular check-ups. We can make s routine of healthy eating and cooking at home. Moreover, we can learn from each generation and apply them in our lives. For instance; how can we change our ways and be more inclined towards nature and life?
To conclude, this is the right time to instill values of coherence, compassion, connectivity and inter-generational spirit, which will benefit the psycho-social, emotional hemisphere of our society, eliminating diseases, depression and abandonment issues, leading to healthy ageing.
Mahima Devkota is Student of Masters in Social Work ( Gerontology)
