The Premise
World Senior Citizen’s Day has the temerity to fall on the 21st of August every year. This is a mere week after Independence Day in the world’s most populous democratic country and is consequently overshadowed by the celebration of our renewed independence. This year, the event has been pushed even further into the shadows by the novel coronavirus pandemic.
Yet a day celebrating and invoking the rights of senior citizens in our community is more relevant than ever before. Not merely because 2020 is the beginning of the WHO Decade of Healthy Ageing. Not even because India had 1.2 billion senior citizens in 2016 and will probably by 2030 be the country with the largest number of senior citizens in the world.
The Coronavirus disease 2019 (COVID-19) has put older adults at disproportionate risk of mortality and morbidity. Yet all the risks to their health and welfare are not direct. Several indirect factors such as ageism, patriarchy, loneliness and social isolation have operated with renewed urgency to marginalize and exclude older adults. We have sometimes, taken social distancing a tad too literally. Shelter in place has often meant lock up your ‘old and throw away the key’. “No country for old men indeed”, let us pardon ourselves the paraphrasing.
Yet inclusion and equality of older adults in the community is not enough! That is heartening and much needed. We are perhaps, seeing a belated awakening of our social conscience by striving for the rights of older adults.
However, inclusion and equality (powerful concepts in themselves) are of limited benefit without a celebration of the diversity inherent to life and ageing.
Gerodiversity: The Change in Approach
Iwasaki and colleagues had proposed a novel concept named ‘Gerodiversity’ in 2009. What is it? This is what the authors have to say:
“Gerodiversity is the multicultural approach to issues of ageing. This approach provides a theoretical foundation for the medical and psychological treatment of older adults within an ecological context that includes their cultural identity and heritage, social environment, community, family system, and significant relationships.”
What Does Gerodiversity Include?
“ Gerodiversity encompasses a social justice framework, which considers the social and historical dynamics of privilege and. In addition to issues of ageing, gerodiversity includes race, ethnicity, language, gender identity, socioeconomic status, physical ability or disability, sexual orientation, level of education, country of origin, location of residence, and religion or spirituality.”
This might seem a wordy and longer than warranted explanation of a simple concept. Yet it is necessary that the definition itself embrace the very diversity it celebrates and embraces. And proposed though it may have been in the American context, with overtones of advocacy against racial discrimination, it is, one might argue, even more relevant from the vantage point of developing countries like India which are greying at a faster rate.
India with its rich, multicultural and syncretic heritage encompasses a veritable diapason of races, religions, ethnicities, languages, genders, orientations and lifestyles. To be Indian isn’t a unitary concept as there is no one way of being an ‘Indian’. The citizenship is lived and is based on social inclusion. Most of us are raised across these spectra and learn to juggle our varying identities. Our country celebrates and thrives on diversity which needs to be devoid of age and gender-based stereotypes.
Why then, would we think that crossing an arbitrary threshold of 60 or 65 years and attaining the title of a ‘senior citizen’ would imply homogeneity on a vast, multiform population?
Perhaps because our notions of ageing are guided by popular culture. We have then , in our minds, the Bollywoodised image of the senior citizen as either this “irascible, cranky, bitter and lonely old man” (think Rishi Kapoor in 102 Not Out or Amitabh Bachchan in Piku) or this “sweet, maternal, self-sacrificing sanskaari old woman” (the traditional stereotype of “mere paas maa hain”).
The popular media generates from and influences socio-cultural thinking and this has led to ‘age’ being labelled as something ‘fragile, degenerative and dependent’.
Tropes and stereotypes of older adults are infectious and problematic for two reasons. First, though they invoke warmth and affection in the young consumer of the culture, they prevent us from seeing attributes, desires and needs of older adults that exist outside this template. An artificial homogeneity is assumed and imposed. Second, our public health and welfare policies, advocacy and social work is designed for these stereotypes of ageing. The lower berth in railway travel, the wheelchair in airports, the senior citizen queue in public offices are examples of how our welfare measures are designed with ‘a cranky, arthritic old man’ in mind. Ageism thus gets propagated in subtle forms, perpetuating in our subconscious, attitudes and beliefs.
That is not to say these welfare measures are not necessary or welcomed by older adults and their caregivers. They often are. But while they are a useful start, they are not sufficient for the scope of our diverse senior citizen populations.
Translating to the Indian Context
What then, would adapting gerodiversity to the Indian context imply? Perhaps adapting to a newer understanding of age, as we live longer than ever before.
First, there is much in a name. While this might seem a semantic difference, it is an important one. One would no longer call a person living with schizophrenia as “schizophrenic”. A person who has experienced sexual violence is a ‘survivor’, not a victim. A person should not be labelled or identified by their illness or trauma alone. Just so, a person is much more than their age! Thus, words like aged, elderly, 'these old people are problematic’ are pejorative because they make the person other and inflict ageist stereotypes. Many older people even object to the label of a senior citizen as a handicap and source of stigma, however well meant. Older person is slightly more acceptable, because it indicates a demographic fact and is flexible. As we live longer, the goalposts of older too may change. We need to remember that 45 was considered old prior to the Industrial Revolution!
Age is a continuum that affects us all, and hence ‘marking’ a threshold for dependence is culturally inappropriate.
Second, the abilities, needs and wants of all older persons are not the same.
Some older people might look forward to retirement, which too unfortunately is based on an arbitrary number. Some might wish to continue working and contributing to labour. Some might wish to pursue avenues, dreams and skillsets that they now have the time for.
Several older doctors have expressed unhappiness with COVID-duty rosters that keep them away from out-patient departments and emergencies. This was well meant, but communicated the unfortunate meaning that senior doctors are redundant and even a liability during a pandemic. Neither did the policy account for the fact that many of them might wish to work – an undermining of autonomy. Many educational institutes have an age limit on their admissions, based on an assumption that people beyond a certain age cannot or will not learn.
The story of a 105 year old woman from Kollam (the hometown of one of the authors) appearing for and clearing her school exams last year was heartening because it challenged these ageist stereotypes. Indeed, psychotherapy is often not offered to older adults. The assumption is that older adults cannot change, just as they cannot learn. A related belief is that older adults would just prefer taking a pill to cure the blues rather than talk to a therapist. That is a myth. These are just some of the areas and opportunities where an appreciation of diversity in ageing would enrich both the individual and the community.
Third and perhaps most importantly, a recognition of diversity in ageing also carries the recognition that not all older people have the same opportunities, rights and freedom. Lack of our sensitivity to diversity also makes for stigma and discrimination, as hate crimes all too often remind us. Religious discrimination, casteism, misogyny, ethnic violence, poverty, illiteracy and disability continue to operate across the lifespan. These are not social evils that miraculously disappear with age.
Not all older adults have meaningful access to smart devices and phones in a country where digital literacy is still a dismal 45%. Apps and helplines may mean very little in the absence of access. Telemedicine – the new and much touted alternative to in-person consultations during COVID-19, does not reach socio-economically underprivileged older adults. Thus, there is inherent irony of it being the least useful where it is the most necessary. Digital India is of limited meaning unless the digital movement carries along older adults through digital training initiatives. So too, several state sponsored social welfare benefits and tests of citizenship are based on documentary evidence of date and place of birth and residence. Documentation too, is a luxury for underprivileged older adults and is least available where most required. The classic example is that of a senior citizen who has to prove both their age and poverty before availing free, state sponsored healthcare, no matter how urgent the need. Here too, an appreciation of diversity and discrimination is required.
A Word of Hope
This is not to portray an overtly pessimistic or critical picture of what we are doing for older adults. Our resilience and goodwill are considerable! The authors merely wish to imply, that more can be done, and can be done better if we appreciate on this World Senior Citizen’s Day that ‘age’ does not make everyone the same. One size does not fit all, indeed!
In today’s world focused on rights and justice-based approach, it is vital that the older adults are involved in decision-making and participation in their welfare. Independence needs to be fostered: “The same hands who have always guided us can be supported and cared for with respect and dignity that they deserve”!
Our collective awareness, empathy and responsibility for this diversity can enable a benevolent approach towards our seniors beyond just a “day” or “week”, but as a lifestyle that can work towards an “age-friendly and age-inclusive society”, the very basis for a civilized world!
(Dr Migita D’Cruz and Dr Debanjan Banerjee are DM Geriatric Psychiatry Senior Residents, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru)
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