There are times when daadi looks through us, like a still-life portrait.

There are also times when her great grand-daughters, Hooria, Umamah or Sanaya, skip in to drop a kiss on her hand, and her eyes twinkle with a smile on her wrinkled face. Even at seven or eight years, they know that she matters. At times she does not respond to a call, but when she does, her words are a mere mumble. One day she enjoys her broth, but the next day baby-like, she purses her lips.

Conversation is a one-sided affair in trying to read her mind and wondering if she needs something. A force to reckon with until she turned 90, now only an occasional wince or a barely discernible sigh gives away the discomfort she may feel.

Separated by the barrier of time and space that is becoming increasingly oppressive and impossible to penetrate, we watch her descend slowly into an incommunicable void. Thankfully, there is no visible indication of any disease, and the shared handling of her gradual waning has drawn us together as a family.

In his book The Sky Gets Dark, Slowly, on the pitfalls of ageing, Zhou Daxin — the Mao Dun Literary Prize winner — warns that, once you move to the other side of 60, the sky gets darker, albeit subtly. The light begins to wane until, one day, you are back to lying in bed like the baby you were born as.

Zhou’s warnings, detailing and prescriptions for handling the ageing process are an account of what we are all destined to face. He sensitively explores old age and the complex, hidden, emotional worlds of the elderly. Ageing does not always bring disease, nor should it be taken as a burden, as the family witnesses the gradual disintegration of a once-active body.

As social demographics and lifespans change, the need for holistic, specialised healthcare addressing the unique needs of the elderly has become imperative

Apart from the imminent potential for broken bones, aching joints and waning utility, Zhou warns of loneliness, the erosion of spotlight, losing on loving, on being loved and wanted, and on needs and desires being sidelined because the silence of the ageing can be misleading. “There will come a time,” he writes, “when we will need to be ‘mothered’ but a ‘mother’ will be hard to come by to take you into her arms or coax you to eat and drink.”

The medical term for handling the condition Zhou describes is called geriatric care. “So far in our society, geriatric care has been a duty of the immediate family,” says Dr Muhammad Shoaib Shafi, acting president of the College of Physicians and Surgeons (CPSP). “The importance of family is undeniable but, with changing social demographics and lifespans, it is now imperative to introduce streamlined professional care for the ageing, and we are introducing this specialty at CPSP.”

Enthusiastic about the response to the introduction, Dr Shafi says, “The international medical community regards geriatric care as extremely valuable. CPSP-trained geriatricians will be trained in multiple conditions older adults face and which often go unrecognised because the aged cannot communicate.

“When you’re dealing with several conditions, such as diabetes or chest infections, at the same time, each has to be handled differently and with greater sensitivity, so integration of expertise and trust-building becomes the bottom line of care.”

So far, no Pakistani medical institution offers geriatric care as a subject. Perhaps the necessity for professional expertise was not felt because elderly care is considered a cultural norm and religious obligation. “Presently, according to a rough estimate, just 10 percent of Pakistan’s population requires geriatric care, but the numbers are going to increase drastically,” says Professor Dr Jehangir Khan of Abbottabad International Medical Institute.

“Our postgraduate exams carry only perfunctory test questions about this specialty, with the result that, far from being taken as a specialty, it is brushed aside,” he points out. “[Whereas] after basic medical courses, medical professionals in the UK are put through a six-month rotation in geriatric care.

“Geriatric nursing may focus on physical ailments and general supervision of medication, but psychosomatic intervention is also important. The organs of the body are working at borderline capacity and drug reactions vary from individual to individual. We use the media to disperse information about medical conditions, but nobody talks about the personal and public needs of the elderly. In the years to come, we will see geriatric care as a prominent umbrella discipline for all medical conditions and public awareness about it will increase.”

Daadi’s ‘preservation’ uses our family’s pool of energies when we nebulise her, spoonfeed her, or help her with her bedtime routine. On the other hand, Mehtab Ali, a 93-year-old retired public servant, is being looked after round-the-clock by an attendant, and frequently being carried to the hospital. One day it is a festering bedsore, another day it could be breathlessness, a persistent cough or extreme weakness.

Ali is the fading member of a nuclear family, who could well do with professional geriatric care service, which is currently unavailable. His hospitalisation takes on another dimension because he is treated by general physicians for his conditions, like any other younger person. The subtler issues are overlooked.

Pakistani doctors agree that along with what is done to provide a better, happier quality of life to daadi and her peers, how it is done is an equally important factor. Gently easing daadi into her wheelchair or coaxing her to change sides to prevent bedsores, or keeping a wary watch for breathlessness while helping her dress, the occasional smile or gesture of affection — even if it brings no response — goes a long way. A spray of her favourite perfume and nebulising for easier breathing, both are little things that work for the cared and the caretaker.

The darkening sky of daadi’s world and our own frenzied lives are moving at a steady pace, and yet we hold on to the belief that, deep down in the silence that has overtaken her life, emotions of love and care, mental cognisance of pain and pleasure, the essential human need for company and conversation, matters. As long as an elderly person breathes, human connection matters.

Daadi’s family and caregivers have to persevere to maintain it, irrespective of her response. Would there still be a need for old people’s homes if the elderly get access to sound geriatric care and some empathy?

The writer is a freelance journalist, translator and report writer with a special interest in stories of creative development. She currently teaches content writing and editing for journalism at the Lums Lifetime Learning Programme. She tweets @daudnyla

Published in Dawn, EOS, October 3rd, 2021