Abstract
In the name of Allah, Most Gracious, Most Merciful
O mankind! if ye have a doubt about the resurrection,(consider)that
We created you out of dust, then out of sperm,
then out of a leech-like clot, then out of morsel
of flesh, partly formed and partly unformed, in
order that we may manifest (our power) to you;
and We cause whom we will to rest in the wombs
for an appointed term, then do We bring you out
as babes, then (foster you) that ye may reach
your age of full strength; and some of you are
called to die and some are sent back to the feeblest
old age, so that they know nothing after knowing
(much),and (further), thou seest the earth barren
and lifeless, but when We pour down rain on it,
it is stirred (to life), it swells and it puts
forth every kind of beautiful growth (in pairs).
This is so, because Allah is the Reality: it is
He Who gives life to the dead, and is He Who has
power over all things.
*Sura Al-Hajj [the Pilgrimage]
(The Holy Qur'an)
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Old is a nebulous term. An active
and fit eighty-year old woman can be as young as a sedentary,
sixty-year old woman. We all have both a chronological
age measured in years, as well as a psychological age
that is expressed in our emotional and mental state.
Furthermore, the ageing process does not occur at a
uniform rate all over the body and is a very individualistic
phenomenon. But what actually happens to us when we
get older? Do we gradually disappear as our memory and
eyesight fail us? As our bodies and minds begin to fail
us what do we become? It is said when you are 80 year
old you know everything, but remembering is the problem.
My grandmother a small woman in her mid nineties with
rough worn hands and a warm smile; I love her raisin
tea bun and the plateful of homemade cookies she offers
every time I visit her in her room which is filled with
unhurried peaceful stillness which encourages a slower
pace of life. Wearing glasses magnifying her eyes she
tells me that her legs are stiff and all hanged up;
she can no longer perform her ritual prayer (genuflection)
as she used to do before. She finds her hearing aids
too bothersome to wear so she 'd rather avoid social
events with large crowds of people, being in a large
room with boisterous people where she is unable to follow
a conversation is uncomfortable and distressing .However
she is fortunate because I know people at her age require
incontinence pads. For some of them their sense of pride
often leads them to avoid social company (who can blame
them!). Even though she has had to deal with many losses
in her life in the war torn country Iraq she has managed
to create her own enjoyment out of simple things in
life. I set out with questions only to arrive with handfuls
of new questions. Ageing is too often like the process
of peeling.
Layer by layer, year by year, we surrender yet another
piece of our independence, another part of our identity,
as our bodies and minds fail us and as we lose another
ability, another friend, and another cherished memory.
However, amongst these stories of losses, I sensed underlying
optimism and determination. How can we turn each loss
and each new hardship into an opportunity to reinvent
ourselves, to create a new connection, to experience
another facet of life?
Ageing, says Richard Suzman is "reshaping our world".
Like climate change, "it seems inexorable, and
is gradual", but the global impact of ageing on
health, disability, wellbeing, and poverty might eventually
turn out almost as profound for society as rising temperatures.
Awareness is growing that the world's population is
rapidly ageing. Although much of the related policy
debate is about the implications for high-income countries,
attention is broadening to less developed settings.
Middle-income country populations, in particular, are
generally ageing at a much faster rate than was the
case for today's high-income countries, and the health
of their older populations could be substantially worse.
Recently, a medical student entered an operating room
in a tertiary care medical centre affiliated with a
leading American medical school. The room had pale walls,
bright lights, lots of chrome, and a gurney on which
lay a large, unconscious man, his abdomen open. A surgeon
greeted the student enthusiastically. He had a reputation
as an outstanding teacher and explained the procedure
so the student could understand what he would be doing
and how she could help. Until that moment, the student
hadn't considered surgery as a career option. As if
he could read her thoughts, the surgeon asked, "So,
do you know what you want to go into?"
"I think I do," replied the student. "Geriatrics."
The surgeon's head jerked up. Then he raised his voice
to a high pitch whine and intoned, "Doctor, I'm
constipated. Doctor, I'm constipated." Laughing,
he scanned the room for agreement before returning to
work. At regular intervals during the surgery, the surgeon
repeated the same phrase in the same tone as if by doing
so he could communicate everything a young almost-doctor
needed to know about older patients. Although some might
argue that this story represents nothing more than the
indiscretions of a misguided physician or attitudes
at a single institution, conversations with colleagues
nationally and internationally suggest otherwise.
In such anecdotes, replace the older patient with a
black or female or disabled patient, and you get a sense
of the scope of the problem-derision, segregation, and
discrimination. But as Harvard psychologist Gordon Allport
pointed out more than a half century ago in his seminal
book, The Nature of Prejudice, "People who are
aware of, and ashamed of, their prejudices are well
on the road to eliminating them." This is not a
new problem-either for medicine or for society. During
the 1960s, US physician Robert Butler coined the term
ageism, which he defined as: "A process of systematic
stereotyping of and discrimination against people because
they are old, just as racism and sexism accomplish this
with skin color and gender". "Aging,"
wrote Butler "is the neglected stepchild of the
human life cycle. Though we have begun to examine
death,
we have leaped over that long period of time preceding
death known as old age." He ascribed this neglect
to ageism, noting that older adults are often viewed
as universally sharing certain negative attributes,
including senility and rigid thoughts and beliefs. In
fact, older age is the most varied time of life; there
are the 80 year olds who hold public office or run marathons,
and there are those who live in nursing homes because
they can no longer walk, think, or care for themselves.
Why then might people ascribe such uniform negativity
to older age? Butler had the following explanation:
"Ageism allows the younger generations to see older
people as different from themselves; thus they subtly
cease to identify with their elders as human beings."
This makes sense, but it doesn't fully explain what
seems to be a widespread need to hold older adults apart.
It's also true that we feel sympathy for-and those of
us in medicine may devote our careers to caring for-people
with malaria, lung disease, or cancer perhaps in part
because many of us don't and won't have those challenges.
We are safe. Not so for old age. Barring an early death,
old age is every human's fate, and not one generally
met with eager anticipation. In some ways, even death
might be more attractive. It is more clear-cut we are
either alive or dead. For many, it is the way in which
life might be compromised by advanced age, limping slowly
rather than leaping towards death that brings the greatest
dread. In reality, most older adults are content, productive,
and living independently. But we rarely acknowledge
how well old age can and often does go, with years and
decades offering new opportunities for work, pleasure,
family, relaxation, and self-knowledge. Instead, in
everyday life, we see grey hair and baldness, limps
and stooped posture and slowed paces, wrinkles and canes
and hearing aids. In medicine, we see the disquieting
extremes: the acutely ill, the multi-morbid, and chronically
disabled, and the almost, but not quite, dead. Perhaps
it is because the effects of age are so visible, even
in the healthiest older adults, and because most people
do become ill or disabled in some way before death that
we reduce the last, decades-long phase of life to a
single, noxious state, despite overwhelming evidence
about its joys and variety. The English literary humanist,
William Hazlitt, described prejudice as "the child
of ignorance". This comment rings true for certain
sorts of prejudice. But we all know older people. We
have parents and grandparents, friends and mentors.
Sometimes, it seems, prejudice is borne less of ignorance
than of fear and dread. I am inclined to go with Voltaire
who said, "We are all formed of frailty and error
let us pardon reciprocally each other's folly."While
elimination of prejudice is utopian, recent advances
in the rights, achievements, and medical care of other
systematically marginalized groups offer precedents
for how we can reduce bias and improve care for older
adults. The first step toward overcoming ageism in medicine
is acknowledging the problem. As Allport pointed out:
"If a person is capable of rectifying his erroneous
judgments in the light of new evidence he is not prejudiced
A
prejudice, unlike a simple misconception, is actively
resistant to all evidence that would unseat it."
To combat ageism in medicine, we cannot tolerate speech
and jokes based on stereotypes and fear, or allow isolation
and avoidance of patients on the basis of age (or other
inherent characteristics), or continue age-based and
age-blind policies, research agendas, and care plans.
The care of older patients may differ from that of younger
patients, but older people are no less deserving of
our respect, compassion, and highest quality care.
Finally in Muslim culture, respect and esteem increase
with age. Elderly parents are respected on account of
their life experiences and hierarchic position within
the family unit. The opportunity to attend to the needs
of one's parents in their later years is viewed as a
gift from the mighty Allah. In the Muslim community
one is astonished that so much emphasis was put on the
relationship with the parents. Here are a few sayings
of the prophet Muhammad on this subject.
May his nose be rubbed in the dust! May his nose be
rubbed in the dust! (an Arabic expression denoting degradation).
When the Prophet was asked who he meant by this, he
said " The one who sees his parents, one or both,
during their old age but does not enter Paradise"(by
doing good to them).
A man came to prophet Muhammad and asked him permission
to go to battle. The Prophet asked him, "Are your
parents alive". The man replied "yes'. The
Prophet responded, 'Then strive to serve them".
References
1. Angelique Myles. Ageing and Loss. UTMJ2010;88:54.
2. Louise Aronson. The human lifecycle's neglected stepchild
.Lancet 2014; Published Online November 6.http://dx.doi.org/10.1016/S0140-6736(14)61819-5.
3. Bloom DE, Börsch-Supan A, McGee P, Seike A.
Population ageing: macro challenges and policy responses.
In: Beard JR, Biggs S, Bloom DE, et al, eds.Global ageing:
peril or promise? Geneva: World Economic Forum, 2012:35-38.
4. WHO. Good health adds life to years. Global brief
for World Health Day 2012. Geneva: World Health Organization,
2012.
5. Isabella A G Aboderin, John R Beard. Older people's
health in sub-Saharan Africa .Lancet 2014;Published
Online November 6 .http://dx.doi.org/10.1016/S0140-6736(14)61602-0.
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