Over the last couple of months, I have been thinking not just about particular health problems but rather about what we as humans have to worry about that could conceivably change or even end the way we live today.
My generation grew up under the shadow of the ‘mushroom cloud’. The second half of the last century saw the height of the Cold War when a nuclear holocaust seemed inevitable. But we, and the rest of the world, survived.
Just as the nuclear powers were making bigger and more lethal bombs, the rest of the world was busy trying to make life better for ordinary people. The decades of the cold war also saw major improvements in medicine and while predictions were made that the world could run out of food, enough food was produced for the ever increasing population.
This does not mean that human beings are not under threat. There are basically three things that could change life on this planet. First is a natural disaster like a meteor strike that might have led to the extinction of the dinosaurs.
More likely to change life as we know it is global warming that will slowly but surely make this planet progressively inhospitable to human life. Perhaps the recent weather related problems in Karachi were an early taste of what global warming will bring us. What worries me almost as much is the rise of social media and of artificial intelligence (AI). It is important to understand that AI is more than just a big and fast computer.
Already because of social media we, humans, are starting to lose the ability to communicate directly. But as technology advances we will eventually have AI or what we might call the ‘thinking machines’. Once that happens, humanity will be threatened as if the earth was invaded by an alien species.
Ordinary people can only hope that the leaders of the world will take steps to slow down the trend towards global warming and the leaders of nuclear armed countries will demonstrate sanity as far as future wars are concerned, especially in our part of the world. As far as the threat from AI is concerned, for most people it is still more science fiction than fact.
But life goes on. People get sick and doctors must do what they can to make them better. Experts in almost every medical field are seeing an increase in problems related to their fields of specialisation. Rather than blaming one thing or another, it might just be a good idea to accept that we are victims of own success. Life expectancy has gone up in most of the world.
People are living longer and so all sorts of medical problems that were uncommon or seemed to be uncommon are now happening more often. Also as life styles improve, and the need for physical activity decreases, things like obesity, high blood pressure, diabetes, and joint problems become more common.
Fortunately we are also able to diagnose and treat most conditions that were once life threatening. Even cancer is no longer the death sentence it used to be. That said, it is important to remember that we must all die eventually.
As medicine advances in this century, the focus of medical care will slowly start to shift. Preventing early deaths will remain important but now greater emphasis will be placed on the quality of life especially in the later or the last few years of life.
Quality of life is a fluid concept and can mean different things to different people and to people in different cultures. For instance, people in Pakistan are still totally wedded to the idea that the best thing for older family members is to live with their children.
That is now changing. Many families among those I know in Pakistan now have adult children that are working and living abroad. Many of these children have become permanent residents of countries in the West. In time the parents of such children will have to make a choice. Continue to live in Pakistan alone or move abroad.
My purpose today is not to discuss the problem of families split up between cities or even countries but rather the simple question about help available for older citizens who do live alone. In the United States, for instance, they have ‘assisted living’ homes where older people can move to and where they can have company of similar people as well as help in normal living activities.
The next step for older and more infirm people is the ‘nursing home’ where it is primarily a healthcare and medical support environment. Of course neither of these two types of facilities have become available in Pakistan.
People in Pakistan keep thinking about improving healthcare. That will happen but it will take time and a lot of financial input. Once some of the basic medical problems have been taken care of, we will see a rapid increase in the life expectancy of our population. Once we reach that point we, as a nation, will have to start worrying about ‘elder care’.
And that brings me back to the idea that a reasonable quality of life is more important than trying to prolong life at any and all costs. Yes, treatable conditions will be treated but the emphasis is going to be on restoring and maintaining normal physical function or as close to normal as possible.
That reminds me of a joke often played upon doctors by their patients. Even I was once the butt of that joke. The patient scheduled for open heart surgery asked me on a pre-op visit: ‘Doc will I be able to play tennis after the operation?’ I of course said, yes. The patient then laughed loudly and said, but Doc I never could play tennis!
Normal is a difficult thing to define when it comes to individuals. But from a medical point of view normal function essentially implies that a person can live independently with very little help needed from other people. In Pakistan, where hired help is relatively inexpensive, it is possible for older people to live quite comfortably in their own homes.
In my opinion then it is more important in older patients to try and keep them as functionally active and independent as possible. Here I have seen the disadvantage of the joint family system when children pamper their elderly parents to the point where the parents lose the ability or even the desire to take care of themselves.
There is another important part of care for the elderly and that is the effect of loneliness. People who have lost a life partner of many decades are very susceptible to depression and can develop medical problems that are unexpected. For such people the ability to interact with other people is very important.
In western countries where nuclear families are the norm, loneliness among the elderly is emerging as a serious health problem. So it would seem that along with physical health, mental health is also important to allow a functionally adequate quality of life.