Wednesday, July 18, 2018

Social determinants of health: How social factors determine health in the elderly

Social factors are increasingly being recognized as important determinants of health for the young and the old alike. These factors relate to the conditions of life and occupation and are therefore called social determinants of health. According to the World Health Organization (WHO), social determinants of health are the conditions in which people are born, grow, live, work and age.

The elderly or senior citizens have their unique social needs. These are people who have led active productive lives until their retirement, following which their social circle tends to decrease. Some people may perceive retired life as loss of status and respect in the society.

Loneliness, neglect, loss of self-esteem, loss of control, fear, abuse, financial insecurity, food insecurity, decreased mobility due to either disability or physical illness or lack of suitable transportation are some of the factors tied in to their health, which can lead to mental and physical illnesses and also worsen health outcomes. They increase non-compliance to treatment; consequently, the patient may present to the doctor’s clinic very frequently for chronic complaints that don’t seem to resolve.

Social isolation or exclusion is a very important problem in this age group, because of which they feel rejected by the society and sometimes, unfortunately by their own family.

Herein lies the significance of a good support system. While a good social support or a positive social environment has a beneficial effect on health and enhances quality of life acting as a ‘stress-buffer’, the effect can be quite the opposite when social support is either present but the quality of support is poor or support is totally lacking.

All these factors add on to each other and the net result is a poor quality of life as well as poor mental and physical health.

Loneliness and social isolation have been recognized as risk factors for coronary heart disease and stroke. So, while the doctor may be treating the heart disease and stroke with medicines, he/she could be missing out on these underlying ‘causes’ that caused the disease – “the causes of the causes”.

In a recent judgement, the Bombay High Court has ruled that elderly parents can take back property gifted to a son if he fails to look after them or harasses them. Citing the special law for the maintenance of senior citizens ‘The Maintenance and Welfare of Parents and Senior Citizens Act, 2007’, a division bench of Justices Ranjit More and Anuja Prabhudesai upheld a tribunal's order that had cancelled a gift deed given by an elderly Andheri resident by which he had granted 50% share in his flat to his son, reports TOI.

The Maintenance and Welfare of Parents and Senior Citizens Act, 2007 provides for the maintenance and welfare of parents and senior citizens. Maintenance includes provisions for food, clothing, residence and medical attendance and treatment. As per this Act, any senior citizen, after 2007, who have “transferred by way of gift or otherwise, his property, subject to the condition that the transferee shall provide the basic amenities and basic physical needs to the transferor and such transferee refuses or fails to provide such amenities and physical needs, the said transfer of property shall be deemed to have been made by fraud or coercion or under undue influence and shall at the option of the transferor be declared void by the Tribunal.”

It is therefore important for the treating doctor to be aware of the unmet social needs of the elderly, beyond their immediate presenting complaint, when they seek help and identify them and address them. This is important for healthy aging. They should also help the elderly patients be aware of their rights.

Dr KK Aggarwal
Padma Shri Awardee
Vice President CMAAO
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Immediate Past National President IMA

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