Caring for the aged: Parsis of the world : Is there a solution?

 As we pose this question and we look at a horizon of say 50 years the answer to my mind that in the long term there is no solution as probably 50 years later we may be staring at extinction so the net sum will be no one to care for and no caregivers.  

Country/Region	Population	Year
India	50,000	2011 (Indian census)[12][13]
Iran	15,000–25,271	2012[1]
Kurdistan Region	15,000	2020[9]
United States	14,405	2012[1]
Canada	7,285	2021 (Canadian census)[14][1]
Uzbekistan	7,000	2013[15][16][non-primary source needed]
United Kingdom	4,000	2021
Tajikistan	2,700	2021[17][better source needed]
Australia	2,577	2012[1]
Pakistan	2,348	2023 (Pakistani census)[18]
Azerbaijan	2,000	2006[19][better source needed]
Afghanistan	2,000	2020[20]
Bahrain, Kuwait, Oman, Qatar and United Arab Emirates (Gulf Countries)	1,900	2012[1]
New Zealand	1,231	2012[1]
Other countries in Europe and Central Asia	1,000	2012[1]
Singapore	372	2012[1]
Hong Kong	204	2012[1]
World	100,000–200,000	2019[5]

By the broadest definition of Parsis in 2011 there were less than 2,00,000 Parsis and with a Total Fertility rate 0.8 which is way below the 2.3 required to stabilize population we are looking down a dark tunnel with no light at the end. 

So is it time to give up or what options do we have for say the next 10 to 20 years. Does the community have the leadership and foresight to zoom out and see the larger picture or we have leaders who continue to look in a fragmented manner and solve some segments of the problem? We are staring at a tragedy where many will be completely disabled, unable to perform even activities of daily living with loneliness, dementia, ill treatment by caregivers, slow suffering death which is happening in front of our eyes. 

Medicine 2.0 as I call it is Allopathic Medicine. As practiced today it is Reactive medicine where we are reacting to disease as it occurs and treating the symptoms after they occur. The Parsis based on their education and relative prosperity and better hygiene are less affected by infectious diseases and more by diseases of lifestyle which in medical language are the non communicable diseases. The 4 most important problems affecting the community are Cardiovascular ailments, Cancer, Neurodegenerative ailments which include dementia and Alzheimer's disease, Type 2 Diabetes and metabolic alcoholic and non alcoholic Fatty liver disease. While most Parsis have access to healthcare the Parsis are often guided in their decisions to seek treatment by factors like choice of certain favorite doctors based on past reputation, and the choice of hospitals they patronize is dictated by similar considerations. The old go to destination Parsee General Hospital is no longer their first choice as the hospital has no super speciality units and besides the Parsis living in the suburbs have good options closer to where they live. The community does not encourage or patronize hospitals run by Parsi trusts as these hospitals have not yet been able to provide modern facilities matching the ones they get for the same price in resource rich corporate or even trust hospitals. 

While I do concede that the median age of the community is quite high, the Parsi life expectancy is around 85 at least a decade more than the others in India. In this situation I feel that Medicine 3.0 which is built on a predictive model needs to adopted by the community immediately. While I do believe that we may have missed the bus partially but it is definitely in the realm of possibility that the younger generation should be tested by going genetic studies based on the present knowledge in a systematic manner. During my research on longevity and lifespan I felt that even as the science of using supplements to prevent ageing and prolong health span is nascent and the supplements have not been fully researched for their effectiveness and side effects the Parsis cannot afford to wait. https://vhjokhi.blogspot.com/2023/08/lifespan-why-we-age-and-why-we-dont.html

The above blog written in 2023 describes the possibility of increased lifespan and health span by judicious genetic modification and use of supplements which act as antioxidants and stimulate the body to create an environment conducive to increased lifespan. Today, those in their 50’s or 60’s can look forward to doubling their lives without too much degenerative deterioration. The two books along with the Avestagenome project can potentially provide a reasonable solution. It will be dangerous on my part to recommend you take supplements advocated in these books but the advice on healthy diets, exercise and reduction of mental stress and fatigue can without controversy give a glimmer of hope to our community and prolong the inevitable end.

   

The subject of reform and admission of certain non Parsis into the fold by change of faith is one subject that I am not willing to comment on in this blog for the moment or in the near future.  

What stares us in our face at present is old age, loneliness, poor health and bodies and minds suffering with disease mainly cardiac, cancer, neuro degenerative disease, senile dementia and Alzheimer’s disease along with metabolic disorders like type 2 diabetes and alcoholic and non alcoholic fatty liver disease. These are the killers in terms of disease and the immense suffering of the last decade of life. The migration of the young population into foreign lands and their inability and unwillingness to comeback to look after their parents is becoming a problem in need for an immediate solution. The community must create a single unified space and facility of partially assisted living or complete assisted living which has quality care givers trained in providing comfortable humane and affordable care in a congenial vibrant happy atmosphere. 

A book Being Mortal by Atul Gawande has the philosophical and practical basis of an assisted living center.  

Is it possible or easy? My answer is yes and no as in possible but not easy. Such a place must have diversity by not labelling it as a pure age care center. A mixture of young adults who are differently abled both in terms of mentally and physically challenged, along with old who will not be excluded irrespective of ability or disability. In fact this mix will enable the physically challenged to provide the intellectual stimulation to the old and mentally challenged. The most important thing is to keep each and every member busy in terms of providing work which can be a myriad of activities from the simplest tasks of sorting nuts bolts, to packing and weighing stuff, to rolling bandages, gauze pieces, origami, block printing , screen printing, candle making, agarbatti making, origami decorations, crochet, kusti weaving, knitting, bag making, sewing, painting, ceramic painting, chocolate making, cooking etc. etc. All this is scalable if we have the numbers and the location of all these activities in one place with shared resources. While this maybe a community initiative, it is my humble plea that far day scholars who are not availing of residential care perhaps this activity can be secular. This place should become an experimental ground for offering all kids of therapy, like art therapy, movement therapy, dance therapy animal assisted therapy, aroma therapy, music therapy. Along with all this regular physical activity like Yoga, safe sports and walking tracks should be made available. The availability of Aqua therapy and physical therapy and occupational therapy is also essential but all these therapies must be based on a comprehensive simple one point assessment which can be then allocated goals which are measurable and show progressive improvement. This center can combine pets and natural garden spaces to create better results. The place must have a training center for care givers for those who do not seek admission but want to live at home. This center must also have fun and games and celebrations but not indulgence so the health span of the inmates improve. For example many want to feed the old and heavy Lagan nu Bhonu is served which is detrimental to their health and digestion. The flexibility of any person improving wanting to go back home should be provided. Counseling, treatment of neuro psychiatric illnesses and the availability of hospital and palliative care can tie up to this center too. 

I would go to the extent of all Parsi old age homes or facilities should wind up their facilities and pool resources to create a unique center which has no exclusion criteria and becomes a place which can create a most memorable experience which virtually lacks nothing and becomes a benchmark of  scaled happy assisted living and working facility. It cannot be a one person show but requires our best brains to show up come to the party. 

Conclusion

• Increase Health span more than life span. 
• Genomic mapping and study to work on preventive measures so physiological aging is less than chronological age. 
• Life style modification and exercises very important. 
• Aggregation of resources and scalability possible to make assisted living viable. 
• A focussed deliberation on this bringing all syake holders on a common platform will bring out solutions. 
• We must in my view be ready to plan very well and make this center one of its kind. 
• All Parsi Hospitals and homes must meet to deliberate and stay the course if the community is to survive. 

Vispi Jokhi