沙克夏·昌多克

Asia is facing an impending ageing crisis， wherein the population of younger people is decreasing and that of the elderly is rising. This has had several economic and social implications， and it is imperative for countries， like China， Japan and even India， to develop high-quality healthcare facilities for elderly people. But first， it is vital to understand why populations are ageing. Meena Ganesh， CEO， Portea Medical， says there are a number of reasons for this surge， such as the common practice for people in their 20s and 30s to focus on their careers and financial stability， especially in the middle and lower-middle income groups.

This has contributed to a decline in birth rates and thus， in the percentage of the younger population. Another factor is that a drastic improvement in healthcare facilities has led to a much higher life expectancy rate compared to， say， 20 years ago， Ganesh added.

Chinas “one family， one child” policy， which was implemented in 1979， leads to a low proportion of youngsters to take care of their ageing parents and grandparents. India， compared to China or Japan， is a much younger country; however， there still seems to be a burgeoning population of senior citizens， Ganesh asserted， adding that the conventional healthcare system in India is inadequate to cater to patients who suffer from non-critical illnesses and chronic diseases.

This is where “at-home” services come into play. Portea has been providing at-home healthcare facilities for elderly people in India since 2013.

It has created a framework which involves employing “caregivers who maintain a safe environment at the patients home and handle health-related issues， like personal hygiene1 of the patient， overall sanitation2， noise control et al.，” Ganesh said.

However， most sections of Indian society dont seem open to the idea of at home care just yet. One of the biggest challenges in this regard is the “societal mindset which associates a stigma to bedridden family members being attended to by outsiders instead of family members，” Ganesh said， adding that such a stigma detrimentally affects the well-being of patients and deprives them of much-needed professional care.

Moreover， elderly care is a multipronged3 approach; while some sections of society are able to afford at-home healthcare， a massive proportion is not due to financial limitations.

However， according to Ganesh， when one looks at the long-term cost of care for elderly people suffering from chronic diseases or long-term illnesses， the overall cost usually turns out to be lower than a normal “in-hospital” treatment.

Also， professional medical care provided in the patients home environment often helps them heal faster and better and enjoy a better quality of life， she explained. Another problem that has plagued4 Indian society for years is elder abuse and abandonment. Abuse， in this regard， can take many forms， such as physical and verbal assault5， torture， mental agony and economic exploitation， like ridding elders of property rights forcefully.

It is pertinent to mention here that aged widows are one of the most oppressed and destitute sections in India who are shunned from their families and from society and are forced to live in beggarly and pitiful conditions.

Such instances of ostracization6 will only tend to proliferate7 as populations grow older， unless measures are taken to counter them.

Thus， the government has a massive role to play in this area. India is home to one out of every ten senior citizens in the world. A survey conducted by HelpAge India found that half of the elderly people that they surveyed （including 48 per cent men and 52 per cent women） reported that they had suffered abuse. Such exploitation is carried out because， after a certain age， elders are considered unproductive， dependent on others and， most importantly， a liability. What is a matter of grave concern is that most elderly people in India are not even aware about their rights and about laws implemented to protect them， like the Maintenance and Welfare of Parents and Senior Citizens Act 2007， for instance.

The government is taking measures， yes， but more must be done—in the form of awareness programmes and speedy trials to create a secure atmosphere for elders， free from the fear of abandonment and abuse.

The importance of civil society cannot possibly be overstated in this regard： a large number of NGOs has acted as a saving grace for thousands of abandoned and abused senior citizens in the country.

This years budget has announced a layout of Rs 9，000 crore8 for elderly care. What remains to be seen， however， is how these funds will be utilised.

Some positive steps have been taken to counter elder abuse in India in recent times， like amendments to the Maintenance and Welfare of Parents and Senior Citizens Act 2007—providing for an increase in the jail term for those who abuse or abandon their aged parents from three months to six.

However， as is often the case in India， there lies a wide lacuna9 between enactment and actual implementation of laws. What is needed most of all is a change in peoples mindset， a mindset nurtured by love and morality， not imprisoned by hate and greed.

亞洲正面臨著迫在眉睫的老齡化危機，年輕人口數(shù)量正在減少，而老年人口數(shù)量正在增加。這一現(xiàn)象帶來了一些經(jīng)濟與社會方面的影響，中國、日本甚至是印度等國家亟待發(fā)展針對老年群體的高質量醫(yī)療設施。但是首先，了解人口老齡化的原因至關重要。印度家庭醫(yī)療護理平臺Portea Medical的首席執(zhí)行官米娜·加內(nèi)什稱，有多種原因導致老齡人口數(shù)量激增，例如人們在二三十歲時習慣專注于自身事業(yè)與經(jīng)濟穩(wěn)定，中等收入及低中等收入群體尤其如此。

這一現(xiàn)象導致生育率下降，因此年輕人口占比也隨之下降。加內(nèi)什補充道，醫(yī)療設施的大幅改善使得人口預期壽命較20年前大為提高，這是導致人口老齡化的另一個原因。

中國1979年實施的“獨生子女”政策導致能夠照顧年邁父母、祖父母以及外祖父母的年輕人占比很低。與中國或日本相比，印度是個年輕得多的國家。然而加內(nèi)什稱，印度老年人口似乎仍在迅速增長。她同時補充道，印度傳統(tǒng)醫(yī)療體系已經(jīng)不能滿足那些患有非危重疾以及慢性疾病患者的需求。

在這種情況下，“家庭服務”開始發(fā)揮作用。Portea平臺于2013年開始為印度老年群體提供家庭醫(yī)療幫助。

公司創(chuàng)建了一套體系，該體系涉及雇用“護理人員來保持患者家中的安全環(huán)境以及處理與健康相關的事宜，例如患者的個人衛(wèi)生、總體環(huán)境衛(wèi)生以及噪音控制等”，加內(nèi)什說道。

然而，目前印度社會大多數(shù)群體似乎還不贊同家庭護理的觀念。這方面一個最大的挑戰(zhàn)是社會觀念：人們認為“如果臥床不起的家庭成員由家人以外的人照顧，那是恥辱之事?！?加內(nèi)什繼續(xù)補充道，這種污名對患者的健康造成了不利影響，并讓他們得不到急需的專業(yè)護理。

同時，老年護理是一個多方面的舉措。雖然社會上一些群體負擔得起家庭醫(yī)療，但大部分因為經(jīng)濟條件的限制而負擔不起。

然而，加內(nèi)什表示，從長期的護理花費來看，患有慢性疾病或長期疾病的老年人在家庭護理方面的總體花費，通常要比正常的“住院”治療花費低。

此外，加內(nèi)什解釋道，在患者的家庭環(huán)境中為其提供專業(yè)的醫(yī)療護理，通常有助于患者更快更好地恢復并且享受更好的生活質量。長期困擾印度社會的另一個問題是虐待和遺棄老人。虐待有多種形式，例如身體和言語攻擊、身體和精神折磨以及經(jīng)濟剝削，比如強行剝奪老年人的財產(chǎn)權。

值得一提的是，老年寡婦是印度受壓迫最重及最貧困的群體之一，她們被家庭與社會忽視，被迫生活在貧窮無助的境地。

如果不采取措施應對，這種排斥老年人的例子只會隨著人口的老齡化與日俱增。

因此，政府要在這方面發(fā)揮巨大作用。世界上每十個老年人中就有一個是印度人。印度助老會開展的調查顯示，被調查的老年人中（包括48%的男性及52%的女性）有一半曾遭到虐待。這一剝削現(xiàn)象產(chǎn)生的原因是，當老年人到了一定年齡之后會被認為是沒用的，要依賴他人生活，更重要的是他們被當成累贅。令人深感憂慮的是，印度大多數(shù)老年人甚至都不了解自身權利以及保護自身的法律，例如《2007年父母和老年人贍養(yǎng)和福利法案》。

政府確實在采取措施，但是還必須有更多作為——要提高老年人的認識，加快審判流程，為老年人創(chuàng)造一個安全的氛圍，不再擔心被遺棄和虐待。

在這一方面，民間團體的作用也至關重要，大量的非政府組織為該國數(shù)以千計被遺棄和被虐待的老年人提供了救助。

印度已經(jīng)宣布今年的預算將900億盧比用于養(yǎng)老項目，然而這些資金將如何使用還有待觀察。

最近印度已經(jīng)采取一些積極舉措來應對虐待老年人事件，例如《2007年父母和老年人贍養(yǎng)和福利法案》的修正案將虐待或遺棄年老父母的刑期從3個月延長到6個月。

然而，正如在印度經(jīng)常所見，法律的頒布與實際實施之間存在巨大差距。最迫切的是改變?nèi)藗兊挠^念，要用愛和道德去培養(yǎng)，而不是被恨和貪婪所禁錮。 ? ? □

（譯者為“《英語世界》杯”翻譯大賽獲獎選手;單位：北京外國語大學）