Aging Population in India 4

Life, Health and Aging in Ayurveda

This section examines how Ayurveda, a major Indian traditional medical system views aging and what healthcare response is feasible from the point of view of Ayurveda. Caraka Samhita, the olderst traditional treatise available today starts with a chapter on long life (deerghamjeeviteeyam). The mythological origins of ayurveda according to this chapter is that great ascetics disturbed by diseases in their religious observances due to worldly indulgence, gathered in the abode of Himalayas to seek a solution to the problem. Wishing for a long and healthy life they sent Bharadvaja as their representative to Indra, the king of devas, who had received the knowledge through a lineage originating from Brahma. Brahma in turn revealed this knowledge of life to the ascetics through Bharadvaja. Whereas the mythical origins and anecdotes may have layers of meanings intertwined in the cultural context what is most interesting is Ayurveda’s pursuit for healthy and long life imprinted in these lines.

The term Ayurveda is comprised of two words Ayu (longevity of life) and veda (knowledge), the word Ayu is further explained as sukha ayu (happy life), hita ayu (sustained happiness), and deerghayu (long life) thus extending the definition of longevity to include a holistic approach to health and wellbeing. This perfectly signifies the role of Ayurveda in geriatric care. Health according to Ayurveda is a balance of structural and physiological principles (dosas and dhatus) of the body, excretory mechanism (mala), and a balance of self (atman), sense organs (indriya) and mind (manas). Ayurveda has primarily a predictive and preventive approach to healthcare management with self awareness and self reliance as its focus. From this perspective health is a state when one is established oneself (svastha). This is based on the understanding that each individual is born with a specific constitution and predisposition for health and disease. Maintaining the balance of one’s constitution (which is unchangeable though tendencies can be modified to certain extent) is healthy state while promoting a positive approach to health and wellbeing.

Though the exact cause of aging is not discussed in detail, it is mentioned that it is a natural state of ‘disease’ (svabhavabala roga) among other such six other states such as hunger, thirst, sleep, and death. Describing that no cause is needed for natural decay, Caraka says that the growth or deterioration depends on two factors such as daiva (effects of the past) and purusakara (efforts of present life). By stressing the importance of time (kala) Caraka says growth depends on place and time of birth; quality of seed and soil; diet; mind; natural mechanism; physical exercise; cheerfulness etc., which are essential for growth (Tiwari and Upadhyay 2009).

According to most Indian traditional medical systems there are three dosas (roughly correlated as humors) in the body namely kapha (nourishment principle), pitta (transformation), vata (movement and destruction). Starting from early stage of life, nourishment, transformative and movement and destruction factors will be strong respectively. In other words towards late stages of life vata principle manifests strongly in the body thus leading to diseases of neuromuscular and musculoskeletal conditions. Apart from this, each individual by birth acquires either singular or a combination of the characteristics of these dosas known as prakriti (physical and mental constitution). Similarly every factor such as seasons, geographical regions, tastes, food items, medicinal plants and so are classified on the basis of the relative preponderance of these dosas. These are cardinal principles in understanding the predispositions of health or disease, diet, lifestyle or suitable medicines for an individual. Equilibrium of these principles is the desired state of health.

Geriatrics is one of the eight core branches of Ayurveda since its written history. Rasayana or jara chikitsa mainly deals with rejuvenation, improving growth and reducing deterioration of the body. Jara indicates a process of reduction in lifespan due to changes in the body (Tiwari and Upadhyay 2009). This encompasses concept of vayasthapana (stabilizing or regulating aging), rejuvenation, regeneration, immunomodulation and so on. There are different approaches to rasayana (Patwardhan 2012).  Early aging which is an unnatural state can be prevented by this treatment, at the same time it can slow down the process of natural aging. Rasayana also encompasses other topics such as healthy living and social conduct. Treatment regimens and medicines have effects on promoting longevity, strength, stabilizing and regulating aging, promoting intellect, memory, alertness and minimizing fatigue (Badithe and Ali 2003).

There is also a systematic approach to social and community health involving an intricate psychosomatic approach. Svasthavrita (healthy regimen or preventive care) a central tenet of ayurveda reinforces this approach through elaborate daily and seasonal practical advices.

Coming to the curative dimension, some of the major diseases encountered during old age are arthritic conditions, rheumatic and neurological conditions, dementia, Alzheimer’s disease, psychiatric disorders, physical disabilities due to injury and slow healing, skin disorders, impairment of sense organs (chiefly visual and hearing impairment), mental morbidities like anxiety or depression due to social isolation and feeling of alienation, lack of immunity and infections like pneumonia, tuberculosis (multidrug resistance), dietary problems of  the aged mainly due to teeth loss, low backache, chronic bronchitis, hypertension, digestive disorders, aneamia etc. Additionally for those who already suffer from chronic conditions like diabetes, cardiovascular disease the secondary effects during old age can be challenging. In stages of conditions with syndromic nature, conventional symptomatic medications like those for pain, antidepresents, anti-inflammatory agents, laxatives cannot address the basic cause, may create dependency on these medicines and chronic after effects. This can also lead to loss of autonomy, inactivity and so on. In such stages there is a definite preventive, curative, promotive and palliative role that traditional management regimens can contribute to. Apart from these ayurveda advice on diet which is constitutionally and seasonally planned, physical exercises based on yoga or other exercise forms especially sensitive to brittle bones and joints have an important function. Spiritually oriented meditative exercises, breathing techniques, daily and seasonal diet and lifestyle modifications based on traditional medical principles, personal and social behavior and so on also have key contributions to make.

Panchakarma therapy consisting of major purificatory and rejuvenative management methods as per ayurveda also has an important role in geriatric care. For instance regular oil application based on the individual constitutional specificities and health condition requirements is a good support for maintaining health. This would help reduce the healthcare costs. Early monitoring and surveillance can also produce good results.

Apart from the formalized, institutionalized traditional medical systems, local health traditions also has a lot to offer in rural healthcare and especially in areas like gender specific interventions due to the fact that public health facilities are often not used by women.