He brought into sharp focus the wrenching trauma and dilemma convulsing rapidly aging Kerala, their frustrating emotional and social vacuum and insecurity, their orphanhood despite offspring, and their increasing medical needs.

It is a ticking time-bomb that reinforces the need for geriatric care that extends beyond old-age homes, currently the last and only resort. And, the growing need, in Kerala's context, for more geriatricians than paediatricians, though the State does not even have a faculty for geriatrics in medicine!

Thomas thus exposes the unpreparedness of Kerala, the non-existent social support system for a society aging rapidly. While Kerala has 30 per cent of under-15 population, 10 per cent are 60-plus, which means a whopping 3 million.

By the year 2002, the under-15 will be 20 per cent, and those above 60 will be 20 per cent, widening the age gap between the very young and the very old. And, 20 per cent of India's old will be in Kerala! Do we have the support system to bear this enormous social burden?

Even the West finds it difficult to tackle the problem. UK spends 90 billion pounds on social security. The US has a 490-million-dollar housing system for the elderly.

India has 100 million of 60-plus. The estimated social security budget is Rs 60,000 crore. Can India afford it?

Hence the relevance of the poser of Thomas Master. Thomas spoke for every anguished geriatric, verbalising his eternal anxiety at the relentless advance of age and its possible fallouts. Like Alzheimer's, Parkinsons disease, heart problems, malignancy and other afflictions which project voluntary death as a seductive option. Especially when you are losing your self-esteem, feeling deserted, dependent, deprived and depressed.

``It is not a novel concept for Indian culture. Sree Rama walked into the Sarayu when he felt that his role was over. Sita opted to be swallowed up by mother earth. Bhishma opted to die at his choice. Rishis and kings retired into the forest. Now there are no rivers or forests where one can seek out death. Hence assisted death,'' argues Vincent Panikulangara, the lawyer for Thomas Master.

Earlier, M R Masani had argued for the right to die and established a Society for the Right to Die with Dignity.

Despite the silvering of Kerala and the increasing socio-psychological pressure on senior citizens, Kerala has not geared up to geriatric care.

Social planning for geriatric health care, psycho-geriatric specialty etc. do not figure in Kerala's Planning. There is total failure at the political, medical, and planning level as well as in health care delivery.

Most of the old continue to be mentally agile, healthy and productive. There is no fixed point at which you can categorise them. Yet Kerala has no plan to tap this latent bank of wisdom and talent.

The changing lifestyle and value system which discard the old, the nuclear families holding dual jobs having no time for the old, the social structure where even the nuclear family vanishes with the death of a spouse, the health care problems when people live longer, and morbidity are geriatric problems.

According to psychiatrist Dr Philip John, elder abuse is becoming quite common -- verbally, physically and psychologically -- both at the hands of spouse and children.

``An elderly patient of mine was beaten up so badly because her age prevented her from being an efficient housewife. She came crying to me for help,'' he recalls.

Alzheimer's make it worse as the old forget who they are.

``We need to blend the Indian ethos with the US model, like the Elder Hostel for the 70-plus. In the US, the old feel free after retirement, globetrotting, doing things they always wanted to do, like learning a new language.

``Longevity is the leitmotif of life, the purpose of all our medical care. It will not be long when the old attain 125 in the West,'' says R Balachandran, project consultant for `Senior Citizens Care,' stressing the need for advanced concepts for age care.

``We need to look at positive aging, maintaining the mood and morale of the aged through community living, social support system, elevating loneliness and stimulating the mind to give them quality of life, providing them freedom, independence, security and care,'' according to Balachandran.

The emerging concept is a retirement community with its own infrastructure -- a combination of housing, health care and hospitality. It has three facets: The cared-for healthy at 58, the 60-plus needing continuing care for the rest of life, and the really old who needs assisted living service (ALS), who need to be bathed and needing medication and housekeeping.

What this calls for are nursing homes which are not hospitals, providing 24-hour care. And imaginative care for Alzheimer's, like memory walks.

``The need is for a new cadre of paramedicals and medicals -- an arena replete with job opportunities in job-starved Kerala. Every town and every community needs geriatric care,'' says Dr Philip John.

This is one of the topics being discussed at the coming 14th international conference of Alzheimer's Disease International to be held in Kochi from September 24 to 27.

Martin Prince from the Institute of Psychiatry will discuss the psycho-sociological and medical issues on aging. Dr Shah Ebrahim, epidemiologist from Royal Hospital, London School of Medicine, will speak on positive aging.

It will be a satellite symposium. Resource persons include Dr Philip John and R Balachandran.