Senior concerns

When determining health care requirements for the elderly, physiologic age should be given preference over chronologic age. An abrupt decline in any organ’s function is almost certainly due to a disease and not due to normal ageing. Therefore, symptoms in the elderly should not be automatically attributed to old age. It is important to look for potentially reversible causes of symptoms. Improvement or maintenance of functional abilities is the major goal of medical care for senior citizens.

As we age, our bodies fail to function as they used to when we were younger. For most, illness is not even a consideration. So when our bodies start showing some symptoms, we fail to understand them. Being prepared is half the battle won. Here’s what we all should know.

Watch out for these symptoms

Delirium

Approximately one third to half of the elderly patients suffer from altered sensorium [confused state or delirium]. The presence of altered level of consciousness, easy distractibility, irrelevant talk, illogical flow of ideas, failure to recognise near ones and agitational behaviour should indicate to the relatives to seek proper medical advice as early as possible.Delirium indicates diffuse brain dysfunction and is associated with four classes of diseases:

1. Primary brain diseases such as brain infection, tumour or stroke.
2. Systemic illness that secondarily affects brain functions including heart disease, liver dysfunction, kidney failures. Lung problems leading to low oxygen or high carbon dioxide level, low or very high blood sugars, electrolyte imbalances and anaemia.
3. Intoxication or drug overdoses.
4. Withdrawal from dependency producing agents like alcohol, barbiturates and benzodiazepines [sleeping pills].

Breathlessness

The second most common clinical presentation is breathlessness and chest pain. These symptoms are most commonly associated with heart and lung dysfunction requiring urgent hospitalisation.

Digestive dysfunctions

Diarrhoea and vomiting leading to dehydration, kidney failure and electrolyte imbalance feature next on the list. Most of the time a decreased ability to recognise or express thirst and limited access to water worsen the situation. On the other hand, poor dietary intake, chronic constipation and laxative abuse makes them susceptible to intestinal obstruction leading to acute abdomen [a sudden, severe abdominal pain that is less than 24 hours in duration requiring immediate medical attention].

Urinary problems

Symptoms arising from dysuria [painful urination], increased frequency to failure to retention urine are all a possibility.

Falls

Accidental falls may cause fractures.

Know the challenges involved

Elderly patients are a challenge to clinicians because of their decreased physiological reserve. Though they often develop symptoms at an earlier stage of the disease, the advantage is lost because of two factors:

1. Symptoms may show later, if there is a function limitation in another system. For instance, if a senior citizen has arthritis, she may not experience classical heart disease-related symptoms of breathlessness and chest pain during physical activity because arthritis has restricted her movements.
2. There is a change in pattern of illness that occurs with age.

Detect the pattern

There are some classic variations in how elders will react to illnesses. These are as follows:

1. Seniors consider feeling unwell to be a natural and an unavoidable part of ageing. So they often tend to live with the symptoms without revealing them. If they convey their discomfort early, the treatment can start in time.
2. Many have hearing and vision problems which hinder effective communication. So they tend to get agitated.
3. With age come a host of problems such as reduction in the effectiveness of cough, diminished gag reflex, difficulty in swallowing, and decreased immunity. This exposes them to the risk of aspiration pneumonia if they lie down for prolonged periods.
4. The reduced muscle mobility may cause contractures, pressure ulcers, and deep vein thrombosis. Functional faecal and urinary incontinence are other problems faced.

Special consideration

It is essential to provide coordinated care typically by physicians, nurses, physiotherapist, dieticians and social workers. Elderly patients with complex conditions should seek treatment from a geriatrician.

The current disease-orientated model of acute medical care promotes a sequential approach to diagnosis and treatment that generally ignores the practice of restorative care until the patient is discharged from the hospital. In case of frail elderly, this approach may lead to decline in functional abilities despite effective treatment of acute medical illnesses.

The high rate of psychological decompensation [inability to maintain defence mechanisms in response to stress] in the hospitalised elderly may lead to excessive bed rest with accompanying loss of mobility, muscle atrophy contractures, pressure sores, greater tendency to fall, incontinence, anorexia, constipation, and lack of motivation.

This has been called “Cascade of illness and functional declines” since the physiological characteristic of aging population include both a decreased functional reserve and large individual variation. Medical management should centre on individualised treatment plans that incorporate maintenance of functional status, protection from the hazard of immobility and low risk of complication from treatment.