Old age is often called a person’s ‘second childhood’. It may be a much overused term but it is a very relevant one from the point of view of health. There are many similarities between the two extremes of age, for example- the dependence on others, poor immunity and hence the need to use preventive strategies like vaccines, special attention to nutritional requirements, higher risk of accidents apart from other health issues. In spite of these similarities, there are major differences in the delivery of healthcare. The smallest of health issue that a child has is bound to draw the attention of the caregiver, and there are plenty of specialists and clinics to address this, whereas in old age, this is often not the case. This can be due to many reasons including socio-economic factors, lack of awareness or the lack of facilities.
The presentation of illnesses is very different at this age which makes a definite diagnosis difficult. Thus there are more chances that in spite of the best possible attention given by the caregiver, the early signals can be missed and very often attention is given only when there is a crisis. Visits to the doctor at this point become need-based and very often the preventive aspect, nutritional needs and drug review are not addressed due to the urgency of the situation and a lack of time.
The IMPACT of old age
The question arises—how can we attend to the needs of this important and ever increasing population within the framework of our country’s health care system? Let’s see what the parameters are and the challenges that need to be addressed at this age and whether we are doing them right.
To understand and remember this let’s remember the important points as an Acronym “ IMPACT”—Where I stands for Independence, M for Mood, Memory and Mobility, P for Prevention, A for Appetite, C for control over urine and T for treatment including on-going medications.
The independence of a person is the first thing that is impacted as one grows older. However, it is not necessary that just because you are older, all your faculties will be impacted. There would be some responsibilities such as grooming, washing, bathing and eating that the person would be able to manage but other tasks such as using phones, shopping, travelling, cooking and managing money could become an issue. Assessment of these aspects acts as a reference point for further evaluation and can tell a lot about the physical and mental ability of the individual.
Mood Memory Mobility
- Mood—The older population often experience a low or depressed mood due to loneliness, feelings of worthlessness, troubled relationships at home or some chronic medical condition and pain. Often these aspects are overlooked by the person and the family as well. A careful observation during a consultation can provide invaluable insights with regard to the person’s mood. A well accepted tool called the Geriatric Depression Scale [a questionnaire] helps the clinician to make a decision to offer treatment for depression.
- Memory loss—Dementia is one of the most common and challenging problems of the geriatric population the world over. It is a condition with impairment in cognitive function [memory, reasoning abilities, language skills, forgetting learnt skills like how to eat, dress etc]. This may be accompanied by behavioural changes, personality changes, hallucinations and delusions. The symptoms can be very subtle initially and so they are easily missed. During a visit to a geriatric clinic, clinicians often use a MMSE scale—a 30-point questionnaire which helps a clinician to objectively diagnose and assess the level of dementia.
- Mobility—One of the biggest challenges in the elderly is to prevent a fall. Like children, the elderly population is very prone to falls and since they are more likely to have weak bones, they are at a higher risk of fractures as well as head injuries due to smaller brain mass. Mobility is tested with simple bedside tests like the “Get up and go test”. If an individual suffers from problems related to balance, physiotherapy exercises may be recommended to resolve the problem. The home environment plays an important role in fall prevention. Employ simple measures such as the use of anti-slip flooring in bathrooms and toilets, provide support handles in areas that have steps or a slope, avoid the use of carpets and bathtubs and leave a night light on to minimise the risk of a fall.
When you are over the age of 60, prevention is a much better bet. There are two aspects to prevention:
- Annual health check ups which are specific to old age such as blood tests thyroid, sugar, lipid, scan to know the bone strength, mammography and stool tests. These tests are more or less standardised the world over and are based on common geriatric health problems.
- Vaccinations for flu must be taken annually and for pneumonia every five years apart from other vaccinations.
With age, appetite may decline but a very rapid weight loss of 5 per cent in 6 months or 10 per cent in 12 months should always be investigated for the presence of an illness.
Control over urine
Often, the control over urine is a common problem with the elderly. In men, this can be due to prostate problems; in women it is due to stress incontinence. It can also occur as a symptom of an illness like pneumonia. A quick discussion during the doctor’s visit regarding this is very important to prevent medical emergencies such as the acute retention of urine.
All the drugs that the individual is taking for various illnesses should be reviewed periodically for any possible side effects and drug-to-drug interaction. Chances of drug side effects are higher at this age even with a normal or low dose, so a careful drug review is of the utmost importance.
To really have a positive IMPACT on the health of the Geriatric population, the most important tool required is time. Sometimes more than one visit to the doctor becomes necessary to address all issues at least in the initial stages. A clinic specially dedicated for the care of the elderly is doubtless as important as any other speciality.
Sir Richard Steele, the great writer, says, “There are so few who can grow old with a good grace”. I strongly feel that modern medicine should help every person to grow old and live with a good grace—that is the challenge awaiting the doctors in India today.
This was first published in the March 2015 issue of Complete Wellbeing.
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