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.

Independence

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.

Prevention

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.

Appetite

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.

Treatment

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.

The post Grow old and grey, the healthy way appeared first on Complete Wellbeing.

Low mood

Due to the many health problems at their age and the on and off aches and pains they experience, we expect a grumpy mood in most elders to be normal. However, that isn’t how it should be. If you notice your otherwise cheerful parent, elderly relative or neighbour appearing sullen, it’s worth probing further and also seeking medical advice if things remain unchanged for long. Elders could feel low or depressed due to loneliness, feeling of worthlessness or troubled relationships at home. Often these aspects are overlooked by them and their family as well.

Memory loss

We all forget things occasionally but this is one of the most common and challenging problems of the geriatric population world over. If the person forgets names of people who s/he regularly interacts with or memory of very recent events then it could be concerning. Forgetting things like where did they place something or why did they enter the room is normal. But if they lose the trail of a sentence during their speech or forget words it could be a sign of dementia.

Lack of care

A sudden drop in the way your ageing parents dress or take care of the home should call for your attention. If you notice a lack of interest in bathing, brushing, dressing neatly then the reason should be probed. Also, if your parents have been living by themselves, keep checking on the condition of the house, especially the bathroom and the kitchen. The reason for this decline could be that they have lost confidence to manage on their own and it’s time they moved in with you or arrange for an outside support to help them with their daily chores.

Loss of sensation

If your elderly parent is unable to taste excess salt in the food, or has hurt himself and isn’t feeling any pain it calls for serious attention. Some amount of sensory loss is normal and expected as you age but if this becomes a hindrance then it should be fixed. For instance, loss of hearing has to be fixed with a hearing aid even if it is only a partial loss. Loss of sensation of touch should be diagnosed by an expert and treated. If not it could lead to accidents as the person may use too hot water in the bath or touch a hot utensil in the kitchen causing a burn and not even be aware of it.

Loss of appetite

Again just like children are fussy about the foods they eat, elderly become picky about foods and their appetite changes and reduces from what it used to be. If this is due to dental problems such as caries or absence of teeth, it could be fixed and normal appetite can be restored. However if the loss of appetite is due to indigestion, inability to procure or cook foods of their liking or a general loss of interest due to loneliness or depression, these concerns need to be addressed separately. They may also have a lack of taste which may make all foods taste bland.

Mobility

One of the biggest challenges in the elderly is to prevent a fall. Like children, the elderly are very prone to falls and with weak bones they are at higher risk of fractures and head injuries. If balance is not good, physiotherapy exercises can help to restore balance. Home environment plays an important role in fall prevention.

Loss of control in urine and stool

Loss of control over urine is a common problem with the elderly. In men it can be due to prostate, and in women it can be due to stress incontinence. It can happen as a result of an illness like pneumonia as well. A quick discussion, during the doctor’s visit, on this is very important to prevent emergencies like acute retention of urine. Due to embarrassment your parents may not disclose this complaint to you, so look for signs such as soiled clothes or bed linen.

Making the home safe for the elderly

• Encourage them to wear shoes that fit properly and wear non-slip footwear while at home
• Wipe spills immediately, do not leave it for later
• If possible, opt for non-polished floors
• Leave on the lights in the bathroom and passages
• Use door locks that can be opened from both sides in bathrooms and bedrooms
• Keep emergency phone numbers written in big bold fonts, and stick it near the phone
• Keep a fire extinguisher handy at home
• Clean bathrooms regularly to avoid slipping
• Install and use hand rails in bathrooms
• Remove rugs to avoid tripping over
• Use bright lights
• Keep an emergency lamp near the bed.

In the kitchen

• Keep kitchen floors uncluttered
• Stick “On” and “Off” position stickers on electrical appliances written in bright colours
• Keep sharp objects in one rack
• Use labels for items that are kept in opaque boxes
• Keep cleaning materials tightly closed and away from food materials
• Use cotton clothing and aprons while cooking
• Check expiry dates of packaged food.

There’s a lot you can do for the elders of your family and community to make them feel comfortable, wanted and secure. But the best thing you can give them is some of your time, spent meaningfully with them.

This was first published in the November 2012 issue of Complete Wellbeing.

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