“To care for those who once cared for us is one of the highest honors.”
1st October is celebrated as “International Day for Older Persons”. The theme for the year 2020 is “Pandemics: Do they change how we address age and ageing”
Geriatrics is a specialised branch of medicine dealing with care of the elderly. The older adult has a tendency to accumulate diseases, disabilities and deformities over the years unlike the younger adult. Until recent years, the elderly were treated the same way as the younger adult. Today, recognition of the unique differences of illnesses in the elderly, the advancement of medicine and the development of newer approaches has yielded a new speciality, the Geriatrics. The care of the elderly requires patience and participation of the patients and family caregiver and a structured team approach for both short-term and long-term care is the need of the hour.
Geriatrics in India
India, along with developed and developing countries has been promoting elderly care (Geriatrics) under the National Program for Health Care of the Elderly (NPHCE) since 2010. As the program requires proactive roles in all aspects of promotion, prevention, curative and rehabilitation services, Public Private Partnership (PPP) between the Government and the Private Institutions may bring better and targeted outcomes.
What makes Geriatric Care different?
Elderly Care (Geriatric Medicine) is a multi-disciplinary care anchored by a Geriatrician, who also do the follow up and long-term care using holistic approach. Just as young adults are different, the elderly are different physically, mentally, socially and spiritually. Age brings changes; some of which are good whereas some may be challenging and adapting to new changes may be difficult. Many of the elderly problems need support and care rather than jumping to medication. The illness presentation can be different from young people with typical clinical features; in fact, most elderly may present illness atypically. Some abnormal findings in an elderly may even be normal. Hence, follow up and close observation are beneficial. Careful and planned intervention can prevent or minimise the subtle changes with potential disastrous outcome.
Geriatrics Care – how it is done?
Geriatric Care, like any other branch of medicine provides promotion, prevention and curative aspects of care. The approaches are built to suit the elderly health needs. Prevention of the GERIATRIC GIANTS (Goliath like threats to the elderly) including fall, frailty, confusion, infection etc. need special attention. Preventive measure and enhancing activities by means of physiotherapy, treatment of chronic illness, dealing with multiple medications (polypharmacy) and the use of prophylactic measures by means of medicine or non- medicine or both and many others are incorporated in Geriatric Care. The Geriatric Practitioner may suggest modification in prescription of any speciality to suit the needs or purpose of a patient. All focus is on the wellbeing of the elderly. Life expectation is calculated; treatment risk and benefits are discussed with patient and family for any procedure that involves substantial amount of risks. The success of Geriatric Care lies in educating the caregivers at home and systematic home visit by the Care Team. The elderly should be evaluated adequately but not overtly burdened with batteries of investigations and assessment. Therefore, sorting out the problems which need immediate attention and other contributory co-morbidities that can be evaluated and treated later is also a concern.
Overall, Geriatric Care aims at improving the quality of life and maintains independence in activities as much as possible.
When is Geriatric Care applicable?
Deciding which age is the right age to be included into the elderly category is difficult and differs from country to country. A commonly accepted one is 60 years and above. Some countries, consider 65 years as the retirement age. However, it is not that everyone ages the same way. An elderly adult can be strong and healthy till the final stage of life. In the early phase of six decades, one may be strong and doesn’t seem to have any age related health issues. But the healthy adaptation, healthy habit formation and preparing for the difficult days ahead have to be incorporated into the care protocols well in advance once a person reaches 60. Whatever the age may be, everyone benefits from the adoption of a healthy lifestyle, avoidance of harmful habits, modification on diet and nutrition, fall prevention and other preventive measures including immunization against infectious diseases and medical therapy. Therefore, if any six decade adult wishes to be seen under the Geriatrics Care Clinic, it is acceptable and appropriate.
What is focused / done in Geriatrics Clinics?
The following common issues faced by the elderly are:
1. Memory problem (Dementia, Delirium, Depression).
2. Movement and mobility disorders (Parkinson’s disease, Parkisonism Syndrome).
3. Low mood/ Anxiety (Late life depression, Anxiety disorders and Adjustment disorders).
4. General weakness & difficulties with performing Activities of Daily Living (ADLs) (Frailty, failure to thrive).
5. Too many different medicines (Polypharmacy).
6. Fear of fall, history of fall with/without fractures (Fall prevention, Fragility fracture).
8. Difficulties with urination and stool control.
9. Pain / Palliative Care especially in terminally ill patients.
Sometimes Home based care may be best suited for the elderly with slow progressive illnesses like Dementia, Parkinson’s disease, Rehabilitations, End of Life Care (EOLC), Stroke and other bed-ridden patients for various reasons.
Ageing is a slow process and does not happen overnight! Therefore, any rapid deterioration of function, sudden fall (unless cluttered and slippery environments), confusion, immobility and changes of behaviour should be a trigger to seek medical attention.
The joy of caring for the aged!
Elderly care is very rewarding, both in terms of quality and quantity. There are evidences of decreased number of fall, decreased number of hospitalisation and improved quality of life with longevity with elderly care. Preservation of functional independence, restoring lost function or enhancing the activity of daily living (ADL) improves quality of life for the elderly patient.
The elderly people are full of wisdom, gratefulness, humour and having readiness to bless the younger generations. The presence of elders in the community reflects the advancement and progress of the society. The one highest virtue of a society, a community or a country lies in the values and care of the weak, widows or widowers, women and children. So, let us arise and be involved; pray and contribute to the care of our older people, who has been a source of blessing, wisdom and joy to us.
Dr Nepuni Athikho
DNB Family Medicine
Fellowship in Palliative Medicine
PG Diploma in Geriatric Medicine
Eden Medical Centre, Dimapur
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