kaaranam-ketkadey: MAKING OLD AGE WORTH LIVING

Saturday, January 1, 2011

MAKING OLD AGE WORTH LIVING

Here is a forward from Sri Raghavendra Rao. I like this article for many reasons. It describes a number of diagnostic tests a senior citizens may undergo to prevent health problems. Useful statics on Ageing Population in India are given in Box. Importance of timely screening efforts are highlighted. The author is a competent GEriatrician who has set uo three healthcare institutions in tricities.

Now read on --------

---------- Forwarded message ----------
From: Raghavendra Rao Venkatasubbarao <vrvrao45@gmail.com>
Date: Sat, Jan 1, 2011 at 7:22 AM
Subject: [sss-global] MAKING OLD AGE WORTH LIVING
To: sss-global@yahoogroups.com

Making old age worth living
Brig M.L. Kataria (retd)

One can live a full span of life with proper eating and drinking, clean actions and pious and tranquil thinking

MORE than 2500 years ago, deeply grieved at the sight of disease, old age and death, Gautama, a young prince, renounced his palace, a pretty princess and a sweet son, to discover the cause and cure for these three inevitable states of life. For 12 long years he roamed around in forests and hills, and deeply meditated. The enlightened Buddha discovered 'Karma' as the cause, and an eight-fold middle path of divine lifestyle as a cure to attain 'Nirvana', and emancipation of the soul from the ailing body, to prevent a millennium of rebirths.

But what about the ailing body?

From the ancient period till modern times, medical scientists have also been struggling to find out the cause and prevention of disease, how to deal with the agonies of old age, and how to keep death at bay, to enjoy 100 conformable years of life, as promised and prescribed in all holy scriptures. Long strides of success have been achieved, and new paths of progress are being discovered year after year. Some of these, which make old age worth living, are highlighted here.

FACTSHEET

India has more than 76 million people above the age of 60
Today, India is home to one out of every 10 senior citizens of the world
Their number is expected to swell to nearly 200 million by 2030 and 326 million in 2050
There is virtually no social security net for them from the government's side
Of the elderly in India, 3.7 million live with dementia, each spending Rs 43,000 per annum on medical care
Dementia mainly affects older people, although about 2 per cent of cases start before the age of 65
After the age of 65, the prevalence doubles every five years with over a third of all people above 90 years being affected
Senior citizens face three serious problems: poverty, loneliness and disease

Abandoned

According to a survey conducted by the Agewell Research and Advocacy Centre conducted earlier this year, 22.01 per cent of elderly persons in the urban areas said they had no say in their family matters. In rural areas, 17.36 per cent felt the same way. In rural areas 22.68 per cent were helping their families and societies by giving general guidance or direction.

Old age is a syndrome of several ailments, creeping in individually, but multiplying into many with every decade after 60 years of life. Most notorious of these maladies are hypertension, ischemic heart disease, myocardial infarction, heart failure, cataract, glaucoma, retinal degeneration, osteoarthritis, prostate hypertrophy, diabetes mellitus and its complications, loss of memory, tremors, dementia, Alzheimer's disease, stroke with loss of motor power of limbs and speech. In women there are cervical and breast cancers, obesity and hirsuitism due to hormonal imbalance, senile and fungal vaginitis, osteoporosis, uricaemia etc.

Pessimistically, in all our geriatric health care centres, we find that every senior citizen has three to six of the ailments mentioned above, depending on his/her age, but optimistically these are preventable, curable or manageable to ensure a conformable, mobile and physically non-dependent and self-managed old age, well into the eighties and nineties.

Buddha's eight-fold middle path of life, which broadly advocates clean eating and drinking, clean actions and pious and tranquil thinking, are very relevant for preventive do's and don'ts for geriatric good health. Modern lifestyle of haste and hurry, defective fast-food eating and so-called social drinking are responsible for hypertension, heart attacks, strokes and diabetes with all its complications.

Awareness, early detection and timely curative measures are imperative steps to nip the evil in the bud. Geriatric health care centres for every 500 enrolled senior citizens, run by state of NGOs, should play a vital role for upkeep of geriatric health care.

Every senior citizen must get a bi-annual lipidgram done. Serum cholesterol must remain below 200mg%, Triglycerides below 15 mg%, High density Lipids above 40 mg%, Low Density Lipids below 150mg%. control of diet and weight must be regulated accordingly under medical advice.

Similarly, a bi-annual electro-cardiogram — and where necessary a treadmill and Holter's tests — shall depict ample assessment of cardiac functioning. When indicated, angiography, angioplasty and stent insertion, which now are routine procedures, must be done immediately when advised. Why wait for a heart attack?

To suffer from high blood pressure, leading to strokes and heart attacks in modern times is an inexcusable lapse. There are very effective drugs, such as beta-blockers, calcium channel blockers, angiotensin converting enzymes inhibitors and sleeted diuretics to keep the blood pressure within the accepted range of 120/80 mm Hg.

One can live a full span of life with a controlled diabetes-preventing ocular, cardio-vascular and kidney complications, by a well adjusted diet, exercise and drug regime. A monthly blood sugar assessment should remain around 100 mg% fasting and about 130-140 mg% post parindial level.

Besides injectable and oral spray insulins, a plethora of oral drugs for diabetes, like Metformins, Glybenclamides, Gliclazide, Glimpride are available and their use singly or in combination under medical advice can effectively control 24-hour blood sugar profile.

Foldable intra-ocular lens insertion through a button-hole incision has revolutionised the cataract surgery, permitting the patient to go home after a few hours and to work after 3-4 days. Laser and photo dynamic therapy and intro-ocular injections for retinal degeneration, though expensive, go a long way towards arresting the degenerative process. Gradual and painless loss of vision due to the rise of ocular tension (glaucoma) in elders discovered on routine examinations is easily controllable with Latanoprost, singly or in combination with Timolol eye drops, if discovered in time.

Herbal glucosamines, glucontinin and intra-articular steroid injections with physiotherapy not only arrest the osteo-arthritic pains but also control the deteriorating osteo-arthritic process, necessitating joint replacement.

For insomnia, most elderly resort to increasing doses of Alprazolems. These are not only habit forming but, also lead to degenerative changes in the brain with prolonged use.

Frequency of micturition, particularly at night, retention and dribbling of urine, may be due to enlarged prostate gland. Per urethral partial resection of only the enlarged part of the gland has considerably simplified the surgical cure of this very common problem. An annual prostatic specific antigen test in elderly men and a cervical smear test and mammo-graphy in women to detect any malignant changes is necessary, to ensure a timely cancer cure.

Fractures of bones due to trivial slips, falls and injuries, sometimes spontaneous fractures, particularly in women, and nightly bone pains, are due to gradually depleting calcium and osteoporosis. An annual accurate assessment of osteoporosis with a bone-density-meter is necessary and severe cases should preferably, be dealt with by an orthopaedician.

Due to sluggish digestion assimilation of essential vitamins and minerals from natural amount of food is reduced. Therefore, supplements as daily doses of calcium with Vit D3 500-1000 mg, Vit 'E' 200mg/day, along with daily diet may be required in most cases.

All the drugs mentioned above have on-the-counter availability with chemists without a medical prescription. Therefore, many a time, educated elders are inclined to self-medication, which has proved to be dangerous in several cases.

Although, our economy is improving every year, yet health care in India has a low priority, and geriatric health care still lower. India has seven crore elders, maximum in the world, and this number will increase by 1-2% at every census. In view of rapid changes in our social and family setup, both in urban and rural population, we need an old age home and elders nursing home in every city, town and a group of 3-5 villages. The state should encourage NGOs and private sector to undertake this responsibility.

Dr (Brig) Kataria (retd) is a pioneer in geriatrics health care and has established five senior citizen health care centres in the tricity, besides several rural health centres.