Geriatrics - Caring Old age People
The world is aging! Although aging is not a disease the risk of developing illness is increased. The aging population is just not increasing in the developed world but it is global phenomena. The developing nations would see a rapid increase and hence they will have less time to take necessary measures. The increasing age causes high morbidity and high use of medical services. With increasing food security, medical health care and through various social welfare programs the fertility declines and life expectancy increases. The number of People above 60 years of age is increasing at a faster rate than all younger age groups.(World population prospects 2017 )
As of 2017, 13% population of the world is having the age of 60 or above contributes around 962 million people. The aging growth is 3% per year. Currently, Europe has the maximum number of aged people around 25% of their population. It is estimated that the aged population will be around 1.4 billion in 2030,2.1 billion in 2050 and 3.2 billion in 2100. In the coming decades, it is estimated that many countries will face the heat of health care, pensions, transportation, housing, and social protections for their old age people.1 in 5 Americans will be 65 years old by 2050 and more than 10 million Americans will be having age over 85 years.
According to Indian census 2011, there are around 104 million elderly people and according to the report of United Nations, Population Fund and HelpAge India by 2026 elderly people will grow to 173 million. The percentage of elderly people in India will be around 19% in 2050 from 8% in 2015. Around 2/3 age old people live in villages and almost half of them are poor. The financial stress comes from working to non-working transformation which lead to economic dependency on children or closed ones.
What are the socio-economic issues faced by aged people? Although aging is a natural process it may throw challenges to old adults. The life for old adults is not the same for all. Some may enjoy their golden years with grandchildren and family members if the home atmosphere is conducive and supportive. But some may lose their partners and close friends and if there is a lack of emotional support and care at home they can develop anxiety and depression. They can start feeling loneliness and become isolated from the family, society, and community.
The old age persons lack the physical strength to perform their daily routine activities because of which they depend on other people’s support. Some people can cop up with the psychological pressure of the aging process but many can feel difficulty to accept physical changes due to aging. It is observed that people above 65 years of age develop at least one or more illnesses which require regular medication which increases frustration among them.
After retirement old age people face boredom due to loss of regular work and non-availability of opportunities for creative use of free time. They have less money in their old age and feel financial insecurity. Even though they get the pension but that is not adequate to meet their health and other expenses. Due to the generation gap, the young people ignore the advice of the old people which create a feeling of disrespect among them. With the degradation of the value system in societies, younger people don’t show compassion and empathy towards old age people.
Due to the busy and hectic schedule of young people of the family, they are not able to spend quality time with their elderly people. This also creates a feeling of isolation and loneliness. Moreover, the migration of young people for better economic opportunities makes elderly people vulnerable and helpless.
A feeling of low self-worth comes due to loss of earning power and social recognition. Traditionally elderly people enjoyed the position of power, social status, prestige, high respect in society but in this technological century they are becoming inactive, dependent, sick, and weak and ignored by younger people.
Many elderly people are facing the problem of a peaceful place to live in. They don’t find adequate housing and are not adequate to meet their basic needs.
They also face abusing problem where social system is weak and values are deteriorated. They are ill-treated, neglected, ignored, verbally and physically abused by young people. This type of behavior decreases self-confidence and increases psychological pressure.
Although aging is biological universal phenomena the actual experience of aging depends on social and economic factors. Most of the poor who have in their past depended on their physical strength to earn livelihood suffer the most. Due to the hard work, they performed during their entire life the physical movement in old age becomes difficult. The prolonged state of malnutrition in childhood and youth, lack of basic amenities and poor hygienic conditions and unsafe drinking water takes a heavy toll on health during old age.
The feminization of aging is a worldwide phenomenon. The elderly women are more prone to destitution in comparison to their male counterpart because of widowhood, illiteracy, malnutrition and high economic dependency on others and patriarchal societal setup.
What do you mean by Geriatrics? Gerontology is the scientific study of the aging process and geriatrics is one of the branches related to the health aspect of elder people. Older people sometimes have multiple medical problems and different patterns of disease presentation. Sometimes the response of medicines is slow and hence requires special medical skills. Therefore, it is one kind of medical specialty that solely focuses on health care of elderly people. As the 21st century getting old this field is also growing faster. These geriatrician doctors are specially trained in the aging process.
What are the aims of geriatric medicine? The main goal of geriatrics is to enable old people to live a full and active life. It has an objective of preventing and treating diseases and disabilities in old age people or senior citizens. It aims to reduce the suffering of old people from disabilities and diseases and minimize the dependence on other people by proper rehabilitation. It focuses on early detection of the diseases and timely appropriate treatment. The geriatrician provides emotional support and comprehensive care during terminal illness.
What are the different types of geriatric syndromes? Geriatric syndromes include health issues and their symptoms which are commonly found in old age people. In the old age, the metabolism process slows down and leads to many physical and mental problems. They lack immunity power and become more prone to many diseases. There are four geriatric giants which are major categories of impairment that appear in elderly people. The giants of geriatrics term were coined by Prof.Bernad Issacs to identify the major diseases of the aged people. Gigantic numbers of elderly people are affected by immobility, instability, incontinence and impaired memory.
How serious immobility is? The inability of aged persons to move independently which forces them to live in limited space or under the four walls of the house. This can be caused by muscle’s weakness, pain, poor physical capacity, fear of fall, and visionary problems (cataracts). It affects the overall quality of life and autonomy of the person. Due to this person cannot do important daily tasks or functions freely. Inactiveness increases the risk of other diseases like incontinence, pressure ulcers, and osteoporosis.
Immobility can develop pressure ulcers due to long hours of positioning in one particular direction. To avoid such problems physical strength should be increased by giving a good diet with essential minerals. Old aged friendly mattresses should be used which can give comfortable positioning. Time to time the position should be changed to avoid the pressure ulcers.
What do you mean by incontinence in elder people? This is the condition where there is accidental or involuntarily loss of urine from the bladder and increased frequency of urine. In this case, a person doesn’t have the capability to control the bladder. This can lead to nervousness and unhygienic conditions. The aging reduces the capacity of the bladder. The kidneys can become less active and cannot concentrate the urine.
The first line of treatment for such a problem is behavioral therapy. This can include bladder training, pelvic floor muscles exercises and proper fluid and nutrition management. Behavioral therapy doesn’t have any side effects. The other treatments include medication, use of medical devices and surgeries. Incontinence is treatable and professional medical help should be taken.
How dangerous is fall in elder people? It is estimated that the highest deaths in elder people are caused by falls. It can lead to serious injuries and fractures. This is caused due to the instability of the old people and the inconvenient surrounding. The main reasons behind instability include sensory impairment like poor vision, hearing, dementia, weak muscular strength, low blood pressure, and medications. The hip fractures are caused by the falls in old women with osteoporosis. Moreover, the patient loses the confidence and fear of falling.
To prevent the incidence of fall long term exercise and balance training should be given. Tai Chi is a good exercise to prevent the falls. The home should be old age people friendly and all hazards should be removed. The house should be lighted properly. Overuse of psychotropic drugs should be reviewed. Assistive devices can be used. Low heel footwear should be used. Eye problems like cataracts should be treated to improve vision.
What are intellectual impairments in elderly people? There are multiple causes of cognitive impairment in older people. Medicines which affect brain functions like sedative and tranquilizers damages memory. Imbalances of metabolic function and hormones also affect the brain. Anxiety and deep depression can affect the thought process. Other causes can be overuse of alcohol and drugs, malnutrition and brain injury.
Alzheimer‘s disease is the 6th leading cause of death in the US. The behavior change of the patients makes the care more challenging. Sometimes the patient becomes depressed and sometimes more aggressive.
Dementia affects the memory, communication ability and the ability to do daily activities. Alzheimer also impacts the language and ability to think properly. The risk of Dementia increases with age. In addition to the increasing age some major health disorders like hypoglycemia, Parkinson’s disease, and Huntington disease can worsen the dementia symptoms.
The diabetes type 2 is also a major challenge for Geriatrics because of increased risk of an accident which can lead to injury and even death. The old people who have diabetes have more chances of developing dementia than old people who don’t have diabetes.
So, the diseases which are common in old age include obesity, malnutrition, diabetes, hearing loss, wrinkling of skin, liver spots on the skin, lack of thinking ability, reduced eyesight, poor recalling memory, and osteoarthritis. Their health problems are increased due to the lack of proper health care facilities and a high cost of treatment. The major causes of deaths in old people are cancers, heart attacks, and strokes.
There is a need to protect and strengthen the family system and provide support services to families so that they can take care of their old members. The numbers of old age people are rising and the socio-economic environment is changing because of which there is a rise in the numbers of destitute. Therefore we need a large number of old age homes so that elderly people can live and enjoy the rest of their life with dignity.
With the rising cost of living and an additional high cost of health services, the old people lack the financial capacity to afford basic expenses hence better social security nets and economic support should be in place.
There is a high suicidal rate in old age people due to painful diseases, financial insecurity, loneliness, and mental health problems. The caregivers and family members should provide emotional support. Robots and video games can be a friend of the elderly people and help them in rehabilitation.
Still, in many countries, geriatric doctors are not in enough numbers to meet the demand of the rising population of elderly people. The sick elderly people are still treated in the general medicine department. The countries should take appropriate steps to provide skilled geriatric doctors for elderly people. The presence, experience, and blessing of old people are must for all-round development of the family, therefore, their wellbeing must be a priority for every family.