Tuesday, August 26, 2008

The Elderly - Part III

14. Common Ailments in the Elderly

The structural and functional changes with advancing years is the ‘ageing process’. The theories for ageing as per Gerontologists are loss of irreplaceable cells, production of unsound cells, limited capacity for division and accumulation of waste products. Due to structural changes most organs tend to become smaller in size but some like prostate may increase in size. In the same individual different organs age at different periods. It depends on how much an organ is insulted. Ageing process sets faster in lungs than the other organs in a chronic smoker. Economically poor and those adopting irregular habits in younger age, age prematurely. Functional changes of most organs on the decline will not affect healthy to a great extent. There is decrease in gastric secretions, sluggish colonic movements, reduction in kidney function and decline in hormone functions.
Certain benign changes which can be effectively tackled are cataract, deafness, abnormal taste, dry skin pigmentation and growing of facial hair in women. The old person is prone to develop multiple diseases due to degeneration (arthritis), Infection (pneumonia), neoplasms (cancer) and miscellaneous conditions (obesity, nutritional deficiency, etc.).

The more common ailments, their prevention and treatment is outlined below:
If the blood pressure goes above 160/95 mg. in a person of 60 years or above it is Hypertension. more common in urban (40%) than in rural (18%) elderly. It may be silent or with symptoms like headache, giddiness, breathing difficulty, swollen legs or chest pain. If untreated, it may lead to heart attack, stroke, kidney failure or eye problems. Once diagnosed, mild to moderate hypertension can be treated by regular exercise, nonsmoking, less salt intake and meditation. If not drugs control blood pressure. Homeopathy is also effective in controlling Hypertension.

Familial obesity, restricted activity, mental stress and drugs like steroids result in another common disease, Diabetes Mellitus with ultimate complications like loss of vision, kidney failure, heart attack, stroke or tingling and numbness in limbs. The diagnosis is confirmed when fasting blood sugar is above 120 mg and post prandial blood sugar (1-12 hours after meal) is above 160 mg. When diet restriction and exercises fail, then drugs or insulin keep blood sugar under control with minimal interference to quality of life.

Obesity is more harmful to men than women and obese people are prone to arthritis, hypertension, diabetes, raised cholesterol, gallstones, falls and fungal infections, etc. Restricting calories intake to 1000 cal per day and regular exercises are the solutions.

Heart Attack occurs when blood supply to heart is reduced. In 1/3rd of patients, the symptoms are seven excruciating central chest pain spreading to left side of arm or sides of neck associated With profuse sweating and vomiting. In rest of them, it may be indicated by gastric problem, sudden extreme weakness, breathing difficulty or mental tension. ECG, ECHO, treadmill and coronary angiogram confirm the attack and is managed medically and if not, by coronary angioplasty or bypass surgery. Abstinence from smoking, reduction 0f overweight, control of diabetes, BP and high cholesterol and avoiding sedentary habits, stress and strain prevent heart attack. An intake of 150 mg Aspirin after the meal is advisable under medical supervision.

When the blood supply to the brain reduces, one side of the body faits to function and results in paralysis. A block, clot or bleeding from any artery may reduce blood supply due to hypertension, diabetes mellitus, smoking, high cholesterol etc. And on confirmation by brain CT scan, stroke has to be treated by management of risk factors and physiotherapy.

Due to too much of acidity or loss of mucousal resistance in stomach or upper part of small intestine, peptic ulcer is not uncommon in old age with complaints of stomach pain and blood vomiting. It can be diagnosed by endoscopy and treated medically or by surgery.

Want of fibre diet, disease of stomach and intestine, thyroid deficiency, mental depression, certain drugs, lack of exercises and less fluid intake lead to constipation affecting bowel movement. The complications are chest pain, giddiness during straining for stools, anxiety, hernia, varicose veins in legs and obstruction of intestine.

Constipation can be managed by increased fluid intake, exercises, drugs and high fibre diets like Ragi, Wheat, Bran, Greens, Banana Stem, Cabbage, Cauliflower, Bitter gourd, Dates, Mango, Papaya, Pepper, Coriander and Omum.

Obstructive Jaundice, more common than infective type, in old age is due to the obstruction of flow of bile from gall bladder to intestine due to gall stones, cancer of pancreas or drugs. Tests including ultrasonogram should be done without delay and treated early.

Tuberculosis commonly silent without cough, phlegm or blood in the phlegm, in aged is indicated by loss of weight, weakness or low grade temperature and is more common in diabetics and smokers. On diagnosis by chest X-ray and with modern treatment cure is possible within a year.

Lung Cancer should be suspected among chronic smokers when there is change of voice, persistent cough with rapid loss of weight and could be diagnosed by chest X-ray and bronchoscopy. Treatment by chemotherapy or surgery can be contemplated.

Arthritis are .of two types, Degenerative arthritis involving knee, hip back bone and neck bone are more common than Rheumatoid rtritis involving joints of hand and feet. Arthritis is managed by weight reduction, pain relievers, physiotherapy and surgery.

Urinary problems confronted by elders are frequent urination, scanty and burning urination associated with chills and fever due to enlarged prostate (only in males), infection, diabetes and drugs. Appropriate antibiotics are prescribed as treatment.

Secretion of less or excess hormone causes Thyroid Disease. When the thyroid grand situated in front of the neck, secretes less hormone, the symptoms are lethargy, excess weight, dry skin and change of voice. When it seretes excess hormone it results in excess of appetite, weight loss, sweating, tremors of hand and prominent eye ball. On confirmation by hormone assay tests, the patient receives treatment.

Elderly people are more prone to Cancer. Men are prone to develop cancer of the mouth, stomach, lungs, rectum, liver and prostate and women to cancer of erus, breast, stomach, oesophagus and rectum. Warning signals for cancer are 1. Change in bowel or bladder habits 2. Sore throat which does not heal 3. bleeding or discharge 4, Lump in breast and elsewhere 5. Difficulty in swallowing 6. Change in mark or mole 7. Nagging cough 8. Progressive weight loss with anaemia.

Hernia, piles, hydrocele, intestinal obstruction/ perforation, gall stone, enlarged prostate, uterine mass, lump anywhere, fractures, gangrene, bleeding inside the brain are some of the. surgical problems which the elderly face. Age is not a contraindication for surgery but the risk and complications are more in old age.

Gradual decline of libido or sexual impulse is normal with advancing age but rapid decline may be due to diabetes, cancer, urinary problems, liver disorders and mental depression. Sexuality for the aged is a good thing for those who want it.

Depression is the commonest mental illness in the old age. These persons lose interest in life, eat less, lose weight, suffer from sleeplessness and constipation. They are vulnerable for suicidal attempts and need counselling and antidepressants. With the recent advances in medical therapy they can be cured and those who fail to respond require electro convulsive therapy. A mental illness of increasing inability to remember, to learn, to think and to reason known as Dementia may be due to Alzheimer’s disease in which lack of communication between brain cells due to damages or small clots affect blood supply to brain. The reason for this condition is not known and is often irreversible and progressive. The management is mainly supportive and symptomatic and the old person merits consideration, kindness and respect as a human being.

The word ‘Geriatrics’ was derived from the Greek word ‘Gerios’ (old age) and ‘iatros’ (medicine). Geriatrics is considered as a separate speciality because of difference in diagnostic, therapeutic and social problems. Psychological attitude of elders leads to diagnostic error on the part of doctor hindering early detections and prompt treatment. History taking in the elderly patients is beset with communic,ation barriers of mental impairment and deafness. They attribute problems to their age and tend to suffer in silence. Practical skill and experience are needed to obtain adequate histories in geriatric work. As regards therapeutic problems, elderly are more prone for drug side-effects. This is due to reduced lean body mass, diminished kidney function and altered organ sensitivity.

Since the elderly suffer from multiple diseases, multiple drug therapy is common which leads to more side-effects, drug interaction and omission. Elders should take drugs on the advice of doctors as side effects will be more serious than the disease itself. For healthy ageing, periodic health check-up, at least once a year, is essential. Many old age diseases are either preventable or treatable. Health check-up detects silent diseases, makes early diagnosis and prevents complications, Proper nutrition is vital for promotion of health and prevention of illness.
Quality of diet is more important than the quantity. The general guidelines are more fluid intake, inclusion of dietary fibre and at least one fruit and two glasses of milk. Aged are advised to have a heavy breakfast, moderate lunch and light dinner. Physical exercise is good for all ages, more so in old age. Regular exercise improves blood circulation in all organs to maintain normal function. It reduces obesity, cholesterol, BP, blood sugar, prevents constipation and promotes sound sleep. Consult your physician before choosing an exercise according to individual physical capacity. Brisk walking 3 to 5 Kms or 40-60 minutes in the morning on empty stomach and if possible in the evening too is advisable. Regular exercise and proper calcium intake in diet prevent loss of bone (osteoporosis) and other minerals from the spine which could lead to low back pain or fracture. Mild exercises performed daily to give full range of movement to all joints keep away arthritis. Periodic eye check to detect cataract or glaucoma, ENT check up to remove wax and defective hearing and dental check up as tooth decay affects general health are mandatory.

Mental health is as important as physical health in old age.Due to progressive loss of neurons the brain of a 70 year old person weighs only 56% when compared to its original weight. This results in mental depression, memory loss and anxiety. Brain atrophies and disuse and sensitivity is six times greater in those who have withdrawn from people and life. Loneliness leads to depression which may lead to death. For this right from middle age itself, one should plan for a hobby to keep onself occupied during old age. Hobbies like gardening, indoor games, meditation, bhajans, religious discourses, reading, interacting with others, etc. help the aged persons maintain a sound mental health and enable to age gracefully.

15. Exercises for the Elderly

Exercise is enjoyable, easily incorporated into your lifestyle, cost-free, and guaranteed to positively affect your health and longevity. If you did nothing else different, but incorporated some type of regular exercise into your schequle, you would ensure a life unencumbered by reduced energy and illness. Logic dictates that if exercise is beneficial and rejuvenates the body, then inactivity should accelerate the ageing process. Inactivity has been demonstrated to take a considerable toll on heart function, bones, the blood nerves, body composition, brain waves and the immune system in several studies. Given below are some simple exercises and regimens you could follow.

The following are some recommended strengthening and flexibility exercises. Do only those you feet comfortable doing. As your body adjusts to the new activities, you can gradually add more repetitions and other exercises. Start slowly with two-three repetitions of each exercise you choose.
Strengthening Exercises:
1. Finger squeeze: Strengthens hands; good for circulation. Straighten arms in front at shoulder level, palm down. Make a fist, then release. Turn palms up, make a fist and release.
2. Shoulder shrug:
Strengthens your back and shoulders, help relaxation. Lift shoulders up towards your ears, then back, down and relax.
3. Arm circles: Strengthens shoulders and upper back. Start with arms straight out to the side at shoulder level. Rotate arms from shoulders forward and then backward.
4. Shoulder touch: Increases flexibility of shoulders, elbows and helps tone upper arms. Start with arms straight out to the side at shoulder level. Bend elbow and bring palm of hands to shoulders. Turn palm away and push arm down to start position.
5. Leg flexion - extension: Strengthens hip muscle. Stand erect, holding on to a chair or table for support Lift one leg forward, then back from the hip. Be careful not to lean forward and back.
6. Side leg lift: Strengthens hip and thigh muscles. Stand erect holding on to a chair or table for support. Raise one leg to the side and down. Try not to lean or bring your leg forward. You can try this lying on your side, too. 7. Alternate leg lunges: Strengthens upper thighs and inside of legs. Also stretches back of leg. Start with feet shoulder-width apart. Hold on to something for support if you like. Step forward about 18" to 24" with right leg. Keep left heel on the floor. Shove off with the right leg and return to start position.
8. Calf raises : Strengthens lower leg and ankle. Start with feet shoulderwidth apart. Hold onto something for support if you like. Raise up on your toes, lifting heels. Slowly lower yourself back down to your heels.
9. Leg extension: Strengthens upper thigh muscles and tones lower abdomen Sitting in chair, back straight, knees bent, and feet flat on the floor tighten knee and raise foot up. Alternate with each leg.
10. Squat: Strengthens front thigh muscles. Start with feet shoulder-width apart. Hold on to the back of a chair for support. Keep back straight and slowly bend knees as if you are going to sit. Slowly return to start position. Do not go down too far This will improve as you get stronger.
11. Toe raises: Strengthens ankles. Standing or sitting with feet shoulderwidth apart, raise your toes up off the floor as if tapping to music.
12. Ankle circles: Strengthens ankles. Standing or sitting, make circles with each ankle, to the right and then the left.
13. Abdominal strengthening: Strengthens stomach muscles providing support for your back. Stand or sit straight. Take a deep breath in through your nose, then slowly exhale through your mouth as if blowing out a candle. Feel your stomach go in as you blowout. Hold stomach tight after blowing out, then relax and repeat.
14. Sit-up: Advanced abdominal strengthening. Lay on the floor with your knees bent and feet flat. Reach with your arms toward your knees, raising your head and shoulders off the floor You should readily feel your stomach muscles tighten. Slowly return head and shoulders to the floor Work up to doing five-ten repetitions.
Flexibility Exercises:
1. Neck circles: Maintains joint motion. Standing, or sitting in a chair, slowly move chin over to one shoulder and then to the other as if nodding “no”. Slowly lift your chin up slightly and back down toward your chest as if nodding “yes”. Repeat several times.
2. Flexed leg back stretch: Maintains flexibility in torso, low back, and legs. Stand with knees slightly bent and feet shoulder-width apart. Slowly and gently slide hands down front of legs, bringing finger tips toward the floor. You should feel a stretch in the back of your legs. Hold for the count of five when you start to feel the stretch. Stay within your comfort range - no more than five repetitions.
3. Side bends: Maintains trunk flexibility.Stand with feet shoulder-width apart. Slide right hand down right leg towards knee. Repeat to left side. Hold for five seconds; five repetitions to each side.
4. Trunk rotation : Maintains trunk flexibility. Stand with feet shoulder-width apart and knees slightly bent. Turn from your waist to the right, then left.
5. Back arch Stretches abdominal wall, chest, maintains flexibility. Do not do this exercise if you have a history of back problems. On stomach: Place hands by shoulders, slowly push up on arms and arch back. Keep hips down. Try to straighten elbows completely if back is comfortable. Return to stomach; three-four repetitions.
6. Overhead reach: Stretches shoulder girdle and rib cage. Take a deep breath in as you raise your arms overhead. Exhale slowly as you lower your arms behind your head or to your shoulders, then return to your sides.
7. Achilles stretch: Stretches the calf muscle. Stand facing a wall. with feet two-three feet away. Straighten arms, leaning into the wall. Move left leg forward 1/2 step, right leg backward 1/2 step or more. Keep right heel on floor Lean toward the wall with weight on forward Leg. Stretching the heel tendon of the right leg. Hold five-ten seconds; reverse legs; three-five repetitions.
8. Shin and quadriceps stretch: Kneel on both knees. turn to right and press down on right with right hand and hold.Keep hips thrust forward. Do not sit on heels. Repeat on left side.
9. Hip and thigh stretch: Kneel with right knee directly. Above right ankle and stretch left leg backward so knee touches floor. Place hands on floor or seat of chair for balance.
After the age of 65 or so, the age of participation in active games should be considered over. The only suitable form of exercise at this age is walking which should be continued till the end. Walking provides many benefits of more strenuous activities, without much exertion. For this activity you can progress at your own pace, no equipment is required and you can walk alone or with friends.
The benefits of walking are: ·
.It promotes more restful sleep
.A reduction of tension and stress
Weight reduction. You burn up 320 calories per hour by walking 3 miles per hour For every 11 hours of walking you will loose one pound (3500 calories equals one pound)
·Walking improves circulation and is a good cardiovascular exercise. .Improves the ability to take in oxygen.
Tips for Walking:
· Walk with your head erect and your stomach in.
· Walk on your whole foot.
· Avoid walking when it is very hot or cold.
· Let your arms swing freely.
· Begin with a 15 to 20 minute walk and walk at a slower pace for the first several Minutes as a warm up.
Use comfortable shoes or footwear.

16.Yoga for the Elderly

“Yoga is skill in Action” states Bhagavadgeeta. This is to say, in addition to the skill to improve one’s body, Yoga also comprises techniques that act on one’s mind and emotions providing a “Complete philosophy of Living”. In simple words, practising Yogasana and Pranayama is to achieve good health, keep fit, mentally and physically to be able to cope with various turbulences of life and take up the challenge to go beyond them with renewed vigour.
Yoga is meant for almost anybody between the age of 8 to 80 years. Many examples of persons who have started Yoga as late as 69 years have achieved all benefits. Hence Senior Citizens are advised to practise Yoga. Padmasri Yogacharya B. K. S. Iyengar in more than 65 years of dedicated service has helped thousands of patients through Yoga therapy as a non-conventional medicine.
SVYAS has done a lot of scientific research at their unique centre “Prashanti Kutir” at Jigni, 20 kms from Bangalore under the guidance of medical specialists in allopathy and other systems of medicine and has evolved a capsule consisting of prayer, yogasanas, pranayamas, meditations to reach the needs of common man and accordingly have opened more than 50 Yoga training centres in Bangalore. Yoga has to be practised - whether Asanas, Pranayan1as, Meditations, etc. - under the guidance of a qualified Guru.

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