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Introduction
Old age is a incurable disease Seneca
You do not heal old age. You protect it; you promote it; you extend it Sir James Sterling Ross
Geriatric care
Geriatrics is the branch of medicine that focuses on health promotion and the prevention and treatment of disease and disability in later life. The term itself can be distinguished from gerentology, which is the study of the aging process itself. The term comes from the Greek geron meaning "old man" and iatros meaning "healer", This was proposed in 1909 by Dr. Ignatz Leo Nascher, former Chief of Clinic in the Mount Sinai Hospital Outpatient Department (New York City) and a "Father" of geriatrics in the United States. "Geriatrics" is cognate with Jara in Sanskrit which also means old.
Economic problems
On retirement income reduces to half The working capacity declines with age Provident fund and bank balance is already spent on making houses and settling the children Big sum of money is needed to spend on medical care
Table 1: Percentage of elderly economical dependents in India Compiled from 42nd NSSO, 1986/8
Female
Rural 8.78 13.71 77.51 Urban 4.84 9.13 86.04
Social problems
loss of status after retirement might loose spouse, other near and dear ones or good friends sons, daughters and young friends get busy in their own affairs there is a painful feeling of futility and loneliness which is increasing more due to nuclear families the needs of old age such as mixing up with relatives, playing with children, becoming useful to society, feeling of wanted and needed were well taken care in joint families earlier
Mental problems
Mental changes are inevitable in old age A certain degree of cerebral atrophy in universal in elderly and is associated with loss of memory and slowing of reflexes Sexual changes aggravate mental tension Senile dementia is well known entity Depression associated with social isolation Suicidal tendencies may increase
A comparative study to assess emotional well being of senior citizen staying in old age home verses senior citizens staying in families revealed that 90% of senior citizens in old age home were in border line emotional well being(61-80 score), 5% were having positive emotional well being (81-100 score) and another 5% were having negative emotional well being (40-60 score). Whereas 92% of senior citizens living with families were having positive emotional well being (81-100 score) and only 8% were having border line emotional well being(61-80 score). This difference was statistically significant. Naik Nisha
A comparative study on quality of life among senior citizens living in home for aged and family setup in Erode district showed that majority of senior citizens living in home for aged had moderate quality of life but none of senior citizens reported high quality of life. Similarly in family set up majority of senior citizens moderate quality of life. But overall mean score was higher among senior citizens living at family set up than living in home for aged. Kavitha AK
Physical problems
There are physical changes in the body with the aging process such as
loss of elasticity of skin thinning and loss of hair brittleness of bone weakness of muscles slowness of movements unsteadiness of gait sluggishness of reflexes immune system of body decline metabolism begins to slow down kidney loose 50% of its efficiency lungs loose 30-50% of their breathing capacity
A study to assess the health complains and related self care abilities among the geriatric population highlights that among 117 elderly subjects dental problems (93.1%) headed the topmost rank and the skin problems (20.5%) the last. The other health complaints reported were vision (80.3%), general weakness (80.3%), musculoskeletal (65.8%), falling memory (51.2%), chest and lung problem (50.4%), digestive (39.3%), addiction (48.7%), neurological (46.1%), urinary (27.3%), hearing (27.3%), blood pressure (24.9%). In musculoskeletal system females had more problems (80.7%) than males (53.8%) Similarly in failing memory, urinary complains and hearing impairment females had higher problems than males . In chest lung problems, addiction males had more problems than females. Bhutia TK.
On assessing health problems 100 elderly at old age home it was observed that most residents had cataract (52%), anemia (38%),osteoarthritis (37%), gastroesophageal reflux disease (32%), hypertension (28%), diabetes (24%), constipation (15%), sensorineural hearing loss (14%), coronary artery disease (13%), chronic obstructive airway disease (11%), upper respiratory tract infection (7%), depression (6%), glaucoma (6%), benign prostatic hypertrophy (6%), optic nerve atrophy (4%), low backache (4%), constipation (4%), hypothyroidism (3%), rheumatoid arthritis (3%), corneal opacity (3%), conjunctivitis (3%), blindness (3%), anorexia (3%), knee joint pain (3%), fracture (2%),pulmonary tuberculosis (2%), arrythmias (2%), carpal tunnel syndrome (2%),hydrocele (2%), dementia (3%), sciatica (2%), eczema (2%), senile tremors (2%), chronic fatigue syndrome (2%), and obesity (2%). Besides, chronic alcoholic liver disease, Parkinson's Disease, piles, prolapsed intervertebral disc, schizophrenia, hiatus hernia, dermatitis, diabetes, fibroid uterus, lumbar spondylosis, ascites,dysentry, herpes Zoster, migraine, urinary incontinence, lymphadenopathy,deviated nasal septum, vertigo, pyorrhoea and corneal opacity were also seen.
Government of India WHO India Country Office Collaborative Programme
A quasi experimental study on lacrimation and associated symptoms of mild dry eyeby application of warm compress among geriatric population at village Dhanas UT Chandigarh revealed that 42% of geriatric population was suffering from mild dry eye warm compress was applied on the eyelids of 36 subjects of experimental group for seven days and tear level of experimental group and control group was assessed on first and seven days, It was observed that tear level and symptoms improved significantly in experimental group on seventh day. Madhu Malini
Study on intensity of knee joint pain by Application of moist heat among geriatric population found that 48% of geriatric population was suffering from Knee joint pain. Moist heat was applied at knee joint twice a day on 43 subjects of experimental group. Intensity of pain was assessed in experimental as well as control group on first and 8th day. It was observed that intensity of knee joint pain and intake of pain killers reduced significantly in the experimental group. Parminder Kaur
Elder abuse
Elder abuse is often defined as a single, or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person (WHO)
Elder abuse
There are several types of abuse of older people that are universally recognised as being elder abuse and these include: Physical: e.g. hitting, punching, slapping, burning, pushing, kicking, restraining, false imprisonment/confinement, or giving too much medication or the wrong medication; Psychological: e.g. shouting, swearing, frightening, blaming, ridiculing, constantly criticizing, ignoring or humiliating a person. A common theme is a perpetrator who identifies something that matters to an older person and then uses it to coerce an older person into a particular action;
Elder abuse
Financial: e.g. illegal or unauthorized use of a persons property, money, pension book or other valuables (including changing the person's will to name the abuser as heir), often fraudulently obtaining Power of attorney followed by deprivation of money or other property, or by eviction from own home; Sexual: e.g. forcing a person to take part in any sexual activity without his or her consent, including forcing them to participate in conversations of a sexual nature against their will; Neglect: e.g. depriving a person of food, heat, clothing or comfort or essential medication. In addition some countries also recognise the following as elder abuse: Rights abuse: denying the civil and constitutional rights of a person who is old, but not declared by court to be mentally incapacitated. This is an aspect of elder abuse that is increasingly being recognised and adopted by nations Self-neglect: elderly persons neglecting themselves by not caring about their own health or safety.
Management of geriatrics
Prevention and management of illness or disability Maintenances of general health and nutrition Prevention of accidents Combating ageism
Periodical medical check ups, usually annually to rule out the chronic diseases at the beginning itself Immunization Acceptance and adaptation to the demands of chronic disease Continuity of care Monitoring drug usage Maintaining family and neighbour support system Management of crises Financing the health care Planning for the old age
Adequate nutrition Use of dentures if needed Adequate fluid intake, fresh fruits, vegetables to alleviate constipation Having good sleep as sleep is very important for mental health Self health monitoring and self care
Prevention of accidents
Developing safe environment and habits to compensate sensory loss and slowed or unsteady reactions to danger Limiting driving Wearing comfortable and suitable clothes and shoes Good house keeping Using stick for support
Government Policies
Old age pension Traveling concession Reservation of seats for elderly Separate queue for senior citizens Special reservation in housing schemes for pensioners Old age homes
Management Continued
Kerala government has already announced a policy for health care of elderly in 1997 and draft bill is already ready in 2004. Older person living alone should be encouraged to register with the police stations and a separate cell should be set up at police stations to keep a vigil on such older persons in their jurisdiction.
References
1. Naik Nisha. A comparative study to assess emotional well being of senior citizen staying in old age home verses senior citizens staying in families. Nightingale Nursing Times 2007; 2;10;January:37-38. 2. Kavitha AK. A comparative study on quality of life among senior citizens living in home for aged and family setup in Erode district. Nightingale Nursing Times 2007; 3;4;July:47. 3. WHO. Aging exploding the myths. Ageing and health programme. WHO publication 1999. cited by Nightingale Nursing Times 2005; 1;8;Oct:36-40. 4. Bhutia TK. A study to assess the health complains and related self care abilities among the geriatric population. Unpublished MSc Nursing thesis, Cllege of nursing, PGIMER, Chandigarh 1997. 5. Dey AB. Health care of older people. A manual for trainers of nurses. WHO publication. Ministry of health and family welfare 2003. 6. Mahajan BK, Gupta MC. Textbook of preventive and social medicine. 2nd edition 1995. Japee brothers medical publishers (P) LTD. 7. Malini M, Walia I, Kaur Sukhwinder. A quasi experimental study on lacrimation and associated symptoms of mild dry eye by application of warm compress among geriatric population at village Dhanas UT Chandigarh. Nursing and Midwifery Research Journal 2007;3(4):152-161. 8. Kaur Parminder, Walia I, Saini SK. Study on intensity of knee joint pain by Application of moist heat among geriatric population. Nursing and Midwifery Research Journal 2007;3(4):162-171. 9. NICE training resources. Ministry of social Justice and empowerment, government of India. trainingresourcemht!http://nic.nisd.gov.in
10. PIB Press release. Programme for care of older person. mh!http//socialjustice.nic.in 11. Elder abuse. Wikipedia, the free encyclopedia. 12. WHO. Evaluation of health status and health needs of old age home residents and establishment of minimum standards of health services in long stay institutions in India.Final report. Government of India World Health Organization India Country Office Collaborative Programme 2006-2007. 13. Park K. Parks textbook of preventive and social medicine. 17th edition. Jabalpur:M/s Banarsidas Bhanot Publishers 2000. 14. Mahajan BK, Gupta MC. Textbook of preventive and social medicine. 2nd edition. New Delhi: Jaypee Brothers Medical publishers (p) Ltd 1995 15. Tandan Lavanya. Elder Abuse. Nightingale Nursing Times 2005; 1;6;June:2428.