How are geriatricians different from general physicians and other specialists?

Geriatricians stress on primary care since prevention is not just better than cure, it is in fact the only cure. They focus on preventing the occurrence of health complications to avoid the need for treatment.

Since the elderly often suffer from multiple problems, if they go to various specialists like cardiologists, endocrinologists and gastroenterologists and each one of them prescribes a separate set of medications, the resulting polypharmacy (use of multiple medications by a patient) can cause adverse complications, side effects and drug reactions. Geriatricians adopt a holistic approach and where possible they prescribe one medicine to solve multiple issues, such as the same medicine to treat both high blood pressure and prostrate.

They try to avoid medication and instead suggest healthy lifestyle modifications. For sleep disorders and insomnia, geriatricians suggest better sleep hygiene instead of prescribing sleeping pills which could result in a fall caused by disorientation. Incontinence, for example, can be controlled with decreased fluid intake and exercising pelvic floor muscles.

Geriatricians also think about palliative care. They counsel the elderly patients about their treatment and whether future care will lead to a prolonged productive life or merely prolonged suffering. In cases of advanced or end-stage illness, such as kidney, liver or lung malfunction, or cancer or advanced dementia, geriatricians give their patients the choice to receive comfort care for a pain-free remainder of life instead of aggressive care such as shock treatment and chemotherapy, after explaining the implications of all available options.

Do we have viable geriatric care in Pakistan?

Though people 65 years of age and above do require geriatric care, the age at which patients may need a geriatrician is determined by their individual needs.

As life expectancy in Pakistan is increasing steadily with better healthcare and with the growing awareness of the importance of prevention, more and more people will need geriatric care in the future. We have the example of such programmes in developed countries and we can learn from them, but we have to modify and adapt the programmes according to our socio-cultural norms and religious practices, as their models of family and individual dynamics are different from ours.

What are the most common health concerns faced by elderly?

The elderly mostly suffer from the same ailments as those affecting younger people but the effects are remarkably different. In senior citizens, organs such as eyes, ears, heart, kidneys, lungs, muscle mass and bone density, and their functioning, become weaker and more vulnerable in old age. This often results in comorbids (a disease or ailment existing simultaneously with and usually independently of another medical condition), which may include malignancies, non-cancerous enlargement of the prostate gland (benign prostatic hypertrophy), hypertension, diabetes, high blood pressure, osteoporosis, dementia and stroke. Healing becomes slower and reaction to medicines and treatment becomes riskier.

The presentation of illnesses also changes. Hearing or vision impairment in elderly patients may present with depression. The occurrence of urinary tract infection (UTI) may present itself as confusion and, as a result, the patient and family members may not be able to identify the problem.

Besides health concerns, elderly patients also face psychosocial concerns. They are distressed about losing their status and career. They are anxious about the onset of limitations brought on by poor co-ordination and slow movement. Their dependence increases and physical and mental health decreases. Conditions like incontinence cause embarrassment. They may not be able to take care of their spouse like before; and if they have lost their partner, they may be feeling lonely.

Problems also arise when some side effects of conditions such as loss of bladder control, being taboo subjects, are not discussed with the care-giver (especially if the care-giver is of the opposite gender) and so not dealt with properly.

All these factors combine to create a state of acute depression among the elderly, due to which suicide rates are on the rise. Some phenomena peculiar to Pakistan — terrorism, poverty, political instability, corruption, lack of resources and the high rate of brain drain where children leave their country and parents behind for a brighter future — are also a cause of acute depression in the elderly in Pakistan.

How can the life of elderly patients be improved?

Elderly patients need to focus on staying fit by avoiding habits such as a sedentary lifestyle, drinking, smoking and unhealthy eating. If they wait to fall ill and then seek care it is a big drain on their own and their families’ time and resources. It is never too late to start primary care for elderly patients.

Regular checkups can help detect and possibly prevent conditions like osteoporosis, diabetes and any deficiencies they may have.

Elderly patients should follow medical advice diligently and co-operate with their caregivers. They need to understand that if they refuse to exercise, eat the right food or take medicines on time they will add to their and their family’s problems.

Depression can be avoided by maintaining a positive attitude and being thankful for and enjoying all the spare time they have. Counselling for depression can be sought if needed.

It would help greatly if the elderly patients accept and adapt to their limitations; and modify their lifestyle, such as using a cane or wheelchair for mobility, installing slip-proof flooring and purchasing easy to use gadgets and equipment.

What role does the family play in taking care of the elderly?

The family support that still exists, to a large extent, in Pakistan goes to the advantage of the elderly as they are taken care of by their family members.

Family members who have to shoulder the responsibility of care-giving can make their task easier by educating themselves about the patient’s specific needs including psycho-sociological, dietary, physical, mental and emotional requirements. Awareness about a condition and its related issues can help them understand the patient’s behaviour, such as aggression, and seeking professional counselling on how to deal with these issues can make care-giving easier.

The use of walking and hearing aids, and home nursing for assisting with physiotherapy, medication or hygiene, facilitate both the patient and the care-giver.

A happy patient is a healthy patient. Counselling and reassuring them, preparing them for what lies ahead, instilling positivity, showing love and care and paying attention to them when they talk, even if it is long winding, can raise their spirits. Other morale boosters include involving them in projects, arranging physical, outdoor and social activities with mixed age groups, and letting them know they will always be important and needed.