Aging is defined as “increasing mortality with increasing chronological age in populations in the wild” or “IMICAW”. It is characterized by a decline in muscle mass and strength, when this aging process outreaches pathological levels it is defined as sarcopenia.
WHO classification of elderly individuals:
- Elderly : 60-75 years
- Old: 76-90 years
- Very old: Above 92 years
Geriatric population trends in India:
According to the population census 2011 there are nearly 104 million elderly persons aged 60 years or above in India; 53 million females and 51 million males. It is interest to note that upto Population Census 1991, the number of elderly males exceeded the number of females. Life expectancy has increased in rural as well as urban to 66.3 years and 71.2 years.
Health problems of the aged:
1) Problems due to the ageing process:
- Visual complaints such as cataract , glaucoma and retinopathy
- Locomotors system disorders: Osteoarthritis, rheumatoid arthritis, myositis, neuritis, gout , spondylitis of spine and fibrositis.
- Cardiovascular diseases: Atherosclerosis, myocardial, infarction, arrhythmias, hypertension and heart failure.
- Skin complaints: Senile wrinkles, scaly lesions, dermatitis, neoplastic disorders.
- Neurological complaints: Dementia, cognitive impairment, parkinson’s disease and alzheimer’s disease.
- Hearing complaints: Nerve deafness and conductive hearing loss
- Respiratory complaints: Pneumonia, copd and asthma.
- Gastrointestinal complaints: esophageal diseases, peptic ulcer, constipation, diarrhoea, inflammatory bowel diseases and carcinoma of GIT.
- Nephrology complaints: Glomerulonephritis, acute renal failure and Chronic kidney diseases
- Genito-urinary complaints: Enlargement of prostate, Ca of prostate, dysuria, nocturia, frequency, urgency of micturition, Ca of cervix, etc.
2) Problems associated with long-term illness:
- Degenerative diseases of heart and blood vessels.
- Cancer : Prostate cancer is common after the age of 65.
- Accidents: Fracture neck of femur in elderly.
- Diabetes mellitus type 2.
- Diseases of locomotors system.
- Respiratory illnesses.
- Genitourinary complaints.
3) Psychological or psychiatric problems:
- Mental changes and disorders: Impaired memory, rigidity of outlook and dislike of change,delirium,dementia, depression, panic disorder, generalized anxiety disorder and social phobia.
- Sexual adjustment: cessation of reproduction in women, diminution of sexual activity, irritability, jealousy and dependency becomes very common.
- Emotional disorders: Resulting from social maladjustment, failure to adapt can result in bitterness, insecurity of being abandoned by their children, loneliness in elderly people, inner withdrawal, depression, weariness of life and even suicide.
4) Social problems:
- Elderly abuse.
- Economic .
Case taking approach to older person:
The essential setting for evaluating an older people must be a non-competing environment such as well light or non-slip floors. The environment should be assessed for safety and optimal functioning as the older person becomes frailer and more dependent on the environment. The physician must have an understanding of how diseases processes present in the older individual and also the natural ageing phenomena.
The initial interview should focus on functional decrements and includes on history, social support and subjective findings. While assessing the aged, consider using additional tools such as pain diagram, pain language, pain diaries, etc. for evaluations. In carrying out the physical assessment of older person, attention must be given not only to detailed physical examination but to the functional abilities of the individual as well. For instance, can an elderly individual walk safely with or without a walker or cane stick? Can able to cut his/her food and chew it? Or able to dial a phone? To assess the psychological aspects of an older person may be difficult to deal with; however, using the straightforward approach will be the easiest.
Difficulties of Case Taking:
- Communication barrier because of hearing loss, culture and language differences among physician and patients.
- Difficult situation due to the patient includes senile forgetfulness and reserved nature of elder persons.
- Difficult situation due to diseases situation like suppression of diseases, wrong medical management, habituated or accessory symptoms, complex diseases such as diabetes mellitus type 2 and schizophrenia.
Important rubrics from Schroyens.F.Synthesis 9.0:
- Mind – absentminded – old age; in
- Mind – confusion of mind – old age, in
- Mind – slowness – old people, of
- Mind – weary of life – old age, in
- Vertigo – old people, in
- Head – pain – old people, of
- Nose – coryza – old people
- Hearing – impaired – old people
- Eye – cataract – old people; in
- Stomach – indigestion – old people
- Nose – epistaxis – old people
- Prostate gland – swelling – old people; in
- Bladder – urination – involuntary – old people, in
- Bladder – retention of urine – old men
- Bladder – paralysis – old people,
- Rectum – diarrhoea – old people
- Rectum – diarrhoea – alternating with – constipation – old people; in
- Rectum – constipation – old people
- Cough – old people
- Expectoration – copious – old people
- Chest – paralysis – lung – old people
- Chest – inflammation – lungs – old people
- Extremities – paralysis – old people
- Sleep – sleeplessness – old people, in
- Generals – blackness of external parts – old people; in
- Skin – itching – old people
- Generals – wounds – reopening of old
- Generals – weakness – old people, of
- Generals – old age – old people
Some important national programs and schemes:
- National Programme for the Health Care for the Elderly (NPHCE).
- Integrated Programme for Older Persons (IPOP).
- National Policy on Older Persons (NPOP).
- Old age Social and Income Security (OASIS).
- Indira Gandhi National Old Age Pension Scheme 1995.
- Pace (Programme of all-inclusive care for the elderly).
- The Ministry of Social Justice and Empowerment observes the International Day for Older Persons (IDOP) on 1st October every year in a befitting manner by organizing a series of events and programs dedicated to senior citizens.
- Howard M Fillit, Kenneth Rockwood, Kenneth Woodhouse. Brocklehurst’s textbook of geriatric medicine and gerontology.seventh edition.
- G. Libertini, G. Rengo, N. Ferrara. Aging and aging theories. Journal of gerontology and geriatrics.2017;65:59-77.
- G.Fornelli, G.C. Isaia, P.D’Amelio. Aging, muscle and bone. Journal of gerontology and geriatrics.2016;64:75-80.
- Munir Ahmed R.Fundamentals of repertories alchemy of homeopathic methodology.2016.Hi-Line Publishers and Distributors Pvt Ltd.
- Prof.Dr. Shashi Kant Tiwari.Essentials of repertorization.Fifth edition.B.Jain Regular.2012.
- K. Park.Park’s textbook of preventive and social medicine.Banarsidas Bhanot Publishers.2017.
- Elderly in India-Profile and programmes 2016.www.mospi.gov.in.
- Synthetic repertory radar 9.0.
- James Tyler Kent.Repertory of homeopathic materia medica. B.Jain Large Print.2007.
Dr Eyingthung Odyuo
Govt HMC&H Bangalore