Under my byline

Never too old

Posted in Health, Living by Rrishi on 7 October 2007

Geriatric medicine tackles the real problems of old age, but there’s little support in India

When Dr Sanjogta Sachdeva and a handful of other doctors set about founding the Geriatric Society of India in 1976, to focus professional attention on health care for the elderly, their peers were perplexed. “Have you become old?” they laughed, “We’ll see about getting old when we’re old.”

Geriatric medicine, like many of the elderly, is held in somewhat less than the respect it deserves. After all, we all grow old, and should wish to see specialised doctors available to care for us as our minds and bodies wear out. But geriatrics is not a favoured discipline among medical students, and geriatricians are not among the better-paid doctors.

In part this is because, as Dr Sachdeva observed, geriatrics is the “science and art” of caring for the elderly. Art is required because the troubles of the elderly surpass the problem-and-solution model of modern medicine. An old person will have several serious diseases simultaneously, none of which can be cured — such as arthritis, diabetes, a digestive disorder, respiratory and circulatory problems and perhaps even Alzheimer’s disease or cancer.

The real task of geriatric medicine is to manage the various challenges and assure the patient as independent and unrestricted a life as possible. Various specialists are obviously involved, but a geriatrician will ensure that the overall life condition of the patient is given top priority.

The four most important challenges, says Dr Sachdeva, are blood pressure, diabetes, joint problems and obesity. None of these comes into being suddenly — they develop over time, so we must catch them in time to prevent them from becoming disabling. Another lady geriatrician, who prefers not to be named, adds to this list the risk of fractures, especially at the hips, wrists and spine. If no one is within hearing distance, a fall could be very dangerous.

Both men and women, she goes on, suffer from urinary problems: prostate enlargement in men and, for instance, incontinence in women. Such problems can make it impossible to leave home for any length of time, which severely limits one’s social and mental horizons. Often, “simple measures such as training the bladder, giving drugs, making small lifestyle changes such as drinking less water” can help.

“Rest has killed more people than work,” says Dr G G Mansharmani, a senior geriatrician. He means that regular and sustained physical and mental exercise is the best way to limit and delay the effects of ageing. “There’s no such thing as an old Prime Minister,” says Dr Sachdeva, offering an example, “When they become PM, even sick men become well!”

Loneliness is common among India’s elderly, even within our still-strong joint family system. Retirement takes people away from colleagues, and often from mental work; and time hangs heavy. Wives are usually several years younger than their husbands, and live longer, so their last years are spent alone (if their children live elsewhere) or in one of their sons’ households, where their needs may well be given lower priority than those of their grandchildren. The potential for abuse is very great, and every geriatrician has a sizeable collection of hair-raising tales.

But even independent, active old people can be stymied by bad design in our public places. Even homes are not designed to accommodate the old, although such details are taught at architecture school.

Virtually the only sure safeguard for the elderly in India is wealth — so long as you don’t sign everything over to your children before you die, says Dr Mansharmani. There are a few homes for the elderly, most run by religious organisations like the Arya Samaj. There is also a small number of programmes in India to train and place geriatric care workers in homes, for reasonable fees.

India’s senior population is growing fast. Why should the skills and experience of such a huge number of Indians be wasted in retirement and slow decay? Nobel laureate Elias Canetti wrote in his 80s, of the importance of old age: “To know what no one else knows, to be able to say what no one else can say. There must be enough of this so that it is felt by the others, so that they can clamour for it and refuse to leave us in peace.”

I have arthritis for 40 years. Some doctors treated me, but there was no result. It came to a point where I couldn’t move, sit, hold a cup of tea. Then this [rheumatologist] came, the first day he gave me an injection in my knees and I was standing and walking. He doesn’t give too much medication. I’ve been taking it since 1995. Pain is there but it is mild. My back, shoulder, neck — I’m so used to it that I don’t even notice. Now my hands are changing shape. But I feel lucky that I can still use my hands and I can walk. I have no fear for the future. Life goes on. One has to go sometime. As long as I can enjoy.

Kushal Lata Kumar, 78, who runs her household

People lose patience with you. When you go to make a railway booking, even the senior citizens’ queue has only four seats! There are many who can’t stand for long. Sometimes I have to wait for a long time to cross the road. The divider is so high that I have to push myself up. Why can’t they cut a little step? Youngsters on two-wheelers, they zoom! Climbing into a bus is also difficult, and the conductor is impatient. I don’t want to go to any emergency — the treatment meted out to you and your people! I’d rather die at home. I’m very determined about it.

A gynaecologist in her late 60s

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