Preventive Geriatrics: Need of the Hour
The art and science of preventing diseases in the aging population and promoting their health comes under preventive geriatrics. It aims at maintaining the health of the elderly population with early detection and treatment of disease. As the aging population fetches a myriad of socio-economic and medical problems, it has now become the main concern for the government. Therefore, there is a need to emphasize on the medical problems faced by the elderly people in India, and strategize to bring improvement in their quality of life.
Preventive Geriatrics: Current Scenario
The elderly population in India is affected by communicable as well as non-communicable diseases. According to statistical reports, of the Government of India, cardiovascular disorders contribute to one-third of elderly mortality, while respiratory disorders, infections including TB account for 10% mortality.
Some of the most common chronic diseases affecting the elderly due to the physical and psychological aging factors may include:
- Hypertension: Essential hypertension is very common with aging and if not controlled can lead to stroke, heart disease, kidney disease, eye problems, etc.
- Diabetes: Diabetes is a chronic medical condition that occurs when the pancreas does not produce enough insulin that works on the food to convert it into energy or there is resistance to actions of insulin. Diabetes and its complications may affect the quality of life of elderly patients and come with huge healthcare costs. However, proper diagnosis and treatment can prevent the complications.
- Arthritis: The most common age-related joint disease that affects more than 80% people beyond 55 years of age is Osteoarthritis (OA). It is a leading cause of an elderly visit to outpatient departments and also accounts for almost half of all non-steroidal anti-inflammatory drug prescriptions.
- Stroke: Stroke is one of the most common neurological disorders among the elderly population with a prevalence rate of 33.34% above 60 years of age.
- Dementia: Dementia is a disability-adjusted health issue that hampers cognitive function like skilled movements, language or functions that are often manifested as behavioral disorders and mood swings.
Some of the other health conditions that seniors get affected include:
|Health condition Affected population||(%)|
|Cataract and visual impairment||90|
Geriatric Demography: Current Scenario
According to World Population Aging report, India has attained the label of an aging nation since its 7.7% of its population is more than 60 years old.
Moreover, it has been projected that the by 2050, there will be about 19% of the increase in the elderly population.
As per the recent statistics related to rural and urban areas, 71% of the elderly population reside in rural areas, while 29 % is in urban areas.
In terms of state-wise distribution, the data depicts that the proportion of elderly fully dependent males is highest in Kerala (43%) and is lowest in the state of Jammu & Kashmir (21%).
Assessing Geriatric Care
A good geriatric care is an intensive, meticulous effort. It is a multidimensional and multidisciplinary approach that is specifically designed to assess physical health, mental health status, and socio-environmental statuses.
Assessment of geriatric care has possessed many benefits like:
- Increased diagnostic accuracy: Growing older population necessitates improvement in diagnostic accuracy. However, still, there is a lack of diagnostic instruments that are specifically designed to address disorders in the elderly.
- Improved functional status and survival: Functional status is the ability of people to perform basic daily activities. A thorough screening for geriatric syndromes helps to identify risks and causes of functional impairment.
- Medication adherence: Since the elderly population is susceptible to multiple ailments or health conditions, they are at higher risk of poly-pharmacy (concurrent use of multiple medicines) and therefore may possess a high risk of non-adherence to medications. Ultimately, this leads to reduced therapeutic benefits and frequent hospital visits due to deterioration of their medical condition.
Components of Preventive Geriatrics
Preventive Geriatrics can be discussed under following headings:
- Preventive health check-ups
- Health supplements
Balanced diet is important in preventing many chronic disorders in elderly and also for reducing the severity of these illnesses. Following facts need to be considered while planning an appropriate diet for older persons:
- With the increase in age, lean body mass decreases and fat content increases, resulting in fatigue, difficulty in carrying out activities of daily living and reduced endurance, also often causing weight loss.
- Number and functional capacity of taste buds gets reduced with aging leading to reduced taste sensation. There is also atrophy of olfactory bulbs, which are involved in smell. Due to this elderly cannot enjoy the food, leading to anorexia and mal-nutrition.
- Diseases like dementia and depression also cause anorexia, reduced intake, fatigue and digestive problems.
- Dental and gum problems (including faulty dangers) can result in difficulty in mastication and swallowing, leading to malnutrition.
- Reduced mobility/ locomotion and sarcopenia (decreased muscle mass) also complicate dietary issues.
- Changes in digestive system occur with aging, such as reduced digestive juices like saliva, pepsin and acid in stomach; reduced intestinal motility; indigestion; mal-absorption of proteins, calcium, iron and vitamin-B12 leading to nutritional problems. Constipation is also extremely common in this age group, leading to restrictions in diet.
- Dehydration due to various causes is harmful and should be avoided. Hence, consumption of adequate quantity of water is essential.
How should an ideal diet be?
An ideal diet can constitute of the following:
- Calories: Caloric requirement is reduced with aging. ICMR guidelines given in 1990 suggest that for people above age of 60 and with sedentary lifestyle, diet should provide 1544 – 2280 Kcal. At least 1500 Kcal is must for a sedentary elderly.
- Proteins: WHO guidelines given in 2002, suggests that for healthy senior citizens, daily protein intake should be 0.9 to 1.1 gms/Kg body weight. This means that roughly whatever is your weight in Kg, same amount of proteins in grams should be included in your diet. For critically ill patients it should be increased to 2 gms/Kg body weight. Vegetarian diet is deficient in proteins than non-vegetarian diet, and therefore attempts should be made to improve the protein content of vegetarian diet.
- Carbohydrates: 45-65% of total calories in the diet should come from carbohydrates and therefore the diet must contain adequate carbohydrates.
- Fats: 25-35% of total calories in the diet should come from fats. Omega-3 fatty acids function as anti-oxidants, preventing many chronic diseases and also improve good cholesterol (HDL cholesterol) in our blood and therefore, substances containing Omega-3 Fatty acids should be included in diet.
- Fiber: Adequate amount of fiber and water content in the diet is also crucial.
Certain commonly used medications can also cause nutritional deficiency.
Age is not a bar for exercise. Exercise can begin at any age. Benefits of exercise in elderly include.
- Physical health benefits: Weight loss, prevention from chronic diseases such as hypertension, diabetes, heart diseases, osteoporosis, etc. It also improves balance and flexibility, thus reducing the incidents of falls in elderly.
- Mental health benefits: It improves sleep, increases social interaction, reduces mental fatigue, helps in gaining self-confidence and thus improves overall mental well-being.
However, it is important for senior citizens to take doctor’s advice prior to beginning exercise program. Roughly, four groups of exercises should be included:
- Cardio-endurance exercise
- Strength and power training
- Improving flexibility
- Improving balance
Physiotherapist also plays a very important role in many health ailments in senior citizens.
Immunization in elderly
Vaccines are particularly important for older adults. As they age, the immune system of the body weakens, and it can be more problematic to fight off infections. In India, the following five vaccines are mostly administered to elderly:
- Influenza vaccine: This vaccine contains an inactivated flu virus. The immune system responds to this inactive virus and develops antibodies against it. A high-dose influenza vaccine is recommended for elderly over the age of 65 annually.
- Pneumococcal infection: The vaccineprotects against pneumonia caused by the pneumococcus bacteria. The vaccine is recommended for the elderly over the age of 65.
- Herpes Zoster (Shingles) vaccine: It protects against a painful condition called shingles, a disease that causes a painful, blistering rash. Research studies have shown that age-related weakening of immune systems can activate the dormant virus. A majority of the elderly who suffer from this disease are 60 years or older. So it is recommended once at the age of 60.
- Tdap vaccines: Elderly over the age of 65 should be administered the Tdap vaccine if they never had in order to protect against whooping According to the CDC recommendations, all elderly must receive a booster dose every 10 years.
- Hepatitis B: In India, the reported prevalence of hepatitis B ranges from 2 to 10%. Hepatitis B is a contagious virus that infects the liver. Elderly people over 60 years of age have a decreased antibody response to hepatitis B vaccination. This vaccine is recommended for elderly who are public safety workers and to those who are exposed to blood in the workplace.
Apart from these, cholera, typhoid, hepatitis A vaccines are also recommended.
Regular preventive health check-ups
These should be done as per the advice of the doctor. It helps to prevent or detect many diseases in elderly.
Rehabilitation of elderly patients
Rehabilitation of the elderly is important as it retains functional independence so that the elderly can thrive socially and economically. Strengthening the elderly can be done using social, medical and vocational rehabilitation.
- Social rehabilitation: This is about the participation of the elderly people in social It invludes involving the elderly in the social actions. Various non-governmental organizations, cultural centres often set up elderly clubs organise volunteering.
- Medical rehabilitation: It comprises provisions for counselling services wherein elderly population can benefit from psychological assistance faced under stressful life events, interpersonal conflicts, and changes imposed by aging. Rehabilitation also offers the provision of mobility aids at geriatric health facilities, availability of physiotherapy services, and imparting health education to improve sensory impairment related to vision and hearing.
- Vocational rehabilitation: The vocational rehabilitation programme focuses on the work improvement of interpersonal relationships and cognitive functioning. These programmes can bring essential changes in older people in living, learning, and work-related aspects.
What can be done?
Considering the above scenario in India, the geriatric health care services can be made mandatory as a part of the primary health care services. This can be done by offering specialized training of medical officers and other paramedics in geriatric medicine. Moreover, the policymakers must set up special programmes that exclusively look after the geriatric population.
Policies and programmes undertaken by the government for elderly people
The population aging is evolving as a problem that requires attention before it becomes critical. Considering this, the government has launched various schemes and policies for elderly persons which are meant to promote the health, well-being, and independence of elderly people around the country. Some of them are:
- Integrated Programme for Older Persons (IPOP): This programme is run by the Ministry of Social Justice and Empowerment with an objective to improve the quality of life of older persons by providing basic amenities like shelter, food, medical care and entertainment opportunities, etc. The scheme meets the varied needs of the older persons including the reinforcement and strengthening of the family.
- Indira Gandhi National Old Age Pension Scheme (IGNOAPS): It is implemented in the states and Union Territories through Panchayats and Municipalities. Under this scheme, the pension is given to elderly above 65 years @ Rs. 200/- per month, belonging to a below poverty line family.
- National Council for Older Persons (NCOP): Constituted in 1999 under the chairpersonship of the Ministry of Social Justice and Empowerment is to advise the Government on policies and programmes for older persons. It also provides feedback to the government on the implementation of the NPOP as well as on specific programme initiatives for the elderly.
- Pradhan Mantri Vaya Vandana Yojana (PNVVY): In order to provide social security in the old age, the Government launched Pradhan Mantri Vaya Vandana Yojana (PNVVY). Under the scheme, the member gets a guaranteed pension based on a guaranteed rate of return per annum payable monthly/quarterly/half-yearly/annually after payment of an initial lump sum amount ranging from Rs. 1,50,000 to a maximum of Rs. 7,50,000/- for a maximum.
Under the universal health coverage (UHC) framework, recommendations have been prioritized regarding primary, secondary and tertiary prevention and health promotion, with a goal to create environments for early detection, and routine screening among the elderly.
- Primary prevention: These are the actions preventing a disease or disorder. These are especially needed for the elderly themselves, their family or care providers.
- Secondary prevention: It includes timely diagnosis and timely treatment of diseases and prevention of occurrence the complications. Usually, the activities are for physicians and medical care providers that involve gathering medical history, performing physical examinations, requesting laboratory tests and accomplishing necessary imaging measures like echography, angiography, bone densitometry, etc.
- Tertiary prevention: These are used to prevent disabilities, generally by physicians and rehabilitators. Some of the activities under tertiary prevention offer physiotherapy, occupational therapy, speech therapy, laser therapy in diabetic retinopathies, inserting stents in closed heart vessels, and psychological counseling.
India’s growing elderly population needs quality medical and social care due to demographic changes in the social and economic trends. In conclusion, nurturing a state of good physical health that allows utmost active life expectancy is the ultimate goal of preventive geriatrics. It is high time that the health care system gears itself to the growing health needs of the elderly in an optimal and comprehensive manner.
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