Hello, physicians, elderly friends (well and not so well), young people who are interested in the welfare of our seniors, welcome to my first blog.

I would like to share with you some  ideas about ageing and the health of older people. In this blog I would like to share some general thoughts on illnesses affecting older people, and as we go along we can talk of common symptoms, and how they can be addressed.

Elderly people suffer from diseases just like young people do, but the effects of ageing have a profound impact on the presenting symptoms, course, and outcome of the illness. Age-related changes affect every organ, but some organs are so vital that their malfunction is noticed sooner than others. The dysfunction of the brain, cardiovascular system, musculo-skeletal system, and the urinary bladder, bring the most grief to ageing seniors. The dysfunction of the immune system, kidneys, metabolic functions  of the liver, respiratory tract, the increased prevalence of diabetes and hypertension, and the long term effects of smoking and obesity all add to the increased disease burden. 

An interesting point about ageing is that every individual ages differently, and at different "speeds", perhaps because of genetic programming, and certainly influenced by lifestyle adopted. This means that elderly people are a heterogenous lot physiologically speaking, hence a random "selection "of 70 year olds would look very much like a patchwork quilt, metaphorically speaking. You would have a crisp, athletic, full -of- beans Mr. X, along with a wheezy, hard-of-hearing Mr.Y, not to mention the bemused, frail, bent- double (read osteoporotic)  Mrs. Z; all the same chronological age, but functionally as different as chalk and cheese. This is one of the reasons why the elderly are often excluded from research studies, because one wants to study as homogenous a sample as possible! So, a researchers nightmare, are the elderly!

Elderly people are more likely to have multiple diseases. For example, a Mr. V who is  75 year old, has the following medical problems: diabetes, hypertension, osteo-arthritis knees, impaired hearing and, urinary incontinence. Each problem by itself causes distress, but when combined, the problems adversely impact on each other, causing exponential misery. For example, poorly controlled diabetes is well known to cause polyuria; an impaired bladder control ( detrusor instability) is part of normal ageing, but when confronted with large urine volume, it leads to incontinence. Further, the knee joint disease makes it difficult to reach the toilet in time. Mr. V, is isolated socially because he is ashamed by his incontinence, and also by his inability to hear.

To make Mr. V feel better, not only must the diabetes be improved, but also incontinence, and knee joint pain, as well as the hearing. It is not so important to "cure" all of them; for a start, small improvements in all the problems will have an additive and synergistic effect, and Mr. V's misery will become at least bearable.

In the example cited above, Mr. V is  taking many different medications, and it is well known that the longer the list of drugs, the higher the chance of adverse drug reactions. To add to this seemingly legitimate reason for large list of medications in the elderly,  the practitioner who has inadequate experience in old age medicine is likely to give a "pill for every ill". The elderly are not the only people who are victims of this last sin, in fact, many doctors and younger patients feel comfortable when the litany of "ills" is matched by a different "pill". While the younger person's metabolism is robust enough to combat the medication tsunami, the older person develops serious reactions and new symptoms created by drug effects.  Hence not only is prescribing parsimony a virtue, non-pharmacological therapy is ideal for the older population ( also applies to everyone).

So much for the biological model of disease affecting elderly. Now, what about the social and psychological dimensions of the ageing person? Every person is unique in terms of their gender,genetic personality type, and the  religious, social, economic , cultural, vocational milieu that they live in. As one progresses in age, one develops one's own world view, belief systems, and this has profound impact on one's ability to adjust to ageing and the new life events which occur at old age. Loss of vocation, income  and prestige when a person retires from a job, the physical and mental changes associated with the menopause, death of a spouse  or close relative, loss of social interaction and mobility, all require adjustments by the older person. The physician must see the unique  backdrop of the patient and tailor the advice and treatments accordingly.

Many of us in India are used to older people being ill, and in fact the elderly population worldwide do use a larger proportion of the health services when compared to younger people. Important to remember, however, that old age is not synonymous with disease. Many diseases such as diabetes, hypertension, and disease-producing factors such as smoking, alcohol intake and obesity, to name a few, usually start in young age, and when poorly treated, go on to cause much misery in old age. This apart, the concept of healthy ageing is a realistic one; it is entirely possible to live out one's "predetermined" lifespan in good health, and be ill for just a short time, or not at all, before dying. How does one achieve this? From antiquity man has searched for immortality, but has not found it. It is unrealistic and undesirable to search for that cosmic potion to prolong life; rather we must pursue the goal of achieving a healthful quality of life determined by the limitations of the normal ageing process, sans disease.

Health promotion is the key to healthy old age. Early detection and treatment of diseases such as diabetes,a nd hypertension, cancers, is important.

How can one promote healthy ageing as opposed to "unhealthy" ageing which accelerates the ageing process? Next blog............. ?