By Dr. Raies Ahmad
Traditionally, older adults are taken care of by their families. However, because of the changing gender roles, employment of women, erosion of traditional family values, and an increasing trend for nuclear families, a care giving crisis is predicted. The number of older adults living alone is increasing. With decreased family support and informal caregivers, more of the older adults in India care for themselves. Caring for older adults requires a multidisciplinary approach and we need to become familiarise with the changes that occur in the aging process. This can enable us particularly healthcare professionals to provide better care to the elderly.
We Need to Understand Age Related Changes in the Body
Ageing is a progressive and universal phenomenon encompassing gradual loss of cells resulting in decline in organ functional abilities. Consequently, even the baseline functions of the body also get wasted. Age-related changes affect the function of every system of body, even in the healthiest older people. Heart output declines. Calcium migrates from bones and teeth into blood vessels. Cataracts may dim vision. Hearing fades. Lung, liver, and kidney functions slow. Wear and tear on joints makes pain an unwelcome companion. So, the normal age-related changes may be accompanied by chronic health problems such as diabetes or heart disease. Management of many such chronic conditions may include one or more medications prescribed for regular use. Although medications may relieve symptoms, improve the quality of life, and in some cases increase the lifespan, they are not without risk. For example, research has shown that taking four or more prescription drugs is an independent risk factor for a fall injury which can put an independent older adult into the ranks of the frail elderly. Ageing is not a disease in itself, but the aged do become vulnerable to diseases. These alterations make the human being vulnerable to various diseases with declining immune responses, poor regenerating capacities thereby increasing exponentially the morbidity and ultimate mortality amongst them. The major chronic diseases which contribute globally to the death of those > 70 years of age include cardiovascular diseases, cancer, chronic respiratory diseases and diabetes mellitus.
Elderly Care Tips :
It is very important for the elderly to adapt certain healthy habits in order to decrease the prevalence of various age related problems. Though it is very difficult to change the habits in the old age, however, there is no harm in making an attempt :
Maintain Daily Routine: Maintaining daily routine of activities is a basic step in remaining healthy. They should be asked to fix a time for each activity during the day e.g. eating, napping during day, going for sleep at night and getting up in the morning, exercises, walk, entertainment, religious activities etc. In old age it becomes very difficult for the body to adjust if the routine is disturbed. Sleep requirement decreases with age. Older adults tend to sleep more lightly and for shorter time spans, but they generally need about the same amount of sleep as they needed as a young adult (7 to 8 hours a night).
Physical Activity: The elderly should be promoted for the physical activities as per their capabilities. Thirty minutes walk in the morning as well as in the evening is the best physical exercise. They should be accompanied by someone while going out.
Personal Hygiene: Elderly people should be encouraged to carry out their own personal hygiene routines as much as possible. This promotes independence and a sense of purpose in life. Even managing the smallest task is better than nothing at all. The safety issues in the bathroom should not be overlooked. Make sure there are no throw rugs that could create a risk of fall. A bath chair may be used to sit in the bathroom. The floor should not be slippery. The water temperature should be comfortable. Adaptive equipment such as holding showers can make bathing safer, because sometimes it may be difficult for the elderly to hold a mug full of water.
Dental Hygiene: The dental hygiene should also not to be overlooked. Other than brushing the teeth in the morning and night after having meal, they should be encouraged to rinse their mouth properly after eating anything. Dentures should be cleaned using warm water and anon-abrasive cleanser.
Social Activity: Loneliness leading to depression is quite common in old age. Encourage the elderly to remain socially active by involving themselves in certain activities/joining certain NGOs, spending time with friends, family, relatives etc. This will help utilising their lifelong experiences and maintain their physical and mental health.
Regular Health Checkups: The elderly should be encouraged for regular health checkups. They should undergo all the investigations at least once in a year. Any health problem can be managed properly if it is detected at its early stage.
Bowel Care: Constipation is one of the most frequent problems of the older people. It becomes a source of frustration if they do not pass stool in the morning. Encourage them to take high fibre diet, promote regular exercise, add stool softeners if required and little bit increase in fluid intake.
Urinary Care: The patient may have one or multiple urinary problems leading to disturbed urinary pattern, i.e., either incontinence (involuntary urine loss) or retention of urine. Establish toilet schedule every 2 hours, before and after activity, before and after meals, before and after sleep or rest periods, easy access to toilet, adequate fluid intake, avoid bladder irritants such as caffeinated beverages, alcohol and artificial sweeteners.
Ensure Cautious Use of Medications: Administration of medication through various routes viz oral, intramuscular and intravenous carries a greatest risk especially for the elderly patients. Drugs can accumulate and reach toxic levels more quickly than in a younger person, further emphasizing the importance of increasing dose intervals. The kidneys, which are responsible for most drug excretion, experience decreased function as people age. Polymedication should be avoided as far as possible.
Nutritional Needs of the Elderly: Offer small and frequent meals. Three small meals are better than one large meal. The meals should be eaten at fixed and scheduled time. The number of calories should be considered. These should not be too much or too less. The diet should be balanced in terms of all food nutrients i.e. protein, fat, carbohydrates, vitamins, minerals and fibres. Fried, very spicy food, red meat, animal fat etc. should be avoided
Communicating with Elderly: It has been recognised as one of the most important aspects of nursing elderly people. Ineffective communication with elderly can lead to patients incompliance, disturbance in socialisation and some patient’s needs may be left unmet thereby creating and increasing stress on caregivers. Communicate respectfully and preserve patient dignity when performing physical care as well as when communicating.
Dr. Raies Ahmad ,HOD at KTC Hospital & Research Centre, Kashmir. BLS and ERTC Certified (Directorate of Health Services, Kashmir)
Life Member (Indian Red Cross Society), can be reached at firstname.lastname@example.org