DR ZUBAIR SALEEM
Mashhad Iran 2004: She was not allowed to get inside the NICU (Neonatal Intensive Care Unit). So for the whole day, peeped through a little round glass window on the main door, just to see a small green board with bed 32 written on it. All her relatives and medical staff at the hospital advising to go back to her bed in obstetric ward. She had delivered a baby by cesarean section now admitted in NICU for respiratory distress on bed 32. This was allotted to me as an intern.
For 28 days, this mother outside NICU struggling with her cesarean section wound waiting to see her newborn baby. One could feel the pain and despair in the eyes of this mother. It has haunted me since that day.
Many years later when I was working as resident in Accident and
Emergency ward of SKIMS, an old lady was brought in unconscious state by her frail husband and neighbors. She closed her eyes forever waiting for her three sons to come at the gate of Emergency department. They all worked and lived aboard. Here again I could feel the pain in the eyes of this old mother to have one glimpse of her sons. This changed my course of thinking and life.
Because of their children, are mothers destined only to bear pain?
The Letter:
“Good evening Dr. Zubair. Trust all’s well at home. We have recently returned from Patiala. Mummy passed away peacefully at the age of 92. Only the night before she did have her favourite mango with milk, smiled at her great grandchild as he came up to her. In the morning she was found to have passed away in her sleep. Her body was still warm when my brother touched her. It is so comforting to know she was in no pain. You helped us to give her a comfortable life. Well over a year I recorded her stories on my phone. Both I and my brother were with her 24 hours.
We have no regrets about (her) leaving anything to be said to her or for her to say to us. Her passing away wasn’t tragic, absence is always felt but it is filled with the richness that only a mother can give. After the funeral we spent pleasant evenings of conversations, memories and laughter. To make all this possible we are eternally grateful to the finest doctor and human being we will ever get to know.
Deepest regards
The Kaleka family
Forgetfulness: When does it set in
“I forgot what else I had to buy from you,” said one elderly man to the owner of a provision store after buying some household items. However, this elderly man started discussing news he had read in the newspaper with the people there and also narrated a story of his youth. He was fully conscious of the happenings around him and remembered the past.
People usually think that forgetfulness is the first sign of Alzheimer’s disease. But the most common cause of mild forgetfulness in the elderly is a normal process of ageing. Some other causes of memory problems include medical conditions, emotional problems, mild cognitive impairment, or another type of dementia.
If an elderly adult forgets to buy anything at a provision store, it is a normal ageing process but if he forgets that he went to the provision store or forgets the way to his home, it is not a normal part of the process of ageing.
The common memory-related complaint of older adults is forgetting things easily, however, they are aware of their forgetfulness. Difficulty in recalling a very familiar lane in which one’s friend lives; easy tasks like cooking and washing become tiresome and more effortful; forgetting the word one wants to say but feels it is on the tip of one’s tongue; forgetting to pass on telephone message to one’s son; forgetting to take medicines on time; forgetting to pay the bill on the due date; feeling difficult to store or learn new information. These changes in memory lead to frustration and anxiety which can lead to a vicious cycle worsening the condition. The thought of having impaired memory should be avoided and one should adjust to this change in memory.
Why?
The volume of the brain is maximum in the early twenties, and from the late twenties, the brain begins to lose its cells for the rest of its life and also gets less blood flow during the process of ageing. Subsequently, the more you get older, the more these changes affect your memory, and till your late seventies, brain mass is decreased by 10%. Most of these changes occur in the front area of the brain which is mostly related to memory. In their late forties, several people notice gradual alternations in their skills to remember and memorise. In later stages, they observe changes in verbal fluency or capability to utter the words quickly.
Other factors that affect the memory are the level of education, lifestyle change (retirement, financial problems, change in family structure), fatigue leading to poor concentration, lack of confidence, emotional beliefs (fear of age-related failures) and paying less attention and physical health conditions of a person.
Conditions that alter memory further than the changes of memory seen in the normal ageing process are depression, anxiety, use of psychiatric drugs, alcohol consumption, drug dependency, stroke, Parkinson’s disease, head injuries, vascular disease, brain tumours, and most importantly, Alzheimer’s disease.
Useful Tips
You can remember better by keeping lists of the work to be done, taking your medicine just before or after meals (as advised), taking tea while reading the newspaper, you can even mark on the calendar important days and important tasks, put commonly used things like reading glasses, keys, medicines etc. at a particular place every time, address people by their names whom you don’t see frequently, performing things that keeps one’s mind and body busy, and recalling ABC that may help you in remembering the word you had difficulty in remembering. In addition, memory can be improved by performing one task at a time, separating numerical information into sets eg. phone number 230 0000, keeping attention while conversing, adopting a constructive approach, use of alarm clocks for important tasks and using reading glasses and hearing aids if needed.
Diet and Exercise
As far as diet and nutrients are concerned, herbs like rosemary, brahami booti, sage are helpful. Additionally, the use of almonds, walnuts, apples, figs, grapes, oranges, dates and phosphorus-rich diet like cereals, pulses and cow milk can significantly help in delaying alterations of memory in the elderly. Last but not the least, adequate sleep and rest along with meditation and relaxation, and drinking plenty of water is very important for improving memory Keeping yourself busy in various activities like reading, playing games, solving crosswords, watching television, keeping social contacts and recalling good old days and discussing them with others will help in improving memory.
What needs to be addressed
Memory changes that are not seen in the normal process of ageing are when it affects one’s daily living. When one forgets things more frequently that one has done several times. When one experiences problems in recognising family and friends. When one forgets the way to one’s home or forgets to cook any dish that one has cooked many times before. When one repeats phrases or narrations that one has said before in the same talk, when one is not able to keep track of happenings of the day, when one gets lost in familiar areas, when one’s forgetfulness worsens with time, when one does not have conscious awareness of forgetting anything, and when forgetfulness is associated with behavioural and intellectual deterioration.
Pradhan Mantri Vaya Vandana Scheme (PMVVS)
This is a welfare scheme for the senior citizens of the country, implemented with the help of the Life Insurance Corporation (LIC). Currently, this scheme is open till Mar 2023 and can be purchased online or offline at LIC offices or through their designated agents. Benefits include a pension paid for the life term of the policyholder, a death benefit to the nominee on the death of the Pensioner during the policy term of 10 years, and a maturity benefit for the survival of the pensioner. The minimum entry age is 60 years and there is no max age limit prescribed. The policy term is 10 years and the minimum pension per month is Rs.1000. The maximum pension per month is fixed at Rs. 9250 and the total purchase by a senior citizen under this scheme shall not exceed INR 15 lakhs.
Different purchase prices have been fixed for different modes of pension payment. Premature exit with 98% surrender value is allowed under exceptional circumstances. The loan facility is available after 3 years of policy completion. According to the information available on the LIC website, for the financial Year 2022-23, the scheme shall provide an assured pension of 7.40% p.a. payable monthly. This assured rate of pension shall be payable for the full policy term of 10 years for all the policies purchased till 31st March 2023. This is a good scheme that can assure a monthly income for senior citizens.
Whom do I approach for my geriatric or old age-related problems?
Older people have different patterns of disease presentation compared to younger adults, and they respond to treatments and therapies in different ways, they have unique needs that require unique approaches for treatment. They frequently have complex social and care needs that are intricately related to their acute and chronic medical conditions. The ability to take a holistic and multidisciplinary approach for treatment rather than focusing on a single problem or organ is the idea behind consulting a Geriatrician for old age-related problems.
When does old age begin?
Process of ageing starts just after the fertilization in the womb of a mother and old age begins whenever you think you are old. However, one can consult a Geriatrician in early fifties to screen and diagnose certain diseases in it’s early stage.
How can I age gracefully?
Trusting your Creator and believing that wherever you are, you are placed at the best place.
Hope in sustaining health, both mental and physical, needs to be paramount. The conviction that our life has meaning beyond our own immediate welfare is the foundation of hope. Adapting to change and continuing to grow is a process often rewarding, both in world and hereafter.
Low calorie diet, regular exercises and proper sleep are very important for delaying the process of ageing.
Note:
A public service initiative weekly series in Greater Kashmir on elderly population of our society for health issues, economic and social challenges, legal guidance, government schemes and civil society with question & answers to highlight the elderly cause. Readers can contribute comments and stories, through oldagekashmir@gmail.com;
Elderly seeking health related guidance from old aged specialist doctors and paramedical assistance WhatsApp: 9541334476
Ajaz Rashid , Social Entrepreneur is CEO Prasad Joo Khan Heart Centre
Dr. Zubair Saleem, Sr. Geriatric Consultant
Disclaimer: The views and opinions expressed in this article are the personal opinions of the author. The facts, analysis, assumptions and perspective appearing in the article do not reflect the views of GK.