BY DR. ZUBAIR SALEEM
Due to development in public health and medicine in the recent past, the life span of humans has increased almost in all parts of the world. The increase in life expectancy resulted in an increase in the older adult population.
Older people may 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.
In order to overcome this challenge, the treatment and care of older adults was put under a different speciality named Geriatric Medicine/Geriatrics (Medicine dealing with the ageing adult population). The way we have Pediatricians (Specialists for children), similarly we have Geriatricians (Specialists for senior citizens).
Dr. Ignatz Leo Nascher (Australian-American doctor) was the first to propose the term Geriatrics in 1909 and is known as the Father of Geriatrics.
Pertinent to mention that Abu Ali Ibn Sina (Avicenna) put forward his ideas for the care of older adults in his book The Cannon of Medicine around the 10th century in the section entitled “Regimen of Old Age”.
Getting old is preordained. However, the process of ageing and the course of illness is not similar. To make difference between ageing and illness, the normal inevitable ageing process needs to be understood. Besides, awareness of the expected changes during ageing may even help in living a better life by decelerating and delaying the ageing process. As such, a long life span is not as important as a disease free life.
Studies suggest that the process of ageing begins in the womb of a mother. However, in the late twenties, there is a decline in burning of body calories at rest by 2%, every 10 years.
The muscle power and lung capacity also start reducing. But in older adults, the elasticity of the lungs and stiffness of the chest wall decreases significantly and in the late seventies, the capacity of the lungs may reduce to one-third.
Additionally, the muscle strength is reduced by 30-50% due to a decline in muscle mass. Cholesterol LDL (the bad kind) starts rising gradually after puberty whilst the heart-friendly High-Density Lipoprotein, HDL cholesterol starts declining.
So, regular exercise right from a young age is recommended as most of the ageing processes are accelerated due to a sedentary lifestyle. Limiting calorie intake is also one of the most documented and important interventions known for delaying the process of ageing.
In the early 40’s, skin starts losing its elasticity and moisture, and gets wrinkled. The hair may also get thinner and greyer. Regular use of moisturisers and drinking plenty of water may help in delaying skin ageing.
During the process of ageing, almost all sense organs experience some loss. From mid 40’s, the eye lens starts losing its elasticity, which makes it difficult to read at a usual distance and to perform other close work (Presbyopia). Due to decreased lens accommodation, eyes acclimatise to darkness more slowly.
Opacification (Opaque) of the lens may occur, resulting in the need for more light. Some aged persons may experience floaters, which means some floating bodies may be seen as dark shapes against a bright background.
Eye exercises like holding a pen in your hand with stretched arm and getting it near to the nose and making circles and following the pen with your eyes may be helpful in delaying the use of spectacles for near reading.
Due to constant exposure to loud sounds, gradual hearing loss occurs at higher frequencies. Thus, it is better to avoid loud noise. Ageing also makes taste buds lose their sense of appreciation of different flavours, and avoiding acidic and spicy foods, alcohol and smoking may be helpful in delaying the loss in taste buds.
Some older adults may also undergo decreased sensation of thirst that may result in dehydration. Many older adults may feel reduced pain. The decrease in heart output also results in decreased stamina.
Prostrate enlargement is a common feature among males and atrophy of reproductive organs is frequent among females.
Decreased intake of coffee, tea, and spicy food; and increased intake of water, fresh fruits and vegetables and cranberry juice can be helpful.
In the late thirties, kidney function starts to decrease by 1% every year, which may result in impaired concentrating/diluting of urine. For a person who doesnt have kidney disease, drinking 2-3 litres of water daily prevents early ageing effects on kidneys considerably, and also prevents kidney stone formation to some extent.
Ageing also witnesses mobility of joints getting gradually decreased as joints get rigid. A marked decrease in bone density is observed in older adults (Osteoporosis), resulting in lessening of bone tissue and risk of fracture and slow healing. In older adults, digestion is slowed, liver function is decreased and colonic (Large bowel) motility is decreased. Green leafy vegetables and fruits may be used to avoid constipation and to maintain gut health.
There is gradual tooth decay as well. Proper oral hygiene helps in reducing tooth decay. The immunity system of the body gradually weakens in older adults making them susceptible to infections. Reserves in the body gradually diminish, resulting in difficulty in fighting diseases.
Antioxidants like beta carotene, vitamin E and vitamin C may be helpful. As far as the nervous system is concerned, process of ageing slows the nerve impulses resulting in slower reaction and thinking. Cortical brain atrophy (Shrinking of the brain) occurs in the seventies.
Heat regulation of the body gets affected resulting in low temperature at rest. Keeping warm and keeping oneself engaged with reading may be helpful. The deep sleep also gets impaired. Some may also experience early wakening. Few may even experience forgetfulness and feel irritable. Stress and anxiety should be avoided.
Maintenance of balance/equilibrium of sugar (Glucose) and blood pressure gets impaired due to several external situations. Food with low salt, low sugar, low fats and low calories should be a golden rule to avoid many debilitating and chronic diseases.
Thyroid hormone production and clearance get impaired and may result in thyroid diseases. A decline in vitamin D absorption results in weak bones. The absorption and metabolism of several vitamins and minerals get affected in older adults. For starting any dietary supplement, importantly Vitamin D, C, E, Zinc, Thiamine, Folic Acid, Calcium etc one should consult his/her doctor.
Whatever inevitable biological changes take place in old age, the importance of meaning and 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 this world and the hereafter. Let the aged remember-Every day, in every way. I am getting better and better.
Dr. Zubair is a 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.