Taking care of the elderly or your ageing parents is a responsibility we must all take. After all, they nurture us, educate us, provide for us and are largely responsible for making us who we are. They shape our lives. Therefore, it is our responsibility to look after them when they can no longer look after themselves. Unfortunately, this does not always happen and some children put them into old age homes rather than provide shelter for them.  We spoke to Dr Shehan Silva,  Consultant Physician / Geriatrician, regarding his suggestions for caring for the elderly.  

Q What does Geriatric Care mean and how is it perceived in developing countries like Sri Lanka where it is believed that children must take care of their parents?
Geriatrics is a field of medicine which deals with unique and special physical and psychological problems related to older adults (just as Pediatrics deals with children). This is an area that is gradually developing in Sri Lanka.  The population of Sri Lanka is ageing exponentially. It is projected that by 2030, 1 out of 4 in our country will be older than 65 years. This imparts a greater burden on the labour force of the country, particularly with the young migrating with the brain drain and the elderly remaining.

Seniors although they may be adults have unique problems that may not be seen in their younger counterparts (the middle-aged and young adults). These include conditions such as recurrent falls, delirium (sudden onset of confusion with significant illness), incontinence of the bladder and bowels and mobility issues.

Q What are the factors to consider when taking care of elderly parents?
It should be borne in mind that older adults have specific problems such as multiple diseases occurring together. This is known as multimorbidity. We see therefore that an older adult may have high blood pressure, high cholesterol, and diabetes occurring together giving rise to both ischaemic heart disease and/or stroke. In addition to diseases such as chronic obstructive pulmonary disease, cancers and diseases such as arthritis may be co-existent

This results in frailty. Frailty is a concept where older adults may be weak in terms of tiredness, slowing of movements, reduced use of energy etc. In addition, there is age-related loss of muscle mass which results in the wasting of the body and reduced strength. In the realm of mental health, diseases such as dementia, depression and anxiety will rise.

Furthermore, the activity of older adults and their role in society and family should be considered. Older adults are led to retire and curtailment of income generated for themselves and family. These too would impact the ageing process.

Q Can you tell us about nursing assistance and at what stage it becomes necessary?
As a person becomes more frail, nursing assistance will be required. The signal to be alert is when one becomes limited with activities of daily living such as bathing, grooming, dressing, bladder and bowel control and toileting as well as feeding,

Q What are some of the mistakes that people make when making decisions on behalf of the elderly?
All decisions should be made with the older adult in consideration. Unless someone is limited with decision-making powers such as Dementia, it is unethical to make arbitrary decisions based upon the convenience of the rest of the family. Special care planning needs to be done with the consideration of the medical, and nursing professionals as well as Physiotherapists and Occupational Therapists. A best-interest decision should be arrived at with the practically possible means. This is known as comprehensive geriatric assessment.

Q What about diseases such as dementia?
Dementia with ageing is a disease which cripples the memory as well as the brain’s higher functions such as thought, personality and behaviour.  Alzheimer’s disease is a well-known cause. It results from age-related chemical deposition in nerve tissue. Parkinson’s disease along with slowing of the movement with tremors gives rise to Dementia. Another forgotten disease which gives rise to Dementia includes Vascular Dementia. This results from uncontrolled physical diseases such as high blood pressure, diabetes, high cholesterol levels etc. acting in unison or in concert.

Q What is the basic care for such patients?

• Good nutrition
• Exercise - particularly resistance exercise rather than aerobics
• Control of multimorbid conditions including medicines
• Good bowel and bladder care - regular removal of soiled diapers/ underwear, regular cleaning of openings
• Good Skincare - prevent bed ulcers by prolonged positioning in one posture.

Q What about food and nutrition for them?
It is essential that older adults are fortified with high-quality proteins to replenish the loss of proteins as muscle wasting  (sacropaenia). This can be done by improving the intake of not only animal meat but by dairy products and plant material such as pulses (green gram, chickpeas and dhal). It is essential that adequate calories too are taken into consideration but avoiding high calorie / high fat foods to prevent obesity. The intake of vitamins and minerals too is essential. Advice from your Physician and Nutritionist is invaluable.

Q From a legal perspective should the children meet a lawyer and get advice regarding having authorisation on the parents' accounts, paying their bills, collecting their documents etc?
The best approach is to make such a decision while the parent is having a lucid mind or a mild degree of Dementia.  In medicolegal terms, this is known as capacity. Capacity is the ability for a person to receive information, understand it, make a decision and communicate it back however unreasonable it may be. Thus a person at such good mindset should be encouraged to make decisions regarding Power of Attorney, Will and Testament etc. In those who seem to have advanced Dementia medical personnel should assess whether he/she is incapacitated. If so, Legal Counsel should be sort by the loved ones rather than discretely getting the patient to sign or place his thumbprint on official documents.

Q How often must such persons check their blood pressure, sugar levels etc. and also have medical check–ups?
A person who has medical conditions should regularly check his/her parameters instructed by his doctor. The frequency depends on how well he is controlled by lifestyle as well as medication. It should also be borne in mind that irrational investigations as well as the frequency of checks can lead to overdiagnosis as well as anxiety and hypochondriacal behaviour.

Q Finally, can you give us a checklist/some tips for the elderly?
Be active physically and mentally
Engage in resistance type of exercise (bending/ stretching/ lifting) while engaging in aerobic activities (walking/ jogging/ swimming)
Engage in mind-stimulating activities such as reading, working on technology, creative work and mental exercise (puzzles)

by Kshalini Nonis