Sri Lanka is said to have the fastest ageing population in South Asia. Caring for one's parents in old age has been part of tradition but as life gets busier for a generation that has to balance looking after their kids and older parents while doing a job, the situation comes with challenges. Plus as many people choose to migrate, their elderly parents are sometimes left behind and the need for good care homes with most importantly good carers become essential. 

We spoke to Dr Sithira Senevirathne ( MBBS (Col), MD Geriatric Medicine (Col), MRCP (UK), MRCP Geriatric Medicine SCE, Consultant Geriatrician , National Hospital of Sri Lanka, Colombo.

Q:           What are the most pressing problems faced by adult children when  it comes to caring for their elderly parents?

 Age expectancy at birth increases each year. Increased age expectancy does not necessarily mean older people live independently until later life and they need a lot of support. Caring for older people is a growing issue in Sri Lanka. The number of available carers is decreasing each year -carers sometimes have to take care of more than one older person. Caring for the elderly can be challenging due to many reasons. Increasing prevalence of cognitive/memory impairment, increasing physical disabilities, poor mobility, balance and recurrent falls, problems related to bladder and bowel care, especially urinary incontinence, increased incidence of depression, behavioral problems, complex medication regimens can all be difficult to deal with.

Q: How can they help their parents to cope with anxiety, loneliness etc?

Loneliness among older adults is another growing problem today. Older adults tend to spend more time at home, they tend to have less social connections and find it difficult to engage in purposeful activities which gradually leads to social immobility, loneliness, anxiety, depression and can worsen the progression of memory/ cognitive impairment. Deterioration of mental health leads to deterioration of physical health and medical comorbidities. To combat loneliness in old age, focus on maintaining social connections, engaging in activities, and finding purpose through hobbies, volunteering, or community involvement.

The sparsity of such structured community programmes to keep older adults engaged is an issue. Some tips to maintain social connections include staying in touch with loved ones by making regular phone calls, video calls, or visits with family and friends.  Engage in community activities by joining senior clubs where available, participate in local events. Keep connected with neighbors by having a simple chat. Use online platforms to connect with friends and family or join online communities.  Engage in meaningful activities such as reading, gardening, painting, or playing music.  Learn new skills or expand knowledge by taking classes. Travelling, exploring new places and making new friends, spending time outdoors can also be helpful. Practicing mindfulness and relaxation techniques to manage stress and anxiety can be useful. When needed, talking about your feelings with family members, friends, health care providers and seeking professional help is important too.

Q:           At what stage should the  children move in with their parents or vice versa?

It’s a difficult decision to make both for the elderly and children. Probably when seniors are not deemed to be safer at home alone, we need to think of having them closer to their children which might not be always practical. Having problems with carrying out basic activities of daily living, having problems with mobility, recurrent falls and having memory problems, and mood problems are some situations when one needs to consider moving in. 

Q:           When this happens what  should be done in the  house to ensure that it's safe- ie to prevent falls etc?

Home environmental modifications can be done to ensure a safe environment for older adults, especially if they are at risk of falls. Some of the modifications that can be done include all areas of the home being well-lit to prevent falls especially if you have trouble with vision, installing handrails on  both sides of stairs in  bathrooms and walk ways.  Walkways have to  be maintained free of clutter and carpets has to be secured to prevent tripping. Having contrasting colours on stairs, door frames and different areas of the house can be important specially if someone has vision/memory impairment. Avoid slippery, wet, broken floors. If more than two floors, ground floor living will be safer. It's important to have a phone/ bell within reach at all times to inform the carer in case of a fall or an emergency.

Q:           When it comes to nutrition for  the elderly,  what is  your advice?

Malnutrition is prevalent in old age and increases the risk of muscle loss, frailty and vulnerability to falls, infections and delayed recovery from illnesses. It's important to have a balanced diet with special attention to protein, calcium, vitamin D and fibers. Maintaining hydration is important as well. Problems with dentition, taste, mood, hand dexterity, swallowing are common  challenges older adults face and need to seek specialist attention.

Q:           How can they be encouraged to  do things they  may not  like such as  bathe regularly and  refusing to eat certain types of food?

Changes in behavior, personality, memory and mood can occur in old age and when difficult to manage seek help from a health care provider. It is important to maintain good hygiene and consumption of variety of foods to meet the nutrition requirements, but has to be tailor-made considering the patient’s preferences as well.

Q:           What about assistance with  things such as self care, and from a social perspective?

It’s very important for older people to stay connected with their loved ones. Older adults due to many problems related to their physical and psychological health may require assistance for their daily activities. It’s also important to assist them to be independent as much as possible to maintain their physical functions. Encouraging them to participate in daily chores within their capacity will help to maintain their functional abilities, while providing help whenever necessary.

Q:           Can you briefly  mention the common medical issues elderly parents have to face?

Medical problems in older adults can be very diverse and complex. Non communicable metabolic diseases such as diabetes, hypertension, heart diseases, stroke are more prevalent in older adults, and  immobility, falls, dementia, Parkinson disease, depression, urinary/bowel incontinence, constipation are also common problems. Problems related to medications are very common and recognized as “polypharmacy” related problems. Older adults develop sarcopenia (muscle loss), frailty (vulnerability to stressors) which are also recognized as diseases in old age. Often one person has more than one problem and these diseases and their treatment can interact and affect each other. Due to this treatment targets are different from treatment targets of young adults. Treatments have to be given cautiously considering those interactions and has to be tailormade for the patient. Geriatricians are specialists in elderly care who are trained to provide this type of care.

Q:           How can they prevent people  from taking advantage of them?

Elderly abuse is unfortunately not uncommon. Older adults and their loved ones have to be aware of the ways they can be abused. These types of abuse can be physical, sexual, emotional, financial or neglect. Recognizing this early and seeking necessary support from the legal system, health care providers, loved ones early is very important. High care-giver stress, cognitive impairment in older adults, high dependency, social isolation, low income can be some risk factors that make older people vulnerable to abuse. Monitoring for elderly abuse, providing respite care for carers and strengthening the social support systems can be helpful.

Q:           You are a co founder and SME(subject matter expert) at Engage Wellness Centre. In your  opinion are there  enough care homes in Sri Lanka to  accommodate the elderly with Professional services?

Residential care homes, nursing homes can be important to deliver the necessary care an older person has, if this cannot be delivered at their own homes. There are care homes maintained by both private and state sector in Sri Lanka. Availability of professional services can widely vary from care home to care home. Availability of trained carers, nurses, geriatricians/ elderly care specialists and accessibility to other services such as physiotherapy, occupational therapy, speech therapy can greatly enhance and assure the quality of care delivered at these care homes. 

By Kshalini Nonis