Geriatrics is a developing branch of medicine.
In India, the number of elderly in the year 1990 may be 60
millions. Life expectancy has increased and hence the need
for organized care of the elderly becomes important.
'Add life to years and not add years to life'
is a quotable quote. The elderly are afflicted by the process
of ageing which causes a general decline in health and there
are important life events. Hence, approach to the elderly
should be with an eye for a comprehensive examination of his
physical health, mental health, his family and social life.
A detailed history enables us to know all these factors. To
establish rapport with the patient the physician should remember
every patient's name age and complaints. He/she should be
a patient and good listener too. Emotional ventilation itself
does good to the patient.
Loss of spouse or separation, deaths in the
family and lack of social integration may themselves cause
poverty, physical and mental ill health e.g. bereavement adds
to physical problems. Masked depression manifesting with physical
symptoms occurs in a sizeable proportion. Physical incapacity,
decline in the mental faculties and feeling of generation
gap, add to the problems.
It has been observed that certain normal
variations can occur in the elderly due to ageing viz. triangular
pupils, loss of ankle jerk, decreased or absent vibration
sense, absence of abdominal reflexes especially when there
is a laparotomy scar, loss of position sense in the toes,
wasting of small muscles of the hand and dorsal muscles of
the forearm and absence of posterior tibial artery pulsation.
These should be kept in mind while examining.
The cardiac muscle undergoes fibrous degeneration
and hence there may be a murmur. The pulse rate could vary
from 80 to 84 and due to atherosclerotic changes, there may
be a few extrasystoles too. Hypertension, cervical spondylosis,
vertebrobasilar insufficiency are major cardiovascular problems.
Diabetes mellitus, urinary tract infections, respiratory problems
and benign prostatic enlargement. too occur. Visual and hearing
problems are definite handicaps. Insomnia is a constant occurrence.
Degenerative joint disease incapacitates and restricts the
ambul atory life. A sudden loss of appetite, reduction in
weight may indicate malignancy. It should be kept in mind
that the physician can diagnose these illnesses with a detailed
history and examination and a few limited laboratory investigations.
Ordering unwarranted investigative procedures and putting
forth complicated diagnoses in the first interview is to be
avoided. Iatrogenic disorders should be remembered while prescribing.
Health education forms an important part
of the therapy and the elderly should be advised to take only
essential drugs, regularly and in the prescribed dosage only.
A low calorie diet with necessary vita mins is advised based
on the availability of the type of food in the particular
geographic area. The elderly should be advised regarding regular
exercises, way to improve their social securities i.e., e.g.