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APPENDIX V
MANUAL FOR PHC MEDICAL OFFICERS
SOME GENERAL PRINCIPLES IN THE CARE OF THE ELDERLY

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. enhancing meeting

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