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helplessness and hopelessness and considers himself as unfit to live. The depressives may frankly express suicidal ideation and reject treatment even for their physical problems like cataract. Out of loss of interest and despair, some of them become tearful. There is a gradual loss of weight due to poor intake of food. Such persons should be identified since treatment is rewarding in these patients. Memory failure is common in the aged. It is generally benign and is associated with ageing, when it is occasional and only for details or for names which later, the individual is able to recall. On the other hand, memory failure may be progressive. The person is unable to recall the major events even. He may fail to identify the place and the persons and likely to lose himself on the streets or even within his house. This memory failure gradually leads to other difficulties and this should be recognised as beginning of a serious brain disease, dementia. Some elderly people suffer from ideas of being persecuted and that their food is poisoned etc. They may have hallucinations of voices or vision. Owing to suspicious nature, they have difficulties in adjustment and may lodge complaints with the police. These disturbances occur in 'late paraphrenia' in the elderly. The delirious states are characterised by incoherent talk, hallucination and disorganised behaviour. Place, people around are identified wrongly. They may not know the time, day or date. Although this is generally due to the brain disease, such episodes can result from the conditions like fever, acute constipation, retention of urine, bronchitis or from taking drugs, starvation, vitamin deficiencies, persistent vomiting. The cataract operation or acute psychological stress can lead to such delirious states. In many instances, they are reversible by treating the precipitating cause. However, in some they can be the beginning of the dementia.

Many elderlies are in the habit of self-medication. They suffer from symptoms from such prolonged administration of drugs. They may be taking medicines for constipation, cough, sleep and for depression both prescribed and unprescribed. This is to be enquired into by the MPHWs.

Early detection of cancer carries with it a possibility of complete cure in some cases. Even in advanced cases of cancer, management is possible and in many terminal cases, measures to control pain and to make life tolerable are possible. Patients are to be enquired about the following: Change in bowel or bladder habits, such as persistent constipation, recent onset of diarrhoea and difficulty in voiding urine or urinary incontinence, bleeding or bloody discharge in urine, in motion or in the vomit or while coughing; any ulcer or a sore that fails to heal, especially on the tongue, in the mouth, on the skin; progressive loss of weight and loss of appetite and difficulty in swallowing; a persistent cough or change in the voice; a lump in the breast (in women) or any mass appearing in the body. The women may be advised to periodically examine their breasts for lump and also to report on any bloody discharge per vagina. Research all over the world has proved that certain behaviours predispose to or cause cancer. Cigarette smoking, chewing tobacco cause cancer of the lung and cheeks and tongue respectively. Similarly the excess of chilli powder in the diet can produce cancer. Suitable advice is to be given on stopping smoking, chewing tobacco and use of chilli powders. A family history of cancer also indicates the liability of the person to this disease.

The elderly people in view of their physiology are unable to metabolise drugs and to excrete them as efficiently as the youngsters. For example, a drug like Diazepam takes 20 hours to get metabolised and excreted in a twenty year old individual. On

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