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the other hand it takes 80 hours in a 80 year old person. This mechanism applies to almost all the drugs. This results in a higher concentration of the drug in the blood and other tissues. This causes severe side effects in the elderly. Hence the drugs must be given in smaller doses in the elderly and they should be advised about possible side effects.

Family and social circumstances

In joint family the elderly person is generally considered as its head and many responsibilities are shouldered by him. In recent times, the traditional joint family has been facing dissolution, and quite a number of elderlies are living alone. Some elderlies who live with their children may not be happy owing to the unhelpful attitude of the youngsters. They feel a psychological sense of being rejected. They experience a sense of constant dependency for even day to day economic and material requirements on the younger member of the family. This type of attitude towards them in addition to their own economic privation tends to make them depressed. Solitude is generally the lot of many oldsters. It has been said that the golden rule in old age is a truce with solitude. It is useful for the MPHW to understand the family in which elderly is located and also make out the attitudes of others in the family to the elderly. However there are many families in the villages, where elders are taken care of by the youngsters. Such a care should be encouraged with helpful suggestions. In some the elder members are considered as burden to the family because of their non-contribution to the economy of the family. As opposed to the city or a town dweller, to a rural elderly there is no retirement in a formal sense. He has to work as long as it is physically possible for him to work. This type of employment is seasonal and not continuous throughout the year. This work not only keeps him economically viable in the family but adds to a sense of independence and counters dependency attitude. Many elderlies tend to suffer from diminution of their self-esteem. The acceptance by family and ability to work if employed add to their self-esteem. The type of work that is to be allotted to the elderly depends upon a knowledge of their condition - they are slow, not well adjusted to learning new things. Physically they may not be able to do hard work. Many old people in the village have their meeting place such as chauvadi or temple, where they discuss their personal and general problems. These social encounters should be encouraged and they are important in overcoming their sense of solitude and boredom. This social network tends to compensate in some cases the neglect that they face in their own homes. Many elderly although living alone appear to be well integrated into the social circle. Similarly, many elderlies although living with the families face social isolation. Counselling to the family in such cases is necessary. It is to be remembered that living alone does not cause social isolation and living in joint family does not ensure emotional security. The health workers should particularly be on the look out for these traits in those living alone and those living in the family. Social contact and activity should be encouraged in the lonely people and solitude which is painful must be avoided. The health workers themselves should visit these elderlies at frequent intervals and an informal conversation should help dispel a sense of being neglected and thereby giving them positive feelings of being accepted.

Health education Counselling and Rehabilitation

In addition to the assessment of the current health and family status of the elderly,

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