- Person aged 64 years, is currently active, having asthma issues. What and how much exercise is needed by him to be physically active?
We need to know the type of asthma, if it is seasonal asthma that is very mild form. Definitely exercise or emotional outburst will cause asthma, so he has to be careful. Otherwise, there is no contradiction to do exercise, but if you have acute asthma you better not go for harsh exercise, you can start with mild exercises like walking, then increase the time and speed of walking over time. Some amount of stretching exercise can be done, or consult a physical trainer or yoga trainer. You can also do yoga, which helps in breathing and respiration, like pranayam. Spiro ball can also be used for breathing exercises; procedure to use is available online. But in case of acute asthma it has to be avoided.
- The person haven’t exercised yet entire his life, but is a farmer and used to work in fields. He hasn’t exercise for many years, where should he start from?
There is no age to start a new thing, it is good that you are a farmer and probably have done a lot of physical exercise in his lifetime and that has to be continued, just like feeding of our body and mind, we need to feed our muscles with physical activities and exercise. You need to start with walking and gradually increasing the speed and time of the walk.
- Will the physical activity help to reduce the risk for specific diseases and conditions? (history of heart disease and obese)
Physical exercise will invariably reduce the chances of heart attack or heart related problems, if one is non cardiac disease patient. Obesity is significantly benefitted with exercise, so an obese person should do exercise. But for active heart disease, one must consult their cardiologist, for any kind of physical exercise routine.
- Does one need to consult a doctor before joining or start doing physical activity?
If you are not having any kind of cardiac issues there is no problem in starting the basic routine of exercises, but start with the basic and slow exercises step wise.
- The patient is 73 years old, retired teacher. Is he too old for doing exercise?
There is no age bar to do exercise; even a 100 year old person can exercise. But one must chew
as much as he can digest so start with basic exercises, like walking.
- What are the rewarding points one must acknowledge after the age of 60 years?
After retirement, people have lots of experience with their own lives. He/she will be the right person to take life decisions. He/she must be better knowing things or people which will make him happy or give the feeling of belongingness. Further we usually connect with our social groups and friends after retirement as it gives us happiness and engagement. So try to engage yourself in some kind of social activity and be happy. As happiness is the most rewarding point in one’s life followed by to be independent, physically and mentally healthy till death. But one should not engage in all these activities after retirement only but before that, so that life will be more pleasing and happy.
- What can a caregiver do to avoid or lessen the stress that care giving causes?
Caregiver stress is an important issue which must be dealt with, because they are also human beings. Care giving scenario, in Indian context is informal, so family members has to do the care giving jobs, other house works and their professional works also. So balancing between care giving and personal, professional responsibilities is difficult, which usually adds up in the stress level. So caregiver must take rest, they should go out of the caregiver profession on and off to relax a little. In a family scenario, the caregiving responsibilities should be shared so that the burden doesn’t fall on one single person. Keep some time for yourself which is very important. Do something which gives you happiness other than the care giving job. In case you still fell stressed you should consult a therapist for some kind of assistance and for your better living.
- As a caregiver, what should one know about the older adult’s medication safety?
Randomly prescribed medicines from the Google search must be avoided. Consult a doctor for any kind of medical emergency. Follow the prescription given by the doctor and give the medicines according to the prescription and timely. But for a dementia patient, or a person who is very elderly and totally dependent for medication, over and under consumption of medicines could be fatal.
- Is COVID-19 vaccine safe for the older adults?
Yes, it is 100 percent safe. Every older adult should take vaccine with COVID appropriate behavior.
- Is memory loss normal with ageing?
No, memory loss is not a part of ageing. But processing speed of memory slows down and we might need to be reminded about things more often. Once registered, recalling is not a problem. Memory loss is not a normal ageing phenomenon.
- How much physical exercise is needed?
In older adults of the 65 years and above age group, physical activity includes leisure time physical activity, transportation (e.g. walking or cycling), occupational (if the individual is still engaged in work), household chores, play, games, sports or planned exercise, in the context of daily, family, and community activities. The recommendations from WHO in order to improve cardiorespiratory and muscular fitness, bone and functional health, reduce the risk of NCDs, depression and cognitive decline are:
- Older adults should do at least 150 minutes of moderate-intensity aerobic physical activity throughout the week or do at least 75 minutes of vigorous-intensity aerobic physical activity throughout the week or an equivalent combination of moderate- and vigorous-intensity activity.
- Aerobic activity should be performed in bouts of at least 10 minutes duration.
- For additional health benefits, older adults should increase their moderate-intensity aerobic physical activity to 300 minutes per week, or engage in 150 minutes of vigorous-intensity aerobic physical activity per week, or an equivalent combination of moderate-and vigorous-intensity activity.
- Older adults, with poor mobility, should perform physical activity to enhance balance and prevent falls on 3 or more days per week.
- Muscle-strengthening activities, involving major muscle groups, should be done on 2 or more days a week.6. When older adults cannot do the recommended amounts of physical activity due to health conditions, they should be as physically active as their abilities and conditions allow.
- Is it necessary for a person to suffer from memory issues after 60 years?
No, but as is mentioned above, the processing speed slows down. The best way to register things is by repeated recall.
- Is bone health decline normal with ageing?
Bone health decline is also a part of ageing, due to increased Osteoclastic activity and in women due to reduction in estrogen post menopause but extent of decline is based on how active you are and have been in your life; and calcium and vitamin D intake in your diet. The RDA values for Calcium is 1200 mg daily, and that of Vitamin D is 800 IU daily.
- What can a caregiver do to make sure that the elderly remembers to take his/her medicine?
A caregiver can arrange the daily medicines in a pill box which has the days of the week labelled properly. He can also set alarms on the phone to remind his family member to take his medicine. He can ask him to note down on a notebook at what time he has taken the medication and can review it to check if he has been regular with his medicines.
- Travelling to doctor with an older patient is always tiring, are home visits available?
As geriatric medicine is a new and upcoming branch, the number of doctors in the field are few and it is a little difficult to find doctors who perform home visits, nonetheless, Geriatric healthcare vans have been installed in Delhi, to cater to the problems of elderly in old age homes, and depending on where you are located, there are many private hospitals and clinics that are offering home visits for elderly.
- Mother keeps repeating herself, is it normal, she is 72 years?
The phenomenon of repeating oneself is called perseverance and can be an early marker of dementia. It could also be due to a psychiatric issue. Mild behavioural impairment (MBI) is a syndrome characterized by the appearance of neuropsychiatric symptoms in elderly persons. MBI is a potential marker of incipient cognitive decline and Alzheimer’s disease. It would be better that you schedule a visit to the geriatric OPD and psychiatric OPD to confirm that she is fine, where her memory and attention will be tested by trained personnel. If something seems to be out of order then further investigations and treatment if required can be started.
- With the age the person had socially withdrawn, don’t feel like meeting anyone, is it normal?
There can be many reasons why an elderly person has decided to isolate himself/herself, like memory loss causing distress and loss of confidence in oneself, anxiety, depression. It should be evaluated in the OPD, as a socially withdrawn person will gradually go into social isolation which is a risk factor for many diseases like hypertension, diabetes, heart disease, stroke and premature death. So it will be a good idea to schedule a visit to the OPD.
- Care giving guidance regarding dementia care
- To be patient and understanding with your elderly family member
- To be observant to any new problems that have developed like loss of control of body functions, falls, memory loss, confusion
- To not reprimand or argue with him/her as what is happening is not in their control
- Continue to express love and care
- Focus on functional ability instead of inability
- Engage in multidisciplinary care, seek help from a social worker/occupational therapist
- Taking care of Activities of Daily living which comprises the following areas: grooming/personal hygiene, dressing, toileting/continence, transferring/ambulating, and eating
- Taking home safety measures related to dementia care and keep in touch with emergency health providers
- Spend quality time with them
- To know when is the right time to let go and not prolong their suffering
- To get help when needed and to find someone to talk to whether it be a friend/family member/ therapist/doctor as it can be very difficult mentally and emotionally to be a primary caregiver and to see someone you care about fall prey to dementia. Have some personal leisure time for your own mental health.
- Is there a cure for dementia?
There is no cure but there are ways to slow down the process, with medication and by maintaining a fit and healthy lifestyle and diet (Mediterranean diet pattern) and being regular with your medications. In addition to this, it is important to engage your mind and body by exercising (including both resistance training and aerobics), yoga, stretching and balance training.
- What are the early signs of dementia?
Memory problems, mood and personality changes, getting bored, difficulty performing tasks that were once easy to accomplish, difficulty in remembering words, misplacing things, getting lost on the way back home, and most importantly forgetting immediate events like having eaten a meal/leaving the stove on; are all early signs and if present should be evaluated.
- Why is exercise so important for older adults?
Exercise is important for the body as well as the mind
- Keeps their muscles strong and joints flexible, will enhance mobility and balance and prevent falls.
- Helps decrease bone health issues, and prevents the development of vascular complications like Coronary artery disease, hypertension and stroke.
- Reduces the chances of developing memory issues and psychological issues like depression.
- Prevent cognitive impairment and memory loss
- Releases happy hormones
- Prevents age related degeneration of different organs
- What can I do to lower the stress that caregiving causes?
- Take care of your own health by eating right, sleeping well and taking your own medications correctly.
- Ask for help when required. Join a support group or talk to a friend/family member/doctor.
- Take time for yourself to perform a stress busting activity like yoga/jogging.
- Try not to feel guilty about something you can’t provide to your elderly family member and hire someone to help or try intermittent hospice care if you cannot manage on your own.
- Is routine checkup necessary after the age of 60 years?
Yes, routine check is necessary, that should be head to foot assessment by a qualified elderly care physician or geriatrician, if available. Otherwise, a general physician can help to assess hearing, vision, nutritional status, mood, cognition, mobility(physical assessment). In clinical practice, Blood pressure, sugar, thyroid function, prostate status, Hb level, vitamin D level, but there is nothing to be worried about the routine checkup. The routine checkup after the age of 60, can be done once in three years, as per the geriatricians.
- Why do older adults have knee pain more? And what can be done to cure it?
Common cause of knee pain is osteoarthritis, which is degeneration of knee joint. Knee joint works like a pulley, because of which you can have flexion in your knees while doing activities like cycling, walking on stairs, sitting and heavy weight lifting, these are the risk factors. For the prevention, one should drink plenty of water, take vitamin D and calcium in case of deficiencies, avoid taking stairs in case of living in a multistory setting, avoid cycling, avoid sitting on ground, use chair. In case of pain consult an internist, geriatrician or a physiotherapist. Strictly avoid analgesics which can cause effect on kidney, in case of severe pain paracetamol can be taken, ointments can also be used. Consult a doctor if the pain is unbearable and can further be planned for knee replacement surgery. There is no other medicine or treatment that can prevent knee pain that has been practiced in the clinical settings for knee pain.
- What to be eaten in order to maintain a healthy lifestyle?
It is an individualized question, it depends from person to person depending on their lifestyle. Prefer homemade food, fruits and vegetables, which will have more fibrous diet and help in the bowel habits. Drink adequate water. If you don’t have any kidney disorder, drink 2-3l of water daily. Try to increase the protein content in the diet like, milk and milk products, dry fruits, spinach, soya bean for vegetarians and for non-vegan diet should include fish and poultry products. Don’t smoke. Have small frequent foods as with ageing the motility of the food pipe is reduced, because of this heavy meal is difficult to digest in this age. Also, avoid more of the carbohydrates in the dinner which can cause indigestion. Have seasonal foods, in case of diabetes avoid mango and bananas.
- What diet should be taken if the patient has high BP?
Salt restriction is very important, also sugar restriction as these patients are prone to develop diabetes in future. In any way more of the salt intake is not health for an older adult. Rest, the person can follow the general diet habits as mentioned above.
- In local home settings, how to prevent falls, if patient has a history of fall?
The surroundings of the home should be maintained, there should not be any kind of slippery flooring, there should be grab bars in the bathroom, and staircase and prolonged space in case of imbalance this can be helpful. Bathroom should have anti-skit flooring and floor should be dried up immediately after every use to prevent slipping, it should be well lighted. Avoid clatters on the floor and furniture should be well spaced. If there is a history of fall, there should be proper evaluation by a doctor in order to determine the cause of the falls. There can be several causes for the falls like brain problems, cardiac rhythmic disturbances, knee pain, polypharmacy, etc. So, in case of falls one must visit to an elderly care specialist.
- After retirement, patient doesn’t do anything except for eating and walking, doesn’t even talk much. What can be done in order to make him more active?
This is a question related to your preparedness about active ageing, so one need to have a purpose in their life. Any kind of ambition, goal, aspiration or vision can help in getting engaged with activities that give you happiness. One can list 10 things which gives happiness and pleasure to them, these can be playing with their grandchildren, teaching them, mingling with friends, outings, walking, etc. but a definite goal should be there which can help in giving your life a purpose. Try to be mentally active that can stimulate brain to function more. Play games such as Sudoku, puzzles, mathematical calculations. Try to pursue new skills like learning new language, music, paintings, etc. as new skills helps in giving you a purpose. Also try to be more social and interact with the new generation.
- The person aged 67 years, has fallen once but because of fear of falling again walks with a cane/stick. Is it necessary to walk with cane?
Yes, walking with cane is mandatory but we may also take care of the fear of falling which common after the incidence of fall so he/she may require a psychological evaluation but before that cause of fall should be assessed by a geriatrician. The cause of fall may vary from brain problems like Parkinson’s’ disease, dementia, stroke, etc. it can be spondylitis, cervical which can cause dizziness. Postural hypertension can also be a cause (a medical condition consisting of a sudden and abrupt increase in blood pressure when a person stands up). Cardiac rhythm disturbance can also be a cause so monitoring may be needed; knee and foot problem can be reason. Walking is must, as it improves mobility, and is a good form of aerobic exercise also other form of exercise should also be used.
- How to encourage a person aged above 60 years, to do the daily routine of his own?
In our country it is the common perception of the people hat after retirement they should only rest. But 60 years is not the optimal age to stop working, we can still work as much as we can. On an average people with healthy lifestyle can live upto 80 years or beyond. It should be a practice that one should do their day to day activity of their own that is, clean your house, cooking, cleaning utensils and will help in engagement and sense of belonging and is useful for the mental health too.
- How can one take care of the person, if there is no one else in the family and also if the spouse(Caregiver) is above 60 years of age?
As per various studies it has been shown that spouse is the best caregiver, even if the age is 60 plus years. Due to awareness about healthy lifestyle and advancement in healthcare and accessibility to the same, people above age of 60 years are also healthy. This is also one of the reasons where one can be active and healthy as long as possible. Even if the person is 80 years, he/she can take care of themselves. The purpose of geriatric medicine healthcare professionals is to keep you healthy and active as long as possible. And in order to achieve this one have to take care of diet, exercise and consult a geriatrician if needed. And if the scenario is worst, both the elderly are sick and dependent then they have to hire a paid caregiver, or can resettle to various old age homes.
- After the age of 60 years, how often should one get the vision tested?
There is no evidence based guidelines for screening of vision, but one can preferably have an annual body check-up, including vision, hearing, cognitive, mood and nutrition.
- Is blurred vision related with ageing?
Maybe, blurred vision is indicative of any pathology. So it is not true that ageing means blurred vision. Commonest cause of blurred vision is near vision problem, in such case one should visit a doctor and get the eye test done. It can also occur because of problem with retina and dryness of eyes, which is common with ageing, macular dystrophy or glaucoma, so one must consult a doctor, in any case.
- A person above 70 years is diagnosed with depression, what can be done by the family membersto take care of the patient? (The patient has a joint family, lives with his 2 sons, 2 daughter-in-laws and their kids)
The person diagnosed with depression at this age must be consult a psychiatrist and a geriatrician. If it is a low grade depression called as dysthymia for more than 6 months, he can be counselled by a psychologist. In this scenario, since it is joint family setting, family members should talk to the person as much as possible, try to understand him and discuss the problems he is suffering through. More interaction with the patient is needed with in the family. Moreover, the family members should try to keep the person happy as much as possible. Diet, exercise and lifestyle are also important in this scenario, as these will engage them even at the age of 70 years.
- How to control an anxious patient, aged 71 years?
Firstly, we have to find out the cause of anxiety of this 71 years old person. Anxiety may be because of financial instability, health, family problems, social isolation or loneliness, or it may be because of early signs of age related problems either depression or dementia. This person may be evaluated by a trained doctor and psychologist. The treatment should be given accordingly, if the anxiety is due to loneliness then again the family members have to play a significant role by interacting with the person.
- Does good lifestyle leads to slow ageing?
Of course, good lifestyle but it must be a life perspective that means lifestyle of 30 years old person will define how he or she will perform at the age of 80 years. So good lifestyle should be practiced, beginning from younger age itself to slow ageing process, but it is never late to follow a healthy lifestyle, even if you quit smoking at the age of 60 years, start exercising, follow a good diet pattern in late life that will help you not only in slow ageing but also to live an independent life.
- A female aged 75 plus years, had depression. She currently is not suffering from the disease, but usually forgets daily activities of her own. How to cure that? How to make her remember her own daily routine so that she can do a little of the daily activities?
From the history it seems that she is suffering from some cognitive impairment which needs to be accessed by a trained psychologist or a geriatrician. She must be treated for her depression adequately, because sometimes depressed people have the form of forgetfulness which we call as pseudo-dementia, it should be ruled out. Regarding cure one the diagnosis and thorough investigation has been done than only it can be treated, but for any situation like this one must consult the medical person. At present, for her occupational therapist can be appointed to remind her of her own daily activities so that she can practice the same.
- After the age of 60 years, what medical concerns should take priority?
After 60 years, a person can suffer from many form of diseases, mostly degenerative diseases starts like, muscular-skeletal problems, mood disorders, cognitive impairment, nutritional issues, vision-hearing impairment and mobility issues. A thorough check-up should be done by a trained elderly care physician.
- What can caregivers and ageing adults can do to prevent stress?
Stress is not a single disease entity, it is usually a multifactorial origin, it starts from financial insecurity, family problems and health problems. The caregiver, if he/she is the family member of the patient, they should ensure all this domain to achieve and practice healthy ageing, to prevent stress. As an individual one person should try to find out few important things which give them pleasure and happiness which they should practice every day. Additionally, the lifestyle has to be healthy, the diet, exercise, any kind of social engagement, prevention of disease. So, overall stress in case of elderly, the caregiver should interact and try to understand the problems he/she must be facing, if not they should consult a psychologist or a psychiatrist.