Er. Mohammad Ashraf Fazili
Every day we are all growing older, whether we like it or not. Hence, we need to adjust our minds as nature seeks to adjust our bodies to the changes of time. Modern medical science is still on the lookout for a complete answer to the reasons why these changes occur, although with delicate instruments we can even measure some of the more obvious changes. Most of us are rarely conscious of passing time, but we must face up the profound changes that lie ahead.
Much depends on the attitude of mind. It is said that “a merry heart does good like a medicine.” A cheerful, optimistic outlook is of the greatest importance in helping to face the infirmities of age. It is said that successful living usually depends on choosing a suitable diet, being vigorous and active, getting sufficient sleep, and maintaining a wholesome attitude towards life in general. Younger people should always encourage those older in years to “think young” Help them to look on the bright side of life in spite of pain and disability. An optimistic attitude is the first and perhaps the most important step toward better health.
Medical advisors have to say that many serious conditions may be first noted during the later years of life, which are briefly mentioned here, so that nothing is overlooked in considering the problems of an elderly patient.
Hardening of the Arteries: This condition is common in later life, but it is not a normal part of growing old. Years of neglect, plus a poor diet and bad habits of living, often precede the onset of arteriosclerosis, or hardening of the arteries. Many such patients have been found overweight and fatty deposits are found in the walls of many important arteries. This condition is the main cause of strokes and heart attacks and is often inherited and far easier to prevent than cure. The hardening of arteries often begins early in life, hence younger people should become aware of the danger and do their best to follow a balanced programme of living right from their earliest years.
High Blood Pressure: This comes on usually during the middle and later years of life and is often associated with strokes and heart disease. Its most serious complications can often be avoided by following a lifelong habit of sensible living.
Strokes: These are very common during the later years of life. Small strokes usually cause very few symptoms. But if they occur too often, they may lead to marked changes in the patient’s ability to think normally. A large stroke may leave a person paralysed for the rest of his days.
Most strokes are from a thrombosis or clotting of blood in one of the vessels leading to the brain. If this occurs in one of the larger vessels of the neck, the clot can be removed by surgery, and the patient may make a complete recovery. Unfortunately, we still perhaps have no way of remove ng clots from the smaller vessels within the brain itself.
Sometimes a small artery in the head will rupture, possibly because of high blood pressure. This may then cause a serious haemorrhage inside the head. The trouble may arise from a weakness in the wall of the vessel. The resulting haemorrhage may then badly damage the brain.
Heart Trouble is the greatest cause of death today. The first sign of trouble may be nothing more than a steady rise in blood pressure, followed by heart failure. Doctors call this hypertensive heart disease. If there is a marked narrowing of the vessels in the heart wall, the condition is known as coronary artery disease. The patient may begin then to suffer from angina pectoris or sharp pains over the chest. Later he may develop a true heart attack, or coronary thrombosis.
Long Ulcers and Varicose Veins are also common in older people. Wherever possible, it is wise to have the large, twisting veins completely removed by surgery. Smaller ulcers of the legs may then heal without further surgery. Larger ulcers may need to be covered with a skin graft to promote healing.
Arthritis is often seen during the later years of life. Swelling and pain may occur in the fingers, wrists, shoulders, spine, hips, knees, ankles, and toes. Any weight-bearing joint may be involved. Much can be done to help arthritic patients. Hot moist packs will often relieve the stiffness and pain and help to make life easier for the patient.
Glandular Troubles: Many older people are troubled with itching, dizziness, hot flashes, and other distressing symptoms. Most of these arise from endocrine changes in the body. Hormones are often the answer to these troublesome conditions. Older ladies may benefit from the use of female hormones, while older men may need male hormones to keep them well. A combination of both male and female hormones may help to prevent some serious aging problems, such as osteoporosis or thinning of bones.
Urinary problems are always more common in later life. Because of weakness in the sphincter muscles of the bladder some elderly women may have difficulty in holding their urine. Gently dilating the urethra with a suitable instrument will often relieve this condition. Sometimes more extensive procedures are needed. Elderly men may have difficulty in passing their urine because of an enlarged prostate gland. The gland should then be removed by surgery, preferably by using the transurethral approach.
Diabetes may come on later life, and is usually rather mild, so that it may not be recognized until a person has a routine medical examination. Fortunately, this form of diabetes is easier to control than the juvenile type that occurs in younger people. Most elderly people respond well to the newer antidiabetic pills but injecting insulin is recommended by doctors to have no side effects.
Digestive Disorders: Many older folks suffer from gas and distension of stomach and intestines. This is often aggravated in nervous tension, probably because in that condition the patient is swallowing large quantities of air without realizing what he is doing. He may also have achlorhydria which is lack of hydrochloric acid in the stomach. Many older people fail to drink enough water to keep the contents of the large bowel from becoming hard. Constipation naturally results. Merely increase of intake of water and using bulky foods such as vegetables in the diet, will often relieve the problem completely. However, all patients with digestive trouble should have X-rays of the stomach. Older people should be careful not to use high enemas and harsh laxatives too frequently, for these may cause trouble in the colon. They should also have a careful examination of the rectum at least once each year.
Cancer may strike at any time of life, but it is always more common during the later years. Any chronic sore appearing on the face, head, or neck could be due to skin cancer, and should be removed by surgery. Cancer may also occur in the stomach, rectum, breast, and genital areas. Cancer of the lung or bladder is always a possibility, especially in heavy smokers.
Choosing a Good Doctor: Every family needs the counsel and guidance of a good family physician on whom they can always depend. Do not wait until someone is very ill before finding a good doctor for your family. The more he knows about you the better he will be able to serve you in time of need. Many serios illness can be prevented or relieved when recognized and treated in time. The doctor you choose should be well trained and well accepted by the other physicians in your community. He should be a man of character and discretion. His advice will meam much to you, and his presence will bring comfort and strength in times of severe illness. Why not to get to know him now rather than waiting until too late for him to give you help you need?
Selecting a Nursing Home: When an elderly patient is no longer able to care for himself the younger members of the family have some real decisions to make. Every true son or daughter naturally wants to do what is best for their ageing parents and loved ones, but how can they know for sure what to do?
Wherever possible, older people should be allowed to remain in their own homes if feasible. Some may need the services of a housekeeper or companion, or some help in getting their meals. We need to be careful not to restrict their activities too much. Keep the older person vigorous and active, and this may help to avoid some of the more serious complications that so often arise from inactivity.
At some point of time, we may have to consider shifting him to a nursing home. Its choice needs to be made according to the type of patient. Those who are up and about can usually get along with less expensive care. Bedridden patients may need the services of a trained nurse to supervise their treatment. Others may do well with the help of an attendant. Great care must be taken to prevent bedsores, which are a constant source of infection. The ulcerated area may be painted with compound of tincture of benzene and apply infrared heat lamp for about twenty minutes two or three times a day. After which may be applied neomycin powder and cover the ulcer with a clean dry dressing.
The diet of the elderly patient too is important. His meals should be well prepared and attractively served. If he can not chew his food properly, see that it is cut up or pureed so that he can get all the nourishment from his meals.
Er. Mohammad Ashraf Fazili is a Former Chief Engineer