There are a lot of differences when we compare the elderly people with those who are younger or in their middle-ages. Let us try to understand, by reading below, exactly how this can be explained.
As people age, they become more Heterogeneous, that is they become more and more different, many a times with respect to their health and medical needs. Let’s say a group of 20 men and women, all 30 years old. Most, if not all, have no chronic diseases, don’t see their physicians on a regular term basis and take no long-term prescription. Compare this to a group of 20 men and women who are 60 years or 70 years or 80 years old. Many of them will have chronic heart and lung diseases, memory impairment, are frail, wheel-chair bound and on long term medications. Many will have some form of restriction in their independence in the activities of their daily living like bathing, going to toilet and dressing.
As we grow older, our bodies become increasingly more susceptible to any stressor, called Homeostenosis. It can be related to any infection, trauma or even medications. For example, a common cold, in a younger individual may cause fever, body ache and appetite loss, which can be treated with most of the cold remedies. But same illness in an elderly person may cause havoc. Poor appetite may cause significant dehydration and lead to dizziness and falls, especially if on blood pressure medications. Being bedridden even for a day or two will make an elderly noticeably weaker, again leading to falls. Also, many cold medications may cause confusion, constipation and other unwanted side effects.
Another important difference is Multimorbidity, that is the number of comorbidities or medical conditions present at the same time. Elderly typically don’t come to doctors with one single condition. Instead they have a variety of concerns and illnesses. Sometimes, treatment for one condition may interfere with another or in some instances make it worse. Standard guidelines are streamlined to single disease and it becomes difficult to adhere to multiple clinical practice guidelines. Also, there is lack of representation of senior citizens in majority of the trials determining these guidelines.
- Atypical disease presentations
Diseases may have Different Presentations in elderly. To give a few examples; Classic symptoms of heart attack, chest pain and sense of impending doom rarely present in elderly. Instead, they may complain of stomach ache, nausea or simply feeling tired. Cough, breathlessness and fever the hallmarks of pneumonia or burning micturition, fever suggestive of urinary infection may not be presenting features in elderly. They may manifest as poor appetite, fatigability and confusion.
It is not uncommon to see an elderly individual take 5 or more medicines per day. As we grow old, the number of diseases and disabilities go on adding up. In many cases, it is necessary to take multiple medicines for these conditions. Some elderly individuals take 3 or more medicines for control of blood pressure itself. It is common to see patients with chronic kidney disease on more than 5-7 medicines per day. Many elderly people with diabetes take 3 or more oral medicines and some in addition take insulin for control of their blood sugars. But, as we grow old, our organ systems especially, the liver and kidney have decrease in their functioning capacity. They are not able to metabolize the medicines, as compared to someone in their 30’s or 40’s age group. Also, drug-drug interaction plays a major role in causing side-effects in elderly. Consider a typical 70 years elderly gentleman with diabetes, high blood pressure, cholesterol problems, with heart failure. How many medicines will he be taking per day for all of his health issues?
- Attitude of the Elderly
The improper attitude of senior citizens towards their own health is a very important factor which hampers the early detection and treatment of disease, which at an advanced stage becomes incurable. Many elderly people consider decreased appetite and weight loss as normal and inevitable effects of the ageing process. So, if they get these symptoms, they generally tend to ignore them. What they don’t understand is that these may be the symptoms of some serious underlying diseases like Diabetes, Malignancy, Tuberculosis or others. Elders seem to have an inherent aversion to consult a doctor or to seek medical help. This may also be responsible for delay in treatment.
- Attitude of the Relatives
In many cases, when the elderly people complain of any physical discomfort, it is not taken seriously by other members in the family. They tend to ignore it, thinking it to be an inevitable part of the ageing process. Consider a similar situation in a small child. When a child has even a minor problem, he/she is immediately taken to the doctor for treatment; but when an elderly person suffers from similar issues, most of the times it is ignored by the family without any further action taken. Why this indifference towards our elderly?
- Therapeutic problems
Treatment of diseases is as much complicated as the diagnosis of the condition. The side-effects of medicines increase both with ageing process and the number of medicines prescribed. Multiple diseases mean multiple medications. This leads to more drug-drug interactions and adverse effects. Sometimes, side-effects of medicines are more than its beneficial effects. It is not always necessary to take a pill for every ill. Many diseases in the elderly population can be managed by non-drug regimens like diet, exercise, physical therapy and counselling.
- Social problems
Many senior citizens suffer from socioeconomic problems like isolation, dependence on others for their daily activities, poverty and so on. These problems may aggravate or precipitate the already existing medical problems.
- Geriatric giants
These are major categories of impairment that appear in elderly people. Traditionally these included immobility, instability, incontinence and impaired intellect/memory. More recently, four new syndromes of frailty, sarcopenia, anorexia of ageing and cognitive impairment have been termed as the modern geriatric giants. Impaired vision and hearing impairment are common chronic problems in senior citizens. Vision problems lead to falls from tripping over nearby objects, medicines being taken incorrectly because the written instructions could not be read and finances being mismanaged. Hearing problems can lead to social isolation and depression as the elderly can no longer understand what others are talking to them or engage in simple transactions Only a Geriatrician, who is exclusively trained in the elderly care, can properly assess all these issues in totality and advise appropriate management to improve the functionality and quality of life in the elderly.