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Geriatrics Medicine: Health for the elderly

<p><span style="font-family: helvetica;"><img src="/nairobi/PublishingImages/Geriatrics%20body.jpg" alt="" style="margin: 5px;"/></span> </p><p><span style="font-family: helvetica;">Your elderly parents need utmost care given that this is the period when most of them are either being managed for different acute or chronic diseases or being diagnosed with the same. Geriatrics is a field of medicine that specializes in care of people usually over the age of 65. Anyone over this age falls into the geriatric category and their needs and medicine are slightly different when compared to the younger population.</span></p><p><span style="font-family: helvetica;">Medical conditions in the geriatric population differ from the general population. Furthermore, if you look at the guidelines of how we treat older people in terms of blood pressure, cholesterol and diabetes, they slightly differ from younger adults. Here is what you need to know about caring for these patients.</span></p><p><strong style="font-family: helvetica;">What issues are currently affecting the geriatric population in Kenya?</strong></p><p><span style="font-family: helvetica;">Number one is poverty. As of 2018, 8 million Kenyans lived in extreme property and a majority of our geriatric population are affected by this.</span></p><p><span style="font-family: helvetica;">Another key issue to be wary about is elderly abuse.  This seems to be common problem more in the west than in Africa. Unfortunately, with increased weakness, there&#39;s potential for abuse not only by family members, but also healthcare workers as we have seen in many nursing homes in other countries.</span></p><p><span style="font-family: helvetica;">In addition, screening for HIV remains key in this population. The more we screen the more we discover and sooner we can intervene for a healthier life.</span></p><p><span style="font-family: helvetica;">There is also a high level of illiteracy among the elderly. Many of our geriatric populations grew up when education was not affordable or accessible.</span></p><p><span style="font-family: helvetica;">Given the transition to a more digital world, digital inequity is another issue within the geriatric population with many of our older patients who have little knowledge on how to operate many of our common digital appliances.</span></p><p><span style="font-family: helvetica;">Cybercrime is also a huge issue whereby many people will try to deceive these elderly people of their finances and assets.  This again is more common in the West but also prevalent in our setting.   </span></p><p><strong style="font-family: helvetica;">What health issues usually accompany the geriatric population?</strong></p><p><span style="font-family: helvetica;">As we age, more of the general health issues will now become more prevalent in the elderly. They suffer from multiple conditions such as elevated cholesterol, high blood pressure, diabetes, weak eyesight and hearing loss. In addition, many of the times mobility becomes a challenge with increased risk of falls and fractures of their long bones. Reflexes are much slower which affects their safe driving skills putting them at a higher risk for accidents.</span></p><p><span style="font-family: helvetica;">To manage their health better, they need evidence based preventive screening especially for cancers. Hence mammograms, pap smears, colonoscopies are screening tests that are necessary for geriatric patients. Elderly patients are also prone to being on a variety of medications (polypharmacy) and this can be dangerous due to the interactions of various medication including their side effects on patients.</span></p><p><strong style="font-family: helvetica;">What&#39;s the importance of geriatrics within Kenya?</strong></p><p><span style="font-family: helvetica;">We have about 55 million people in Kenya, and about 6% of the total population or 2.7 million people fall within the geriatric category. If you look at the laws of Kenya, they classify geriatrics as anyone over 60 years old.  Of the 2.7 million people, the majority of them are female living in rural areas.  Many of us are living longer and it is expected that our geriatric population will also grow in size in the coming years.</span></p><p><strong style="font-family: helvetica;">Is there an explanation why most geriatrics are female?</strong></p><p><span style="font-family: helvetica;">This remains a mystery for now, but in Kenya 55% of the geriatric population is female. One can only assume that they have a healthier lifestyle living in rural area, eating fresh food and always active.   Many of the geriatric patients that usually visit our clinic look younger than their stated age and live a relatively active life surrounded by their close family members which in turn promotes graceful aging.</span></p><p><strong style="font-family: helvetica;">Old patients tend to have be on multiple medications, what&#39;s the danger in this?</strong></p><p><span style="font-family: helvetica;">We do a good job in taking care of the elderly, however there are limitations to what we do and what we understand. For example, when you have an elderly patient that comes to your clinic or gets admitted to the hospital, they usually end up being prescribed five to ten medications at a go. Polypharmacy is risky for these elderly patients and can cause many side effects from the medications and interaction between the medications. Fortunately, one of the fields that geriatric medicine specializes in is medicine reconciliation and medicine reduction involving removing of medications that can be harmful to the patient.  This is harder than it sounds and needs to be dome by a skillful physician.</span></p><p><strong style="font-family: helvetica;">What is the importance of having a family member as a caretaker for the elderly?</strong></p><p><span style="font-family: helvetica;">Due to busy lifestyles, families tend to move their old parents, especially in the West, to nursing or long-term care homes. Unfortunately, the people who live in such nursing homes don&#39;t do well because they suffer from a lot of neglect and time away from their loved ones. As humans we are social creatures, and that kind of interaction really is diminished when you move into a nursing home. The beauty about Kenya is we don&#39;t have many nursing homes, which is good. In addition, many of us living here are brought up with the reciprocity that we need to take care of our parents when they age and we are committed to this.</span></p><p><span style="font-family: helvetica;">Many of our elderly patients do much better living in their own houses/setting as they find much comfort in their own environment. Many geriatric patients will often refuse to move in with their children and prefer their independence. This is certainly something that you really don&#39;t want to take for granted because autonomy is something that they really value.</span></p><p><strong style="font-family: helvetica;">Are parents losing themselves raising their children and not prioritizing themselves?</strong></p><p><span style="font-family: helvetica;">Most parents and grandparents live for their kids and will do everything to provide for them. That&#39;s just innate and genetic in us. Certainly there are cases where parents will neglect their children. But in general I think there&#39;s fulfilment and happiness and joy when you take care of your kids and see them grow. I think that at one point it now becomes a responsibility of those kids now to take care of their elderly parents. It is very important to just keep an eye on them, make sure that they&#39;re safe at home, make sure their finances are taken care of, no one is abusing them, no one steals from them. This is what is really important. </span></p><p><span style="font-family: helvetica;"><strong>What advice can you give to these parents who are closely aging?</strong>
</span></p><p><span style="font-family: helvetica;">One of the things that I tell most of the people is just try to invest in themselves so when they get to that age, they have enough resources to take care of themselves. To ensure this, the elderly need to make sure that they have some sort of income or an investment that is giving back to them. An investment that ensures they&#39;re making enough to pay bills and to purchase necessities. Unfortunately, the biggest challenge in low-middle-income countries remains access to healthcare.  As people enter the geriatrician category, periodically they have some issues that bring them to hospital and lack of a comprehensive healthcare plan can certainly, not only affect their health, but put a dent in their finances.

<strong><em>By Prof. Sayed Karar, Internal Medicine Specialist at Aga Khan University Hospital Nairobi</em></strong>
</span></p><p><span style="font-family: helvetica;"><strong><em>This article was first published in Business Daily on August 28, 2023</em></strong>

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