Hear it from the Experts - Physical, Cognitive and Emotional Health for our Seniors

Due to numerous scientific advancements in recent times, it is critical to have effective communication between doctors and patients, in order to eliminate any preconceived notions about healthcare.

To offer such compliance and overall satisfaction amongst people, while also raising awareness on certain vital issues such as chronic diseases involving dementia and strokes, and physical disabilities caused by falls and accidents, Seniority invited two esteemed doctors from Jehangir Hospital, Pune to talk about ‘Ageing with Independence’. Ms. Farzana Mulla, an MA, MSC from UK talks about mental health and cognitive psychology with regards to ageing while on the other hand, Dr. Radhika Patel Ph.D. (Geriatrics), presents a holistic view on preventing physical challenges related to ageing. Providing us with food for thought for both, the body and mind, the doctors talk about the lifestyle problems that affect both the physical and mental health and the importance of promoting an active lifestyle regardless of age.

Ageing in India

“What is the one common thing amongst all of us?” asks Dr. Radhika Patel to the room filled with senior adults.

Ageing.

According to the recent statistics, the world population will reach to some 9.7 billion by 2050, thereby seeing a fall in the overall growth rate. However, fertility rates worldwide are falling, and persons aged 65 years or over are outnumbering children under the age of five. By 2050, the number of persons aged 65 or over will also exceed the number of adolescents and youth aged 15-24.

The growing life expectancy, lower fertility rates and access to better medical facilities in India mean an increasing share of elderly in the population. In order to take care of this growing population of senior adults, it is important to understand the complexities of physical challenges accompanied by age. While it is easier to maintain an active lifestyle and prevent accidents at a young age, at a certain age it becomes unavoidable to prevent accidents and falls due to the following reasons:

  • Difficulty with balance
  • Weakness
  • Chronic pain, causing difficulty in getting around
  • Visual problems
  • Hearing problems
  • Medications that cause dizziness

Dr. Patel, in her discussion also talks about various factors that determine the intensity of an injury at an old age. She says “Either you are healthy for a long time and in the few years towards the end you may have a disability, or you may have a few healthy years in your life and suffer from some disability in the long term, all of which depends on how well you have taken care of your lifestyle during the early age”.

There are certain changes in the body that occur due to ageing like:

  • Weaker muscles
  • Weak heart and lungs
  • Reduced flexibility
  • Reduced motor performance
  • Reduced speed
  • Gaining more fat than muscles
  • Functional decline and disability
  • Weaker bones
  • Greater impact to an injury
  • Decline in the cognitive health

“There is no typical older person, there are different ways on how people grow old” says Dr. Patel.

It is important to maintain a healthy lifestyle at a young age as it determines the quality of life in the later years. There are certain significant factors that play an important role in determining your health as you grow old. A few of them are listed below:

  • Genes -

    Genetics and health-related behaviour affects health in old age. Certain genetic diseases can lead to a decline in overall health amongst the senior adults.
  • Personality Type –

    A person’s openness and flexibility of emotional expression, resistance to stress and healthy self-assertion can determine health in old age. A person who has more positive emotions than negative emotions is said to be healthier.
  • Environment (Urban/Rural) –

    Living in an environment that reduces stress is the key factor amongst senior citizens for improving health outcomes. Pollution, access to proper medical care, timely diagnosis, are all important factors to determine a suitable environment. A stressful and noisy environment can cause excessive stress, worrying can lead to high blood pressure, heart rate and muscle tension, supressing the overall immunity.
  • Health Behaviour –

    Daily habits such as your diet, how active you are, consumption of alcohol and smoking – strongly affect heart health. Following a healthy diet, staying active and getting sufficient sleep can help prevent chronic diseases.
  • Consumption of Alcohol and Smoking –

    Smoking and excessive consumption of alcohol can lead to some kinds of cancer, liver damage, immune system disorders, and brain damage. Leading an unhealthy lifestyle can worsen some health conditions like osteoporosis, diabetes, high blood pressure, strokes, ulcers, memory loss and mood disorders.
  • Access to Healthcare Facilities –

    It is essential to have access to comprehensive and quality health care services for promoting and maintaining health, preventing and managing diseases, reducing unnecessary disabilities and avoiding premature death.

Causes of Disabilities at Old Age

  • Depression –

    Depression, bipolar disorder and other mental health problems are one of the leading causes of disability as it makes functioning difficult or sometimes impossible for senior adults.

  • Disease Burden -

    Heart diseases, lung or respiratory problems, mental illnesses - including depression, diabetes, stroke, cancer, nervous system disorder can cause severe disabilities and mobility issues amongst senior citizens.

  • Increased and Decreased Body Mass Index –

  • A key indicator of a healthy body mass index or BMI recommends a range of 18 to 25, which is ideal for senior citizens. A BMI over 25 indicates overweight, while one over 30 indicates obesity. There are certain health risks associated with having a high BMI, such as heart disease, hypertension, diabetes, and vascular diseases.
  • Lower back pain and lower extremity functional limitation –

  • Musculoskeletal problems, lower back pain and arthritis are common long-term problems relating to disabilities. About 1 in 3 people say arthritis affects their ability to do their jobs while other muscle and joint problems, bad backs, bones that never mend, bad hips are common causes of disability too.
  • Low level of physical activity –

  • Regular exercise improves flexibility and promotes stronger bones. In senior adults, regular exercise reduces the risk of chronic diseases, lowers the chance of injury and can even improve one’s mood. Lack of proper physical activity can cause chronic pain and disabilities.
  • Poor self-perceived health –

  • Certain age-related physiological changes can increase mental problems and low self-esteem in the elderly, thereby causing physical disabilities associated with lack of self-perceived health and dependence.
  • Vision impairment –

  • Conditions such as diabetic retinopathy, age-related macular degeneration, glaucoma can cause low or cloudy vision, hampering the daily activities of senior adults and causing disabilities.
  • Falls -

  • About 30%-50% of falls in the elderly result in minor injuries, including bruises, abrasions, and lacerations, while an estimated 10% of all falls in seniors cause major injuries, including intracranial injuries (ICIs) and fractures, thereby also leading to disability.

Falls and their Causes

More than one-third of adults aged 65 and older fall at least once per year according to the Centres for Disease Control and Prevention (CDC). Falls can result in bone fractures, head traumas, hospitalization, traumatic brain injuries and the increased risk of premature death and fatalities.

Causes of Falls/Accidents at Old Age

Falls can occur due to certain physical issues such as week bones and balance problems while slippery surfaces, rickety stairs and unattended electric cords can also be a major cause of falls. Here are a few reasons why falls are common in the elderly.

  • Age
  • Gender - Falls are more common amongst females
  • History of Falls
  • Muscle Problems
  • Balance Problems
  • Vision
  • Chronic Disease
  • Depression and Chronic Pain
  • Multiple medications that cause dizziness
  • Slippery conditions and bad lighting

How to prevent falls?

Falls are the no. 1 cause of injuries in seniors, resulting in hip fractures, cuts, and even serious head and brain injuries. While falls are common in senior adults, there are measures that can be taken to prevent falls and accidents. Certain simple ways can make your homes safe for your loved ones, physical activities and proper care can also avoid the risk of accidents.

Below listed are a few ways to prevent falls:

  • Exercise -

    “There is nothing that exercise cannot prevent at any age”, says Dr. Patel. Regular exercise can improve physical as well as cognitive health in seniors. Exercising may delay or prevent diseases like diabetes, cancer, stroke, heart disease and osteoporosis. Regular and moderate exercise can alleviate symptoms of depression and anxiety while helping maintain independence in the long-term.
  • Improving balance and stability –

    Regular exercise can promote stronger bones in seniors, thereby reducing the risk of falls. Physical activities can improve balance and the overall quality of life. Calcium and vitamin supplements can also promote strong bones in seniors.

  • Regular health check-ups -

    Getting regular medical examinations and getting medication analysed can provide timely diagnosis of certain health conditions. It is important to get your medications analysed by a professional to treat chronic diseases and vison impairments.

  • Maintaining a healthy lifestyle –

    Reducing consumption of alcohol and smoking can avoid weak bones and improve balance and stability. A healthy lifestyle that includes proper diet and exercise can reduce the risks of fatal accidents.

  • Use of safety accessories at home –

    Since bathrooms can often be a risky place, especially for senior citizens who are unable to get around the bathroom without assistance. A few modifications in the bathroom can make it safer for the elderly and help them attain freedom. Accessories like grab bars, safety rails and shower chairs can reduce the risk of falls manifold and can help the elderly move around freely.

  • Products to help you prevent falls at Seniority

    Grab bars

    Stainless Steel Grab Bar - Pedder Johnson

    Pedder Johnson is a brand known for its senior care products. This grab bar from Pedder Johnson is made from high-quality stainless steel and offers a great deal of support to the user while sitting down or standing up. The dynamic product can be custom-fitted in your bathroom, toilet or any other place, depending on your specific requirements.

    Key features:

    • Made from stainless steel
    • High degree of support
    • Excellent weight-bearing capacity
    • Custom fit

    Swing-up Toilet Grab Bar – KosmoCare

    Here’s a bathroom accessory that can help avoid accidents and injuries. KosmoCare’s swing-up toilet grab bar is made from superior quality stainless steel and is a heavy-duty rail. Installing the grab bar is fairly simple and can help avert any injuries, slips and falls in the bathroom or toilet. This wall-mounted rail is strong and durable and weighs 2.25 kg.

    Key features:

    • Stainless steel fixture
    • Wall-mounted swing-up safety grab bar
    • Strong and easy to grip
    • High load bearing capacity
    • Product weight: 2.25 kg
    • Dimensions: 30 x 8 inches
    • Ideal for all kinds of toilets or bathrooms
    • Two different heights for additional support while getting up

    Anti-slip Mats & Socks

    Anti-Slip Shower Mat - Eversafe by Seniority

    Anti-slip mat made of PVC has an anti-skid texture which ensures that it does not move during use. It is of good quality which ensures a long functional life. The primary feature of this mat is to safeguard your home or pool area from the dangers of smooth floors and water spills which could lead to potentially devastating accidents. The mat is designed keeping in mind the safety and comfort of the buyer. Durable quality of the mat ensures that there is not a lot of wear and tear even after prolonged use.

    Key Features:

    • Soft and durable
    • Anti-slip surface
    • Made of good quality PVC
    • Acupressure massage points
    • Anti-skid texture

    NoFall Ladies Anti-Slip Ankle Length Socks

    Ensure safety and comfort with the Nofall Anti-Slip Socks that can be used when walking, jogging, practicing yoga, pilates or any other form of exercise. Because of the spilt toe feature, the socks can be worn with slippers or shoes, to ensure a strong grip. The socks can be washed multiple times in the machine without having to worry about losing its elasticity or grip. It features rubber dots on the sole, for an improved grip that preventing you form slipping, or accidentally falling when you are walking on any surface or mats.

    Key Features:

    • Dots at the bottom of the socks are for an enhanced grip
    • Can be used on yoga mats and wet surfaces
    • Spilt toe features
    • Anti-slip socks
    • Can carry multiple bags at one time
    • Can be used for buckets
    • Features an oversized grip design
    • Durable locking tab, that safely secures your bags

    Cognitive Psychology - Aging and Mental and Health

    According to World Health Organization mental and neurological disorders among senior adults account for 6.6% of the total disability (DALYs) for this age group. Approximately 15% of adults aged 60 and over suffer from a mental disorder.

    Cognitive psychology is the scientific study of the mind as an information processor. The study talks about processing that goes inside a person’s mind, including perception, attention, language, memory, thinking, and consciousness.

    Ms. Farzana Mulla in her discussion talks about cognitive health in senior adults and how different perspectives in senior adults can have an impact on their mental health.

    A large population of senior citizens in India face the fear of visiting the doctor. Awareness and knowledge to equip people about cognitive health can lower the problems relating to mental health like depression, anxiety and dementia.

    Dementia

    In India, more than 4 million people have some form of dementia. Worldwide, at least 44 million people are living with dementia, making the disease a global health crisis that must be addressed.

    Dementia mainly affects older people but is not a normal part of ageing. Dementia is a syndrome which is usually chronic or progressive in nature, it includes deterioration in memory, thinking, behaviour and the ability to perform everyday activities. The symptoms of dementia can be one or more including memory failure, diminished ability to remember multiple tasks in mind simultaneously and divide attention between them, problems with language comprehension or expression, trouble understanding spatial orientation etc.

    What are the causes dementia?

    • Alzheimer's disease
    • Vascular cognitive impairment
    • Dementia with Lewy bodies
    • Frontotemporal dementia
    • Parkinson’s disease
    • Huntington’s disease
    • HIV
    • Traumatic brain injury

    While a lot of people ask questions on how people suffering from dementia remember the old memories and not the recent ones. Ms. Farzana Mulla says, “Past memories are resilient in dementia, it is the recent memories that are difficult to retain.”

    What are the symptoms of Dementia?

    • Recent memory loss – Asking the same question repeatedly
    • Difficulty completing familiar tasks - Cooking a meal or making a beverage
    • Communication problem - Difficulty with language; forgetting simple words or using the wrong ones
    • Disorientation – Like getting lost on a previously familiar street
    • Problems with abstract thinking - For instance, dealing with money
    • Misplacing things - Forgetting everyday items such as keys, or wallets
    • Changes in mood - Sudden and unexplained changes in outlook or behaviour
    • Changes in personality - Becoming irritable, angry, suspicious or fearful
    • Loss of initiative - Showing less interest in starting something or going somewhere

    “Dementia cannot be diagnosed by just a medical examination; cognitive assessment is very important” says Ms. Farzana Mulla.

    Early signs of dementia may include:

    • Changes in short-term memory
    • Changes in mood
    • Problems with language
    • Apathy
    • Confusion
    • Being repetitive
    • Finding it difficult to figure out things
    • Problem accomplishing everyday tasks
    • Poor sense of direction
    • Difficulty adapting to changes

    Strokes

    The stroke incidence rate in India is much higher than in other developing countries with approximately 1.8 million Indians out of a population of 1.2 billion suffering from a stroke every year, it is the most prevalent cause of chronic adult disability. Stroke is the second most common cause of death after coronary artery diseases globally.

    Strokes occur when a blood vessel that carries oxygen and nutrients to the brain is either blocked by a clot or ruptures due to which part of the brain does not receive the blood (and oxygen) it needs, thereby causing the brain cells to die.

    How to prevent strokes?

    • Monitor your blood pressure
    • Keep your cholesterol in check
    • Stay active
    • Eat better
    • Lose weight
    • Don’t smoke
    • Get your medications analysed on a regular basis

    Mental Health – Depression

    While there are multiple risk factors of mental health problems at every age, older people are more prone to mental health issues such as depression and anxiety. Stressors such as ongoing loss in capacities and a decline in functional ability such as reduced mobility, chronic pain, frailty or other health problems, for which they require some form of long-term care can be a major cause of mental illnesses. All these stressors can result in isolation, loneliness or psychological distress in older people, for which they may require long-term care.

    Apart from significant biological changes associated with ageing, certain transitions including retirement, relocation to more appropriate housing, and the death of friends and partners can also have an impact on the mental health of senior citizens.

    Some causes of depression in senior adults are:

    • Health problems - Disabilities, chronic or severe pain, cognitive decline, damage to body image due to a surgery or sickness can all be contributors to depression.
    • Isolation - Factors such as living alone, no social circle due to deaths or relocation, decreased mobility due to illness or a loss of driving privileges can trigger depression.
    • Reduced sense of purpose - Retirement can cause lack of self-confidence and financial insecurity, thereby increasing the risk of depression. Lack of social interaction can cause a decline in the sense of purpose.
    • Fears - Fear of death or dying as well as anxiety over financial problems or health issues can also be a cause of depression.
    • Recent loss - The death of friends, family members, and pets, or the loss of a spouse or partner are common causes of depression in older adults.

    How to live an independent and active life?

    According to Ms. Farzana Mulla, “Not being active can cause as much disability as a chronic illness, sometimes even more.”

    There a few ways to live an active life at old age:

    • Plan a life after retirement
    • Treat your diseases quickly
    • Don’t be dependent for help
    • Participate in the community
    • Contribute to the society
    • Develop hobbies