INJURIES IN ELDERLY PEOPLE

Many of us have experienced the anxiety of having to deal with an older member of the family or a friend who incurred an injury as a result of a fall.

Falls among older individuals have been accepted and viewed as unavoidable accidents. But this is not necessarily so. The physical and psychological damage done as a result of the fall can be averted if proper precautions are taken.

Hip, and fracture neck of femur are the most devastating, especially in older women with osteoporosis. Even if the physical injury is not debilitating, the damage to the psyche is tremendous, leading to fear and self imposed exile from any kind of activity which in itself leads to a decrease in health and fitness. It is like a self-fulfilling prophecy — they are afraid they will fall, restrict activity, incur muscle atrophy, loss of strength and balance and therefore fall once again when they try to get around even to navigate the most minor tasks.

Some of the most common causes for falls are: the immediate physical environment; poor fitness levels in terms of strength, balance, gait, agility and speed and reaction time; intake of sedating medication or anything that alters cognition; middle ear imbalance leading to vertigo and dizziness; vision problems; other medical problems like Parkinson’s, Diabetes, Multiple Sclerosis; and improper footwear
Simple modifications

Many of the above factors can be addressed by making simple modifications to the immediate environment and intervention to improve fitness levels, strength and balance

Use antiskid tiles wherever possible. Fix railings in the bathrooms for support. Steer clear of carpets that may be tripped on, sharp edges and corners, flimsy stools and chairs, wet areas, stairs without railings and poorly designed or ill fitting footwear.

Some forms of medication, like sedatives, antihistamines, some antihypertensives can lead to dizziness, postural hypotension and hence a tendency to lose balance.

Older individuals who have been active all their lives, participated regularly in fitness programmes and maintained their weight within the optimum range while also maintaining optimum muscle mass have a lower incidence of falls and injury when compared to the unfit, overweight, person.

This may be one reason to encourage people to keep exercising throughout their lives with alterations in routine depending on the age and their state of health.

An exercise programme for the elderly should include balance and strength besides a basic cardio routine. The "principle of specificity" of exercise indicates that in order to improve the condition of a particular system; the exercise should target that system.

"Use it or lose it". This is the dictum for any aspect of fitness including muscle mass/strength. Deterioration is evident with disuse and sedentary living. A strength training programme that targets the major muscle groups can improve leg and hip extensor strength. This improves ability to walk easier, climb stairs, arise from a seated position in a chair or on the floor or bend to pick up something from the floor.
Strength training

Upper body strength (which tends to diminish rapidly due to neglect) is required to perform simple tasks like lifting, reaching and carrying.

Strength training can be performed using resistance bands that are colour coded to differentiate levels of strength, or with other forms of external weights like ankle weights, wrist bands or even dumbbells under guidance.

Is muscle strength related directly to balance? Not necessarily so, according to some studies. Large bulky muscles and enormous strength do not directly translate to great physical balance.

However, weak muscles definitely render an individual more prone to falling down as a result of poor balance and the inability to support ones own body weight properly. Movements of the body mandate a certain level of equilibrium and the ability to accommodate this shift in centre of gravity.

For instance, getting up from a seated position changes the centre of gravity from a lower to a higher level from the floor, thereby decreasing stability. Adequate balance and strength of leg muscles will ensure that one doesn’t tip over during the process.

In order to improve balance, ensure good vision, absence of a vestibular problems and an optimum somatosensory system. This system enables the body to understand its position in relation to its environment through a sophisticated neuromuscular network. The body is constantly kept informed of its position and contact with other objects like the floor or a chair. If there is any compromise in this mechanism (and it has been found that the sensory system diminishes with age), balance may be affected.
Simple moves

Simple tasks like standing on one foot for as long as possible, standing with feet as close together as possible, with heel to toe, putting on pants while standing up, walking on a straight line, getting up from a chair and walking forward, turning and coming back to sit in the chair as fast as possible can be practiced to improve balance.

Specific tests are available to assess balance, strength and proprioception. Some examples of the tests include one leg balance test, "get up and go" test. These act as guidelines to structure the routine for the individual client.

Please note that older adults with poor balance should never be allowed to exercise or perform any of these moves unsupervised.


Some common causes

The immediate physical environment

Poor fitness levels in terms of strength, balance, gait, agility and speed and reaction time

Intake of sedatives, medication or anything that alters cognition.

Middle ear imbalance leading to vertigo and dizziness

Vision problems

Other medical problems like Parkinson’s, Diabetes, Multiple Sclerosis

Improper footwear

To improve balancce

Stand on one foot for as long as possible

Stand with feet as close together as possible, with heel to toe

Put on pants while standing

Walk on a straight line

Get up from a chair and walk forward

Turn and come back to sit in the chair as fast as possible

TIPS TO COPE ALZHEIMER’S

It was in 1907 that Alois Alzheimer described a devastating progressive disease presenting with memory loss and accelerated ageing; but even 100 years later, we have no real remedy for Alzheimer’s disease which is becoming increasingly common i n India too. Earlier it was thought that Alzheimer’s was "rare" in India; studies reported that multi-infarct dementia caused by reduced blood flow to the brain (very common in diabetics and hypertensives), infections of the brain like TB and cysticercosis, alcoholism and simple malnutrition were responsible for dementia in the elderly Indian rather than Alzheimer’s.

But recent studies, particularly from Kerala, have shown that about three per cent of the elderly over 65 years of age have dementia; and what is more, the majority of them qualify by a process of exclusion, to be stricken with Alzheimer’s disease. Unfortunately, there is no simple test to diagnose Alzheimer’s disease. A PET scan can detect the illness but extremely high cost and non-availability make it a non.-option.

Detection by exclusion

However, a good rule of thumb would be to subject the elderly who present with memory problems to other tests that could detect a treatable problem. A simple vitamin B12 assessment could pick up many treatable, reversible cases; a high BP or elevated blood sugar could point to other treatable causes and so on. By a process of exclusion one zeros in on Alzheimer’s disease. What next?

Pharmacotherpy for the associated behaviour problems such as delirium, anxiety, depression etc helps manage the patient better; but none of the drugs, including Donepezil, which is the one most widely used, are able to reverse the process.

However, there is a lot of evidence building up that nutritional supplementation helps in slowing the progression of Alzheimer’s disease. Though purists who practise only evidence-based medicine may not agree, commonsense dictates that one try out nutritional supplementation when one’s near and dear ones are stricken with the disease. The Net is replete with reports from highly reputed medical journals about the benefits of nutritional supplements. From the food and beverage angle, it seems wise to give these patients green tea and fresh apple juice. These contain anti-oxidants and flavonoids which help stem the progression of Alzheimer’s. Adding a lot of turmeric into curries cooked can help as curcumin present in turmeric has shown benefit in some studies. Supplementing B6, B12 and folic acid is a good idea as these help reduce harmful homocysteine levels; high homocysteine levels have been implicated as one of the causes of Alzheimer’s disease. In many studies, improvement has occurred with omega3 fatty acids. Ginkgo tea or proprietary ginkgo biloba preparations have been found to be useful. Lipoic acid and co-enzymeQ are two dietary supplements which have also shown benefit. Reducing calorie intake has also been found to help.
No side-effects

The plus point is that these simple dietary changes and supplementation are safe; they do not have the side-effects of Schedule-H drugs. In private practice one does not have the where-with-all for pukka scientific studies. But the elders I have seen in my practice have done well with addition of these simple measures. The ones who have benefited most are those with Mild Cognitive Impairment (MCI) rather than advanced dementia. .

Keeping the patient mentally active is crucial. Encourage reading, doing crossword puzzles, reciting slokas, singing... Listening to music that they used to listen to in their youth and middle age can help too, as musical memories are among the strongest.

IS SECOND-HAND SMOKE DANGEROUS ?

"Dad, please do not fill the room with dirty air. Please, give me a room to breathe."

Have you ever felt your child’s agony when you light up?

"I smoke in the balcony when my child is in the bedroom. I avoid smoking in front of my kids." This is the explanation I get from my educated patients.

But while they may smoke outside; how many wash their hands and clean their teeth before they hold their children.

"Okay I should not smoke at home. But tell me, is it possible to go out 20 times a day, especially in this cold?" argues a heavy smoker.

Yes, it is difficult to go out for a smoke every time. But are people justified in smoking inside homes, and exposing innocent people to thousands of poisons with every puff.

Many now work in "smoke-free offices" and since the government has also taken disciplinary action for "smoking in public places", smokers are cautious while lighting up in public places. But unfortunately, the situation at home needs to be addressed.

What is passive smoking?

First of all, we need to understand what passive smoking is. Passive smoke or environmental tobacco smoke (ETS) is a mixture of mainstream smoke (exhaled by smokers); and side stream smoke (freshly generated from a passively lit cigarette); as well as contaminants that diffuse through the cigarette paper and mouth end between puffs.

ETS contains more than 4,000 chemical compounds and is even more carcinogenic than active smoking. Second hand smoke is a major source of indoor air pollution.

Tobacco smoke is an irritant. Some of the immediate effects include eye irritation, headache, cough, sore throat, dizziness and nausea. Short-term exposure to tobacco smoke also has a measurable effect on the heart. Just 30 minutes is enough to reduce coronary blood flow.

Alarmingly, nearly 700 million children, almost half of all children worldwide, live in the home of a smoker. Infants of mothers who smoke have five times the risk of sudden infant death syndrome (SIDS). They also suffer from reduced birth weight and reduced lung functioning.

Effects on health

Passive smoking increases the risk of lower respiratory tract infections such as bronchitis, pneumonia and bronchiolitis in children; and is a risk factor for new cases of asthma.

Passive smoking is also associated with middle ear infection in children as well as possible cardiovascular impairment and behavioural problems. Passive smoking may also affect children’s mental development. A U.S. study found deficits in reading and reasoning skills among children even at low levels of smoke exposure

In the longer term, passive smokers suffer an increased risk of a range of smoking-related diseases. Even a short period can have immediate adverse effects on the cardiovascular system and interferes with the normal functioning of the heart, blood, and vascular systems in ways that increase the risk of a heart attack.

Non-smokers, who are exposed to passive smoking in the home, have a 25 per cent increased risk of heart disease and lung cancer. A major review by the Government-appointed Scientific Committee on Tobacco and Health (SCOTH) concluded that passive smoking is a cause of lung cancer and ischemic heart disease in adult non-smokers
Protect yourself

The UN Surgeon General says that the only way to fully protect yourself and your loved ones from the dangers of second hand smoke is through 100 per cent smoke-free environments. The single best way to create a smoke free environment is to Quit Smoking.

Quitting requires planning, and a strong will. Also, there are effective support systems to help in the process.

A Structured Tobacco Cessation Clinic will definitely help you as it combines intensive psychotherapeutic interventions, along with pharmacotherapy to reduce the withdrawal symptoms.

Nicotine Replacement therapy and pharmacotherapy are also available to make the process easier. New drugs promise greater success in managing the cravings effectively.

Everyone knows smoking is bad for smokers and their families. Everyone understands that cigarettes are smoking people to disease and death very fast. Still they continue to abuse their bodies.

Protect yourself and your family

Make your home and car smoke-free.

Ask people not to smoke around you and your children.

Make sure that your children’s day care center or school is smoke-free.

Choose restaurants and other businesses that are smoke-free.

Thank businesses for being smoke-free. Let owners of businesses that are not smoke-free know that second hand smoke is harmful to your family’s health.

Teach children to stay away from second hand smoke.

Avoid second hand smoke exposure especially if you or your children have respiratory conditions, heart disease, or if you are pregnant.

Talk to your healthcare provider about the dangers of second hand smoke.

Quit smoking.