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How old is old?

Edition #5: Guest post by Dr Gita Mathai and a fun video

People have varying perceptions about ageing.

Speaking to people about ageing, you realize it is very much a personal journey, and so are the views. Some prepare ahead in time and others wait till they feel the first symptoms of feeling old. This 1-minute video by the Center for Ageing Better in the UK does a great job of capturing responses to this simple question among people of different ages.

Over 92% of respondents in the Silver Angels Ageing Survey mentioned they had limited or inadequate information about ageing and response systems for care.

Dr Gita Mathai has been running a family care centre in Vellore for over three decades, is author of the book “Staying Healthy in Modern India” and contributing health columnist in The Telegraph. Outside her professional achievements, she is also a black belt 3rd dan in Karate, a national level swimmer, hammer throw athlete and a regular on the half marathon circuit.

In this guest post, she writes about basic at-home signals you can incorporate in caring for seniors at home.

The Indian population has crossed the 1.1 billion mark and 8% of the population is over the age of 60. People now live longer as they have access to health care, enjoy better nutrition and education. Our average life expectancy is expected to increase from 67.5 years in 2015 to 75.9 years in 2050. To look at this differently, between now and 2050, the 60-plus population will increase by over 300% and by 700% for the 80-plus age group.

The retirement age has remained unchanged and people stop working even though they have healthy and productive years left.

They are ‘active’ yet ’retired’

On the contrary, being a young country, 30% of our population is below the age of 30 years. In this scenario, writing about old age may seem inappropriate as it apparently affects only a minority!

Family and society have a role in caring for the 8% of the population financially, physically and emotionally although

the care economy in India is largely defined by parental care

i.e., time and resources spent towards children. It excludes the time spent by family members in providing care for their ageing dependents. Given that women are looked at as ‘primary caregivers’ in Indian families, it impacts them adversely and, in many cases, limits their continuing pursuit of economic opportunities. Corporate policies towards well-being largely exclude care for parents and other older dependents.

How do I know somebody in my family is ‘getting old’?

Simple cues of everyday activities can be early signals in detecting how the body and mind age over time. Here is a basic checklist to refer at home.

Physical appearance

provides invaluable cues. Older adults should appear clean and well groomed. Failure to bathe, brush teeth or wear clean clothes indicates an inability to keep up with daily routine. This may be due to physical weakness, dementia or just depression.

Fixed routine

If you carefully watch the way they do things around the house, you might find inexplicable illogical changes in the routine. The house may be dirty and housework neglected. Also, they may be absent minded, like leaving things on the stove and forgetting about it. These are danger signals indicating that care is required.

Lighting in the house

It should be bright especially in hallways and bathrooms. Narrow staircases and slippery front steps are also difficult to navigate. Bannisters are essential. Indian style toilets are difficult to use if there is arthritis. Supporting bars need to be embedded near the toilet and bathing areas. Otherwise the chances of accidental falls and fractures are greater.

Good nutrition

It is essential for immunity (to prevent diseases), muscle mass (for strength to prevent falls). A balanced diet boosts immunity and helps withstand disease and recover rapidly if illness strikes. Older adults often suffer from malnutrition even when they can financially afford an adequate diet. They may be unable to go to the market and purchase the materials required. Fresh fruits and vegetables may be difficult to obtain regularly. Cooking may be troublesome, time consuming or they may be physically unable to do it. Medications, illness or a recent hospitalization may dull taste and reduce the appetite. Diet restrictions due to diseases (salt, sugar, oil, fluid and spice) may make the food unpalatable, unappetizing and inadvertently limit intake. Social isolation and depression can also make people eat less. Nutrition can be monitored by keeping an eye an eye on the weight, the turgor and quality of the skin, hair and nails. Meals (at least once a day), if necessary, now can be arranged from outside.

Memory lapses

We all have memory lapses and with age these are greater and more frequent. Glasses and keys may be constantly misplaced. Memory loss is abnormal if it extends to names of close relatives (children, grandchildren, nieces and nephews), the route to the neighbourhood shop or involves dosages of regular medications. At that point medical evaluation is required.

Lifestyle, chronic diseases occur with aging. It is important that all medical details and prescriptions be neatly filed chronologically. This should then be placed in an accessible place. Medical check-ups and doctor visits should be regular and scheduled. Medical containers should be neatly labelled. If tablets are in strips, the person should be able to distinguish one medicine from another. Some look very alike (calcium tablets and metformin) and it is possible to make disastrous life-threatening mistakes.

Hearing and eyesight

should be checked regularly and timely corrective measures taken. Hearing loss and partial loss of eyesight leads to dependency, feelings of social isolation accidents and falls. Cataract surgery and hearing aids (if required) often are lifesavers.

Sleep disturbances

are common in older adults. In some it may be because of Alzheimer’s, or dementia when the sleep-wake cycle is disturbed leading to daytime drowsiness and night-time restlessness. In many it may be a side effect of medications, snoring (obstructive sleep apnea), restless legs or just depression.

Good sleep can be promoted with

  • Exposure to a few hours of bright sunlight in the morning
  • Not taking caffeine (tea coffee) after 1 pm.
  • Adjusting medication with the help of the doctor so that any tablets with a stimulatory effect are taken in the morning.
  • Avoid sleeping tablets as they are habit forming and cause confusion.
  • Daytime sleep should be avoided at all costs. No one can sleep for more than 6-7 hours a day. If this quota is used up during the day, night sleep will be affected.
  • Medically treat any diseases that might interfere with good restful sleep.
  • Immunizations should be up-to-date. At the age of 60 years, people need a dose of pneumococcal vaccine to prevent development of silent and often fatal pneumococcal pneumonia. Flu vaccine should be given every year.
  • Physical activity for at least an hour a day should be encouraged. Walking will help with appetite, lifestyle diseases, balance coordination, depression, dementia and sleep disturbances. It will also entail some social interaction as they will meet other walkers.
little extra effort on the part of children and caretakers will pay off in the long run to make old age hassle free for everyone, both the elderly person and the younger adult.

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