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         Compiled by Carol Aloysius

Diseases of old age

Old people suffer more than all age groups, of health problems due to a general lack of awareness. The following article by Dr. Ajih S. Puri is dedicated to Sri Lanka's growing grey population in order to create public awareness about some common...

Elevated blood pressure usually occurs in old persons, and in some only the upper level of blood pressure (systolic) may be raised.

Care should be taken while administering antihypertensive drugs. An elevated blood pressure should not be lowered suddenly, as chances of thrombosis in a vessel increase, and the patient may suffer from heart attack or stroke.

Further, in many old persons, blood pressure is highly labile, i.e. there is a marked fluctuation from a very high level to an equally low level, when the person is taking no drugs.

Hence, if drugs are administered for a high level of blood pressure, periodic monitoring is required for adjusting the dosages or stopping the treatment, well in time.

Osteoarthritis

It is a common disease in old people. The knee joints may be particularly involved, and the patient may have difficulty in walking or climbing stairs.

Both the knee joints may be involved at the same time.

As a preventive measure, exercise is required at an early age. The spine, especially the neck (where cervical spondylosis usually occurs), and the back may also be involved.

In both these cases, suitable treatment/prevention is required at a very early stage, before the disease reaches an advanced stage, causing considerable damage Osteoporosis

Weakness of bones occurs in old age due to depletion of calcium, more precisely bone tissue/mass. Normally bone mass decreases with age. It may occur in a woman following menopause called 'postmenopausal osteoporosis.' However, osteoporosis occurs with age, later in life, in both the sexes, called 'senile osteoporosis'. Since the bones are weak, they become more liable to fracture. Even a little fall may cause fracture of the bones, making the life of the old person miserable, as he/she may be permanently disabled. Falls in the elderly and causes This aspect needs special attention. Due to the limitation in the treatment of osteoporosis, great care is required in this regard. The old person may fall due to various reasons, like muscular weakness, especially in the lower limbs, syncope i.e. when there is a transitory unconsciousness due to several causes, giddiness, etc.

Sudden fall of blood pressure, especially postural hypotension, i.e. when the blood pressure falls almost suddenly when the patient stands after lying down for a long time, say, at midnight or in the early morning, must be kept in mind. Those elderly persons whose systolic blood pressure falls 20 mm Hg or more, and the diastolic to 10 mm Hg or more, within three minutes of standing up from the lying/sitting posture, are suffering from postual/orthostatic hypotension, and should take care that they do not fall when they stand up from a sitting/lying posture.

It would be appropriate to mention here that during the treatment of fracture as a result of a fall (or during any other illness), an old person should not be put on unnecessary rest. Even if the patient cannot walk, all the joints (except the ones in plaster, or as directed by the physician/surgeon) must be moved by the patient, or by some attendant/physiotherapist, so that contractures do not develop.

Once contractures appear, the treatment is difficult and a prolonged one. Even a few days of immobilization of the joints may cause contractures. Early physiotherapy is the rule in such cases.

incontinence

Besides, an old person may suffer from urinary incontinence due to some urinary tract infection (UTI), or when there is diminished nervous control on the muscular tone of the urinary bladder.

Urinary incontinence should be investigated and treated.

Functional problems

An old person may suffer from various functional problems like difficulty in vision, hearing, sleep, etc. There may be loss of vigour/sexual function, muscular strength, or there may occur a generalized weakness. Menopause may created problems in an old female, and urgent medical advice may have to be sought.

Besides, there may be various psychological problems in an elderly person as a result of loneliness, loss of work, identity, etc. and a psychiatrist may have to be consulted. Depression is also seen in some elderly persons, which may need specific/specialist treatment.

Body temperature

In ageing people, the normal body temperature may become low due to the impaired temperature regulatory mechanism of the body. Hence, the elderly may not be able to cope with adverse weather, heat or cold.

If proper care is not taken, an old person may even die as a result of a heat stroke, or hypothermia, i.e. due to excessive cold.

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The autistic child

The following article focuses on a problem that affects an increasing number of children today.

by Dr. R. A. R.Perera

The term 'learning disability' is now commonly used to describe someone who by reason of developmental intellectual impairment needs additional support to lead a normal life. Mild learning disability occurs in about 3/100 population in Sri Lanka. Moderate to

severe learning disability occurs in 3-4/1000 population. Worldwide, about 120 million people are affected

People with learning disability show to main characteristics during the developmental period. They can be categorized as impaired adaptive behaviour and intellectual disability. People with learning disability have an increased prevalence of epilepsy, psychiatric disorder, hearing and visual impairments and autism.

Individuals have difficulty coping with various aspects of self-care, communication and the ability to use community facilities.

Autism

Autism is commonly associated with general learning disabilities. About 75% of those affected have a non-verbal IQ of less than 70. However, autism can occur in people with normal or high intelligence. Asperger's syndrome is a term that is often used to describe this more able subgroup. The overall prevalence is estimated to be 20/10,000 population More males are affected than females (4:1).

About 30% of children with autism develop epilepsy, usually in their teens. There are abnormalities in the brain function in some children with autism. The most common cause of autism is genetic. Families with one autistic child have a 2-3% risk of having another child with autism. About 20% of other family members have milder, but related difficulties like communication and social problems.

Diagnosis

Diagnosis is based on three main criteria. Social and communication difficulties are evident within the first three years of life. It is also important to obtain accurate assessment of intellectual and linguistic functioning.

Patients with Asperger's syndrome have a normal IQ and do not show early language delays, but they have impaired social and communication skills and obsessional interests. Patients with higher IQ levels are more likely to develop speech problems, show greater interest in social interactions, and tend to be preoccupied with special interests or collecting 'facts' rather than objects.

Autism can sometimes be confused with other conditions associated with language or cognitive impairments. Children with severe learning disabilities may show similar patterns of social, communication and behavioural deficits. Children with severe language disorders may show some features characteristic of autism. In these children, however, behaviour generally improves as language develops.

In autism, social and communication deficits tend to be out of keeping with general cognitive development. Many adults with autism remain dependent on their families or require specialist residential provisions. There is no cure for autism with medication. Behavioural difficulties are due to:

. The child's inability to use or understand language effectively.

. Their resistance to changes in routine.

. Their ritualistic and obsessional behaviour.

Early intervention and appropriate educational placement can modify the impact of these problems, which, if not dealt with effectively, may become persistent and disrupt family life.

Intellectual ability can be measured by the IQ test. Scores on test can be linked to degrees of learning disability.

. 50-69, mild learning disability

. 35-49, moderate learning disability

. 20-34, severe learning disability

. below 20, profound learning disability

Life expectancy for people with learning disability has increased and is approaching the level for the general population. Many of these people are able to consent to medical procedures if the information is presented carefully. Parents should be involved in management, even in adulthood, unless this breaches confidentiality.

Social, psychological and physical interventions are used to encourage their development and to treat secondary handicaps.

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An important risk factor for cancer - obesity

Beginning this week till end October is Cancer Month

It is common knowledge that obesity (overweight) predisposes one to a number of diseases such as heart attacks, diabetes mellitus, hypertension, gout, gall stones, kidney stones and hyperlipidaemia (elevation of serum cholesterol and serum triglycerides). It is also a risk factor for cancer

by DR. D. P. ATUKORALE

By obesity we mean those with high body mass index (BMI). Body mass index is weight in kilograms divided by the square of the height in metres. Normal BMI is between 20-24 and those people with BMI between 25 to 30 are said to be mildly obese.

Those with BMI between 31 and 40 are severely obese and those with BMI over 40 are said to be very severely obese.

It has been recently found that obese people are more prone to various cancers compared to those with normal BMI. Dr. Eugene E. Calle et al prospectively studied a population of more than 900,000 U.S. adults (404576 men and 495477 women) who were free of cancer at the time of enrolment in 1982 and there had been 57145 deaths from cancer during their 16 years of follow-up.

The above researchers found that the heaviest members of the above group i.e. those with BMI of 40 and over, had 52 percent higher cancer death rates for men; cancer death rate for women was 62 percent higher than cancer death rate in men and women with normal weight.

In both men and women, the very obese people (i.e. those with body mass index higher than 40), the BMI was significantly associated with higher death rates due to cancer of oesophagus, colon, rectum, liver, gallbladder, pancreas and kidney, non-Hodgkins lymphoma and multiple myeloma when compared to people with normal body-weight. (i.e. normal BMI).

Cancer of stomach and prostrate was quite common in very obese men and cancer of breast, uterus (womb) and ovary were more common in severely obese women. The researchers concluded that 14 per cent of all deaths from cancer in men and 20 per cent of those in women were associated with over-weight and obesity.

The relationship between adiposity and increased risk of cancer of endometrium, kidney, gallbladder in women, breast cancer in post-menopausal women, and colon cancer particularly in obese men have been reported by various authors. Adeno-carcinoma of the oesophagus has been linked to obesity.

The proportion of all deaths from cancer that is attributed to overweight and obesity in U.S. adults, 50 years of age or older may be as high as 14 per cent in men and 20 per cent in women.

According to E.E. Calle et al, more than 90000 deaths per year from cancer might be avoided if everyone in the adult population could maintain a BMI under 25 throughout life. Potential biologic mechanisms include increased levels of endogenous hormones (sex, steroids, insulin and hormones like growth hormones) associated with obesity.

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Heart disease - women most at risk

by Dr. Mohan Jayathilake, Consultant Cardiologist

Each year over eight million women worldwide die from heart disease or stroke, the highest cause of death amongst women. This is almost 18 times higher than from breast cancer and six times more than HIV/Aids related deaths. In developing countries, half of all deaths of women over 50 are due to heart disease and stroke. That is why World Heart Day this year focused on the theme 'Women Heart Disease and Stroke' states the world Heart Federation an NGO dedicated to control heart disease in middle/low income countries.

Stroke accounts for a higher proportion of deaths among women than men (11% vs 8.4%). Among women nearly 3 million of deaths by stroke occur every year.Coronary artery disease affects women 10 years later than men possibly because of protective effect of oestrogen prior to the onset of menopause.

The World Heart Federation gives the following guidelines to help women to keep their hearts healthy.

* Give up smoking. Smoking more than doubles your risk of a heart attack. Among women stroke is more likely to occur in smokers than non smokers.

Passive smoking is also a coronary risk factor for women. It is associated with a 30% excess risk

* Avoid combination of smoking and the oral contraceptive pill. If you take an oral contraceptive and smoke 15 cigarettes per day, you are five times more likely to develop heart disease and stroke.

* Make exercise a part of your lifestyle. 30 mts. of physical activity each day is ideal such as walking, gardening and cycling. Physical inactivity doubles the risk of heart disease, stroke and increases risk of Hypertension by 30%

* Maintain a healthy weight through a balanced diet that includes plenty of fruits, vegetables and variety of whole grain products.

Overweight and obesity lead to an increased risk of premature death due to High Blood Pressure, coronary heart disease and stroke. Hypertension, diabetes and raised serum cholesterol are between 2-6 times more prevalent among very obese women.

Therefore, women need to be extra careful of their weight.

* Avoid frying, foods high in animal fats and cholesterol, too much alcohol (not more than one drink a day for women) and reduce salt intake to 4-6 g/day (1 tablespoon) or sodium intake to 1600-2400 mg/day.

* Diabetes (Type II) is a first degree cardiovascular risk factor and it is a more serious risk factor among women. Diabetic women suffer from Heart Disease risk 8 fold more than non diabetic (just 3 fold in diabetic men). Preventive measurers therefore need to be emphasized even more in the case of diabetic women.

* Women with Hypertension experience a risk of developing Heart Disease that is 3.5 times that of female with normal blood pressure.

* Marital stress worsens prognosis in women with coronary heart disease. You can reduce stress by taking time for yourself, being physically active and by building up your social support network.

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