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| Sunday, 15 December 2002 |
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Features |  |
| News Business Features Editorial
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Compiled by Carol aloysius When you are old and grey... Active ageing: key to healthy longevity Sri Lanka's grey population is on the increase. By 2020 the elderly will comprise 20 per cent of the total population. This means that the number of age related diseases and illnesses will also increase in the future. Old people suffer more than all other age groups, from various illnesses mostly due to lack of health awareness. So, several of the articles we publish today on this page, are dedicated to the elderly population in this country who need to know that, 'Active ageing can make a difference.' by Dr. Ajit S. Puri (From his book "How to prevent common serious diseases")
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. Diabetes: Due to the lack of secretion of insulin, diabetes may be precipitated in old age. It should be investigated and treated. 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, and those who are prone to suffer from it, must consult their physicians, well in time. 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. Anaemia/lack of nutrition: It may occur, especially in old persons who are living alone as they may not be taking a proper nutritious diet, which is required in old age. Besides a balanced diet, a small quantity of vitamins supplements, may also be required in the daily routine of elderly persons. Osteoporosis: weakness of bones occurs in old age due to depletion calcium, more precisely bone tissue/mass. Normally bone may decreases with age. It may occur in a woman following menopause called postmenopausal 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 bones, making the life of the old person miserable, as he/she may be permanently disabled. Once osteoporosis occurs in certain bones, it is difficult to treat. However, further osteoporosis, i.e., osteoporosis in bones can be prevented. Old people should remain active as far as possible, as it helps in preventing osteoporosis. Causes of falls in the elderly: It would be worthwhile to discuss here the various causes of falls in the elderly. 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 postural/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. Diseases of the heart: (i) The rhythm of the heart may get markedly disturbed (arrhythmias). The heart beat may become irregular, or the heart rate may become very slow or even fast. The patient complains of varied symptoms, especially vertigo/ dizziness and in advanced cases, even syncope i.e. transitory unconsciousness/fainting may occur. (ii) The hardening of coronary arteries may lead to angina or heart attack. (iii) There may be thickening/hardening or even calcification of the various valves of the heart, like the aortic or mitral valve leading to the aortic or mitral stenosis/regurgitation respectively. Auscultation of the heart will show various murmurs, and the lesion can be confirmed by echocardiography. Diseases of the brain: (i) Due to atherosclerosis/hardening of the blood vessels of the brain, there may be deterioration of mental functions, like disturbance in memory. The memory of recent events is usually impaired, while past events may be remembered well (ii) Similarly, there may occur emotional instability, irritability, rigidity, etc. (iii) Likewise, the power of judgement/ reasoning may suffer. (iv) Due to the same pathology, i.e. atherosclerosis, the blood supply of a part of brain may be affected a leading to stroke or paralysis.
Psychological disorders of the elderly by Dr. R.A.R. Perera, Consultant Psychologist Psychological disorders in old age may either be organic or functional. Organic disorders consist of the acute confusional states and the dementias. The most important functional disorders are depression, anxiety and manias. Older people are also vulnerable to adjustment reactions, particularly bereavement. Depression
Research suggests that at least 80 per cent of elderly individuals who were identified as depressed had not received any treatment for depression in Sri Lanka and other eastern, countries, the main reasons for this is that patients and their relations may be unaware that depression is treatable. Doctors are often reluctant to recommend physical treatments, which carry slightly greater risks in the frail elderly, and similarly avoid psychological treatments on the false premise that old people are too rigid to change their patterns of thought or behaviour. Physical and psychological treatment is effective in older patients and it reduces social isolation. Medication should be given cautiously, as there are side effects, which may be serious in old people. Most of these drugs take 6-8 weeks to work in older subjects, making compliance a particular challenge. Electro-Convulvie-Therapy or ECT is useful for severe depression, especially delusion and or retardation are present and in-patients at high risk of suicide or those who refuse fluids. Depression doubles mortality in later life. Risk of relapse is also high (about 50 per cent) and up to 25 per cent of patients develop chronic depression. This may be reduced substantially by early detection and appropriate acute treatment. Anxiety Anxiety has a similar prevalence to depression in older age. Generalised anxiety usually coexists with depression and responds to medications. Phobic disorders especially agoraphobia is common, often occurring without evidence of other psychiatric illness, and is important cause of elderly people becoming housebound. Bereavement Bereavement in old age, or at any time of life is followed by stages of shock and bewilderment, denial, anger, depression and guilt, and acceptance, these may overlap and are variable induration. Hallucinations, such as feeling the loved one's presence or hearing their voice at night, are common. Prolonged social isolation, prominent weight loss, delusions of guilt and suicidal thoughts (e.g. longing to join the loved one) suggest that the bereavement has triggered a depressive illness requiring treatment. Supportive psychotherapy and cognitive therapy may be beneficial in this condition. In Sri Lanka these facilities should be improved and social service
workers should be given a training to handle these situations. Lipid lowering drugs in the elderly The treatment of hypercholesterolaemia (High level of blood cholesterol) with drugs in the elderly is a controversial topic. There is no controversy regarding the dietary management of hypercholesterolaemia in the elderly. Majority of physicians do not treat hypercholesterolaemia in the elderly (those over 70 years) with drugs such as statins which have a large number of side effects. There is scientific evidence to show that treatment of hypercholesterolaemia in the elderly patients with drugs is associated with high morality. According to Dr. Guy Cohen M.D. Associate Professor of Family and Health Medicine and Psychiatry at the University of California, elderly patients without heart disease suffering from hypercholesterolaemia should be tried on low cholesterol low fat diet, exercise and lifestyle changes first. Elderly heart patients should be treated on an individual basis to prevent mortality due to cholesterol lowering drugs. "Elderly patients are more sensitive to medications than young and the middle aged patients and accumulate greater quantities of medication in the blood", he says. In a study in Honolulu it was found that persistence of low cholesterol concentrations in the elderly actually increases the risk of death, and the earlier the cholesterol concentrations are brought down to normal concentrations, the greater the risk of death. Those individuals with low cholesterol maintained over 20 year period had the highest mortality. So physicians have to be very careful when they treat the elderly with high cholesterol as cholesterol metabolism and homostatic mechanisms differ in the elderly. Sent by Dr. D.P. Atukorale Nelli: the fruit that heals... Composition- Tanin, Garlic Acid, Sugar, Gum, Albeumin, Sellulose, Amenioacid, Salts, Minerals. Ayurvedic Properties/uses The nelli fruit has been considered as a very important constituent in Ayurveda, as it has acrid, cooling, diuretic, laxative, rasayana, aperient properties. It has six (6) rasas (taste) 1. Madura, 2. Amla, 3. Lavana, 4. Katu, 5. Thikta, 6. Kasaya. This is used in the treatment of cough, cold, sore throat, respiratory tract infection and hyperlipidaemia. The fruit is well-known as an important adoptogenic drug. It contains the antioxidant, Tannoid, active principles such as: Emblieanin A 37 per cent, Emblicanin B 33 per cent, Punigluconin 12 per cent, Pednculagin 14 per cent, Besides Vitamin C. A study indicates that the tennoids of the fruits, which have Vitamin C like properties are more important than Vitamin C itself. This is the most important drug that is effective in enhancing the antioxidant defence system. The aqueous extract of Nelli fruit has been found to be cytotoxic. It has antitumour activity, due to its interaction with cell cycle regulation. It protects cells from free radical damage, and increases primary cells development and regeneration of human body cells. The Liver is the principal organ responsible for metabolism. Nelli works with extra hepatic tissue and cells and maintaining the integrity of the gastrointestinal track, also play an important part in the metabolism. This herb increases the liver function of detoxification. It possesses antipyretic, antiviral properties, and preparing the connective tissue, therefore this is important for wound healing. The role of free radicals has been emphasised in various diseases and also in causing ageing. Nelli works protect cells, tissues and every other organ and increases life span. Nelli is thus a very important drug in improving Bio-energy Dimension of the body, developing primary cells of the body and enhancing the immunity of the body. - Dr. B.A. Rathnapala, (Ayurvedic Physician)
Dysarthria Following last week's article on strokes we publish today, a very common side effect of a stroke resulting in speech disorders by Savithri Panagoda a speech pathologist and audiologist. What if you wake up on one fine morning, realising that your speech is slurring and the words don't come out the way you want them to? This is a quite common condition seen today, especially following a cerebro-vascular accident or a stroke and this is what we call 'dysarthria' in medical terms. Dysarthria is a group of motor speech disorders, resulting from disturbed muscular control of the speech mechanism due to damage to the peripheral or central nervous system, such as in cases like CVAs cerebral palsy meningitis, encephalitis and severe brain trauma etc....In simple words, it is an oral paralysis of speech musculature. Dysarthria could be classified into different types, based upon the location of the lesion, namely...flaccid dysarthria, spastic dysarthria, hyperkinetic dysarthria, hypokinetic dysarthria, ataxic dysarthria and mixed dysarthria etc., and the locations consist of upper motor neurons, lower motor neurons, cerebellum, basal ganglia and brainstem. However, as mentioned earlier, the most outstanding symptom of dysarthria is slurring of speech. But there are many other important factors as well, which account for this outcome. They included the following. Breathing abnormalities, Mis-articulations, Inappropriate stress, Altered speech rate, Impaired tongue movements, Poor lip seal, Dribbling of saliva, Decreased elevation of the tongue, Poor intelligibility, Mono-pitch (no pitch variations), Mono loudness, Short phrases, Breathiness, Hypernasality etc.... Dysarthria could be expressed in different severities, depending upon the severity of the lesion and the degree of the muscular weakness caused by it. Therefore, all these signs and symptoms mentioned above, need not be necessarily expressed by a single individual, who's suspected to have dysarthria. Treatment Treatment of Dysarthria, essentially requires a sequential and lengthy procedure which covers all the aspects of the impairment. Therefore, therapeutic stimulation should be provided to the patient in terms of respiration phonation, articulation, resonance and prosody, ever since the onset of the problem is identified, because of the high correlation between early treatment and a better prognosis.
Healing plants belladonna is made from deadly nightshade, with its attractive but famously poisonous berries. During the Renaissance period, Italian ladies of fashion put the diluted juice into their eyes to enlarge their pupils and make them look more attractive. The name Belladonna means 'beautiful lady'. Homoeopathically it is a major short-term or acute remedy for all kinds of fevers and feverish illnesses, especially in the first stage. Ipecac: comes from the roots and underground stems of the Ipeacucnha shrub. In addition to its homoeopathic uses, the roots can be ground up and prepared as a powder or syrup, which acts as an emetic to induce vomiting. This 'allopathic' use in large doses is exactly the opposite of its homoeopathic use in minute doses - an example of like curing-like. Homoeopathically, if the illness has nausea as a predominant symptom,
this remedy may help. How to apply Bio-energy for life care Continuing the series on Bio-energy key to longevity. this week Dr. Rathnapala Bangama Arachchi writes..... Ayurvedic Medicine classifies life care into two categories. 1. Naisthiki Chikitsa Practice which may help an individual to liberate himself from physical and emotional bondages. 2. Laukika Chikitsa The medicare system designed to preserve health and to cure diseases The former is based on treatment through spirituality and yoga. The latter refers to the system of medicine in a practical sense. The Ayurvedic texts also assert that the medical treatment could be broadly divided into two categories: 1. Dravyabhuta Chikitsa Treatment with drugs. 2. Adravyabhuta Chikitsa Non drug treatment. The non drug treatment includes: Bio-purification, Psychotherapy (Sathvavajaya) 3. Daiva Vyapasraya Chikitsa Energy modulation through Acupuncture, Bio-magnetism, Temperature treatment, Sonotherapy, Electrotherapy and Physiotherapy. As mentioned above it is clear that the organic assemblage of the human body and mind exits in terms of Puncha Maha Bhuta and Thridosa theory in relation to the Bio-sphere and the Universe.
AIDS update : The TB - HIV link HIV and TB are closely linked. Testing in a number of developing countries shows that up to 70 per cent of TB patients are infected with HIV. In addition, up to 50 per cent of people living with HIV can expect to develop TB. Worldwide 36.1 million people are infected with HIV and 95 per cent of them live in developing countries, where TB rates are highest. About 13 million people are infected with both HIV and the germ that causes TB. "People with both diseases suffer double discrimination," said Dr. Peter Piot, Executive Director of the Joint United Nations Program on HIV\AIDS (UNAIDS). "HIV severely weakens the immune system, and makes people highly vulnerable to diseases such as TB. The link between the two is inescapable, and TB is the first manifestation of AIDS in more than half of all developing country cases." - (WHO)
You and Your Doctor The Triple vaccine Q: What is Triple vaccine? My child was given Dual vaccine instead of triple, why? - mother A: As the name implies triple vaccine containing three components, i.e. biological substances against three diseases such as Diphtheria, Whooping Cough and Tetanus. It is also called DPT vaccine. Altogether four doses should be given each at the ages 18 months, two four and six years to develop full and lifelong immunity against those diseases mentioned. There are some contradictions to the vaccination with DPT. One such contradiction is history of fits with the fever in the past. In such conditions dual vaccine (or DT) is given which contain only Diphtheria and Tetanus Preventing agents. **** Blurred vision Q: I have been having blurred vision for sometime. When I saw an Eye specialist he examined me and prescribed lenses, but he did not tell me what was wrong with my eyes. In his prescription notes I found the word 'Astigmatism'. What is this condition? Is it serious? A: Astigmatism is a defect of vision caused by a irregularly curved cornea (outer layer) of the eye instead of being curved equally in all directions, for example, from top to bottom and from side to side the cornea has 'meridians' of varying radius. This means that instead of focusing at a point on the retina (the area at the back of the eye which transmits visual messages to the brain), light rays entering the eye are defused over a wide area. In the same way that an out of focus camera produces a blurred picture, this produces blurred vision. A small degree of astigmation is found in nearly every person. A more serious degree can be corrected by spectacles whose lencers are curved to compensate for the defect in the eye itself. - Dr. Sampath Nanayakkara If you have any illnesses you wish to discuss with our family doctor, please send in your questions to the Editor, Health Page. The Sunday Observer, Lake House, Colombo 10. |
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Systolic hypertension: Elevated blood pressure usually occurs in old
persons, and in some only the upper level of blood pressure (systolic) may
be raised.
In Sri Lanka about 15 per cent of older people have depression of
sufficient severity to warrant medical or psychological intervention. More
females are affected than males (3:2). Both depressed mood and suicidal
ideas are not so overt in old age as earlier in life. Sleep disturbance
and somatic complaints that lack of obvious physical causes, are notable
signs of depression in old age. Individuals who become depressed for the
first time in late life have a lower genetic component. Late first onset
depression is sometimes an early manifestation of brain disease. Social
isolation renders older people vulnerable to depression, and any new
physical illness, financial hardships and loss events such as bereavement
are important precipitants.
