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| HEALTH & FITNESS |
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The Elderly Surgical Patient
Punjabis switch to Mediterranean food
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The Elderly Surgical Patient Older patients are potentially being under-treated out of concern that other coexistent medical comorbidities, typically cardiovascular or neuro-degenerative diseases, may place them at a higher risk. The outcome of these conditions can be influenced by the use of aspirin and other anti-platelet and anticoagulation drugs. A few common conditions that may necessitate admission in these patients are hernias, gallstones, cancer, acute abdomen (intestinal obstruction, perforation, etc), gastrointestinal bleeding (upper and lower) and intestinal
ischemia. It has been observed that there may be a delay between the onset of symptoms and the presentation of an elderly patient to the hospital. This delay may result from difficulties in leaving home, fear of
hospitalisation, alteration in usual symptoms and diminished perception of them, or diminished ability to express themselves effectively. For example, individuals with dementia , may not be able to communicate changes in their health. More patience and diligence is required in evaluating clinical symptoms and signs in the elderly. Biological features of the disease differ in the elderly, who more often than not, are more likely to present with an advanced or severe process than the younger patients. A variety of physiological alterations become manifest as the individuals age. These affect wound healing, oxygen delivery to tissues, immune function, nutritional status, digestion and absorption. Many elderly patients are on more than one medication for the treatment of several ailments. Medical conditions can feature in the elderly patients not only as comorbidities, but also and as the major cause of complications following surgery. Emergency surgery is one of the most important factors influencing surgical outcomes in the elderly and hence risk assessment is essential to formulate a proper management strategy. It is important to decide what can be done to optimize the patients’ condition for surgery. One important challenge the clinician has to face is regarding the patient and his families’ query about the effect of surgery on the patient’s mental function, memory, cognition and intellect. The key here is good communication. The ultimate aim of surgery should be to achieve a lower morbidity and mortality rate and preservation of quality of life. Recognition of preoperative markers – fraility, disability and comorbidity are widely recognized to predict the surgical outcome. Fraility is defined as a state of reduced physiologic reserve which lowers resistance to stressors. A patient who has unintentional weight loss, general feeling of exhaustion, weakness, slow walking speed, and low levels of physical activity is considered to be frail. Disability is defined as difficulty or dependence in one or more activities of daily living. A programme of nutritional supplementation prior to surgery may enhance postoperative recovery. Major surgery is associated with a rise in oxygen requirement. The elderly patient who has a limited cardio-respiratory reserve may be unable to increase the cardiac output and oxygen delivery in order to meet the oxygen debt in the postoperative period. Postoperative pneumonia is the commonest complication in the postoperative period and all necessary precautions should be exercised to avoid this complication. Post-operative delirium – a state of confusion after surgery, can interfere with the recovery of the elderly patient and is likely to prolong their hospitalization. Limiting the depth of sedation safely cuts the risk of delirium by 50%. Sleep deficiency is another risk factor for postoperative delirium , which should be prevented. Some other factors potentially contributing to a confusional state in the elderly patients are infection, hypoxia, or abnormal fluid and electrolyte balance. Recent medical advances have improved surgical outcome in the elderly patients. Better delivery of anesthesia using better instruments and improved techniques, better patient selection and better perioperative cardiac care have all enabled complex procedures being undertaken for the elderly patients. It is unwise to defer surgery on the basis of age alone as an unnecessary delay may result in aggravation of the underlying problem. This may ultimately necessitate an urgent procedure which may have an unfavourable outcome when compared to an elective surgical procedure, as in an emergency procedure the preoperative preparation of the patient may be compromised due to time constraints and the patient may not be in an optimal status before surgery. Recovery following surgery in the elderly can be improved considerably by combining the use of newer techniques, newer technology, early mobilization, adequate pain relief and nutritional support. The patient and his family must become an integral part of the decision to treat, and their wishes and expectations must be respected. Good results depend on careful preoperative evaluation, balancing the risks and benefits of surgery. A twenty four hour recovery facility and intensive therapy unit bed should be available at all hospitals for these
patients.
The writer, former Professor and Head, Department of General Surgery, PGI, is associated with Fortis Hospital, Mohali
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Punjabis switch to Mediterranean food The phenomenon has its roots in wrong traditional eating habits, and now Punjabis are getting awareness about their unhealthy life-style. They are fine-tuning their lives by incorporating the goodness of other dynamic cultures, like the Mediterranean diet in their daily menus. In food-loving Punjabis, studies indicated, the levels of LDL cholesterol (bad cholesterol) and triglycerides are on the higher side, where as the HDL cholesterol (good cholesterol) is reduced. Genetically also North Indians tend to gain weight in the abdominal region which, further doubles their risk to acquire heart diseases particularly, when they prefer to savour delicacies like the irresistible desi ghee laden “Parathas”, “Aaloo Tikkis”, “Butter chicken,” “Dal Makhni” and so on. On the contrary, Mediterranean diets lay emphasis on use and importance to the plant source of food and also stresses on the role of variety in selection with the minimal use of processed foods. These foods revolved around the principle of low saturated fats, rich in soluble fibres and hence, these are advisable as they also help in avoiding certain cancers and a variety of lifestyle related diseases like obesity, blood pressure, diabetes. These diets are being increasingly being reshaped and planned to suit the Punjabi platter. A good breakfast is not just roasted “missi rotis” with curd or oats. It should essentially include fruit, and some nuts. A lunch or dinner might include a combination of mixed cereals, vegetables, and legumes along with fresh salad. Dessert should be a fresh fruit. Choose seasonally fresh and locally grown fruits and vegetables when possible, and use whole grain foods. Milk and its products should form smallest portion of daily food. Healthy diet along with a good lifestyle needs to be ensured to keep diseases at bay. Not only is the diet important but food intake habits are undergoing major changes. From eating big portions two-three times a day, smaller and frequent meal intervals need to be incorporated in the routine up to eight to nine times a day. Enjoy good
health.
— The writer is Chief Dietician. Punjab Institute of Medical Sciences, Jalandhar
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Early puberty linked to obesity
Washington: An analysis of as many as 100 studies has revealed that overweight girls tend to reach puberty earlier than their peers do. While some researchers have argued hitting puberty early in life makes a person prone metabolic syndrome and diabetes, Emily Walvoord has found such diseases are not linked to early puberty, but obesity.“Early puberty is one of the many outcomes of obesity,” said Walvoord of Indiana University School of Medicine. While childhood obesity is a growing epidemic, she suggested other factors include a possible increase in hormone-disrupting chemicals in the environment and more chronic stress in children’s homes. Jane Mendle of University of Oregon said those in her field know the psychological effects of early puberty well. Mendle said girls who mature earlier might develop psychological issues during puberty.
Breastfeeding reduces risk disease
Melbourne: If a new research is to be believed, then negative attitudes to breastfeeding may have contributed to a rise in chronic disease in Australia. Dr Julia Smith, from the Australian National University (ANU), and colleagues set out to assess the public health significance of premature weaning of infants from breast milk on the risk of chronic illness later in life. The study mapped the public health impact of premature weaning over the past five decades in Australia. The researchers found that even now, very few Australian babies are breastfed to six months. “Depending on how we measure exposures for different types of chronic disease, more than one in ten Australians will face heightened risk in later life because they were not breastfed, Dr Smith said.
Begin high-protein diet with breakfast
Washington: Here’s how you can maintain muscle mass, curb hunger, reduce abdominal fat, and prevent age-related bone loss — starting your day with a high-protein breakfast. While humans maintain the ability to build muscle at any age, the effects of insufficient protein increase substantially in older adults, often leading to muscle and bone conditions such as sarcopenia (the degenerative loss of muscle mass) and osteoporosis, said Douglas Paddon-Jones, of University of Texas. Protein makes up about 50 percent of bone volume and 33 percent of our body mass, said dietician and sports nutritionist Marie Spano. “Higher protein diets are associated with greater bone mass and fewer fractures when calcium intake is adequate,” she said. Also, replacing carbohydrates with protein can prevent obesity and obesity-related conditions such as Type 2 Diabetes. The move toward a more protein rich diet could lower health costs and improve mobility and independence in older
adults. — ANI |
Adults
THE burgeoning incidence of heart-afflicting maladies in Punjab has of late, started bothering globe-trotting fat Punjabis and obese north-Indians.