Sunday, January 14, 2001		Keeping fit

Not only years to your life but life to your years
By B.K Sharma

WE are living in the time of technology and graying revolution. French philosopher, Alfred Saucy, had called the 20th century as the century of aging. It is an amazing statistical fact that all of the people whoever lived up to the age of 65, more than half are alive at this time. It took me sometime to grasp this significance of the statement which means that ours is the period in the entire history of mankind when life expectancy has grown so dramatically that the complexion of population has changed beyond recognition. Japan leads with life expectation of over 82 and in many western countries the life expectation is anywhere between 72 to 82. In our own country the life expectancy has gone from 32 in 1951 to over 63 years as of now. The result - nearly 7 per cent of population of our country is over 60 years. In the USA this percentage is 14 per cent.

Old age is neither a punishment nor should it be viewed with trepidation, fear or regret (remember the line Raj Kapoor singing Budhapa dekh ke roya, wohi kissa purana hai".) The World Health Organisation states that:" old age is not an affliction but a great opportunity to make use of the resources acquired over the course of life and old people can be a tremendous asset to the family and the community". In the joint family system, grand-parents are a source of inspiration, wisdom and security to the family. The system is a perfect symbiosis for every body. There can be no greater enjoyment and satisfaction for a grand-parent playing with the grand -children and all three generations can drive tremendous benefits out of it .

Age can be chronological, psychological and pathological. Somebody said one is as old as one’s arteries. I firmly believe that one is as old as one feels there is a gradual decline in organ functions which starts as early as the third decade of one’s life by the sixth and seventh decade, most of the organs are left with 30-40 per cent of their functions. In the absence of disease, this function is adequate for looking after the needs of the body. This decline in function is determined by many factors including genetics, diet, environment and personal habits. Changes are very slow and any abrupt change is likely to be due to disease and not aging. In fact in the absence of disease, aging poses no restriction till very late. Due to this decline in function the reserves of all the organs is less and therefore disease, disability and the environmental changes make a person more vulnerable. If individuals as well as those in medical profession should realise the difference between aging and disease and not up the two at any age by undertaking life style modifications and following general principles of health, the health of the person can improve. In a study conducted in the University of Pennsylvania, on individuals between the age of 40-70, it was found that three potential modifiable factors, smoking, weight control and exercise, made difference not only to life span but also the health span.

People in advanced years present the diseases in an unusual or a typical fashion. A minor ailment may result in confusion, giddiness or retention of urine. They are prone to having more than one diseases at a time. They develop symptoms earlier which in a way is an advantage as it brings them to the doctor early. It also has to be recognised that some of the findings may be normal for an elderly person for example, a few extra beats in the pulse need not raise an alarm. Nutritional problems are very common at this age even in the well-off section of the society, what to talk of the poor. I have repeatedly seen even well-off persons being with anaemia other nutritional diseases because of lack of motivation and social help.

Some decline in eye-sight and loss of hearing is expected. Constipation is a common problem because of the loss of muscular tone in the large intestines, joint pains and loss of calcium from bones. Enlargement of the prostate gland in men and some urine problem in women are common. All these problems can be handled and taken care of with a proper medical check - up and therapy.

Elderly American population has been divided into young-old (65-75 years), old (75-85 years), and old-old (more than 85 years). What this really suggests is that there is no stereotyped label to the old age and the retirement age. Being 58 or 65 does not really mean start of the disability. An attempt should be made by the personal life style modification and a proper medical supervision to postpone disability. Some disability towards the end is inevitable but that should and can be minimised. It is a great pleasure to see an 85 years old person, walking erect and with faculties intact. For this certain general principles are suggested here.

A balanced diet with adequate calories (1500-2000), vitamins and mineral supplements, should be ensured.

No smoking and minimum alcohol (if a person is already used to it).

Regular eye, ear and dental check-up would go a long way in relieving some of the irritants in these years.

Check up of prostate for men and pap-smear, mammography and estrogen replacement in case of women, should be carried out under medical supervision.

While using drugs without medical advice, fewer the better because there are a lot of actions of different drugs. The dose for elderly person is generally lower and doctor should be consulted before starting any drug.

"Falls" can result from even a minor ailment. Similarly immobility due to weakness, stiffness, pain and psychological factors is common and should be avoided as this itself leads to many complications.

The environment should be made safe for this age group and this should include: well-lighted houses and corridors, non-skidding floors (no split-levels,please). In the kitchen, shelves should be at chest level to avoid bending or over head stretching and minimum obstacles on the floor. A toilet is the most risky place for falling and should have rubber mats, minimum projections, hand shower instead of over-head shower, high toilet seats and doors without latches or locks.

If there is a choice, the ground floor should be preferred unless the elevator service is available.

Physical mobility is perhaps the single most important factor which can postpone disability, modify the disease and help in recovering from illness. It not only increases the strength of the muscles and joints but also decreases constipation, and insomnia. It also increases social interaction. This is the best antidote for osteoporosis (loss of calcium from the bones). Although exercise does not halt the underlying loss of muscle fibres, but there is an improvement in the strength which may be equivalent to 10-15 years of rejuvenation. The most important factor, however, is that the physical mobility or exercise can help in recovering from even very hopeless situation and therefore the hope should not be given up and a person should always be encouraged to move out of bed.

Social, spiritual or religious support is a great antidote to loneliness and depression. The immediate family, the surrounding community, NGOs and the Government have a great responsibility in this area and it is time that they do something practical rather than merely talk about it.

Quasi medico-legal aspect of life is becoming evident with the modern medical technology. Life can now be sustained for weeks, months and years with these mechanical devices. Very painful decisions have to be made by the families and the doctors. It is, therefore, desirable and is being practiced in many countries, that a person makes what is known as the ‘living will’ or ‘advance directive’ in which he/she can authorise a surrogate relative and convey his decision regarding a specific situation when a patient cannot decide. This may be regarding resuscitation, use of machines for sustaining life, organ donation and performance of autopsy on the body after death. This may be put in a formal or even informal manner in a note visible in the personal papers.