Life expectancy has increased significantly in the last few decades. The trend is likely to persist in the coming years and life expectancy may well surpass 80 years in most countries of the world, including India. Currently, more than 10% of Kerala’s population is over the age of 65 years. At a 3.5% annual increase, this is the fastest growing segment of the state’s population.
Our society is rapidly undergoing change. Families are becoming nuclear. The vast majority of the young are moving away in search of jobs and careers. These include women who were traditional caregivers to the elderly. We are now facing a situation where the elderly are increasing in numbers and living longer while the number of care givers is rapidly decreasing.
The health needs of the elderly differ from the younger population. They need comprehensive care that, besides routine medical care tailored to the elderly metabolism, also must include social, psychological and functional interventions to improve their quality of life.
Geriatric care has to be necessarily holistic in approach involving multidisciplinary inputs. Diseases often manifest differently in the elderly and the approach to treatment differs considerably from the treatment in the young. There should also be a considerable emphasis on the preventive aspects. While the need of the hour is to keep the elderly healthy at home, today we see a trend of placing the disabled and frail elderly in so called “old age homes”.
To meet this acute need of comprehensive geriatric care, Amrita Institute of Medical Sciences and Research Centre hosts a separate Geriatric Department with a team of healthcare personnel trained in Geriatric care – Geriatricians, Gerontological Nurses, Medical Social Workers, Gerontological Physiotherapists, Nutritionists, etc. Where necessary, specialists from various other departments in the hospital also participate in the medical and rehabilitative care of the patients.
This department is one of the first of its kind in the country and the first in Kerala. During a patient consultation, the various team members interact with the patient and his/her caregivers and advise them on various aspect of eldercare. While investigating, diagnosing and treating specific diseases, the focus is always on the preservation of function and improving the quality of life. This means that the Geriatrician addresses the patient’s psychological, social and environmental issues as well as his/her medical problems and also frequently works with the family or caregivers who are assisting the older person.
In today’s high tech environment, another area of concern is medical decision making in elderly patients. What is appropriate and what is not? End of life issues are a major worry for the patient and relatives. The Geriatric team helps the patient and relatives make the right decision by educating them on the various options and consequences while taking into account patient autonomy (respecting the patient’s wishes).
- Comprehensive interdisciplinary assessment of the elderly
- Optimized medical treatment according to the age, medical status and patient input following counseling
- Life style advice including diet and exercise programs
- Comprehensive preventive care
- Counseling to family members and caregivers on care of the elderly
- Subspecialty referral where required
- Comprehensive interdisciplinary inpatient care where required
- Consult services for the elderly patients of other departments
- Help with medical decision making and end of life care
Assessment of the older Patient
- Comprehensive Interdisciplinary assessment of the patient and his/her support systems.
- Geriatricians, trained nurses, medical social worker, physiotherapist and dietitian interact with patient and family members.
- Investigations appropriate for the elderly and tailored to the particular patient.
- Life style modification – Mental and Physical Activity, diet and fluid management, exercises, social interaction.
- Assessment of metabolic and other parameters and correction to prevent future complications.
- Supplements as appropriate to prevent certain geriatric diseases.
- Screening for certain common geriatric syndromes and cancers
- Vaccinations appropriate for the elderly.
- Regular follow up to reduce functional decline in the patient.
- Diagnosis, treatment and rehabilitation of present illness.
- Identification of various associated problems and suitable interventions to correct the problems and to improve quality of life and functional capacity wherever possible.
- Diagnosis and regular follow up of chronic conditions.
- Optimization of treatment and medications to benefit the patient as a whole and minimize the possibility of adverse effects.
Medical decision making
- Discussions regarding appropriateness of surgical and invasive procedures giving due consideration to the patient’s present condition and life expectancy.
- Planning in advance for medical interventions at end of life – particularly with regard to Intensive care and use of ventilators, so that patient’s wishes for the same are honored.
- Decisions regarding switching from aggressive curative care to comfort care in terminally ill patients.
Comprehensive geriatric health checkup program (Geriatric Package)
This program includes screening test for the functions of all major organs of the body.
- Prostate cancer screening for males.
- Breast and cervical cancer screening for females.
- Vaccination against tetanus and pneumococcal pneumonia.
How is Geriatric care different from General Medicine in the elderly ?
- Geriatric care differs in the following aspects:Disease manifestation and diagnosis often is different from younger adults.
- Certain medications used in the younger adults are inappropriate for the elderly.
- Dosage of medications is often different in the elderly.
- Elderly have multiple medical problems- physical, psychological and socio-environmental and treatment has to be optimized and individualized according to each patient’s needs.
- There are many disease complexes peculiar to the elderly known as “Geriatric Syndromes”. The Geriatrician is trained to identify and manage these.
- Apart from treating the medical conditions, the geriatrician aided by his team, focuses on functional rehabilitation to maximize quality of life.
Does Geriatric Care exclude care from other subspecialties ?
No. Geriatric care includes the best use of various medical and surgical subspecialties whenever required. The Geriatrician also helps the patient and relatives to make decisions regarding various medical and surgical interventions.
Is end of life care the same as Mercy Killing (Euthanasia) ?
No. The Geriatrician, along with palliative care specialist and the Physician in charge of the patient will seek to provide maximum relief from pain and discomfort in a dying patient and helps the relatives to cope with the loss.
Does Geriatric care mean giving up regular medical care ?
No, all the appropriate regular medical care will be continued and optimized by the Geriatrician and consultations with other specialists will be arranged as needed.