Organ donation is the most wonderful and selfless act. While most people would wholeheartedly agree with this statement, many need to be made aware of how and when organ donations can take place or what they can do as individuals to help the cause. Here are a few things to keep in mind when considering organ donation.
• Living Donation: This is when a living person donates one of their organs to another person who needs it. In India, this is done for one kidney or a part of a liver. Most transplants in India are Living donations. Under the Transplantation of Human Organs & Tissues Act (THOTA) 1994, this is only allowed from a near relative to another. Unrelated people would need special permission from an Authorization Committee to donate. This has been done to prevent organ trading between two unrelated individuals.
• Deceased organ donation: This is organ donation from a person who has been declared brain-dead. Organ donation cannot happen after any kind of death. A person must be declared brain-dead by a team of authorized doctors at a hospital for their organs to be donated. If one person donates their vital organs, they can save up to 8 lives! The heart, liver, kidney, pancreas, lungs, and intestines can all be donated if the organs are healthy. A brain death or brain stem death results from a severe irreversible injury to the brain. A person is said to be brain-dead when there is an irreversible loss of consciousness, absence of brain stem reflexes and no spontaneous respiration. Under the THOTA Act of 1994, brain death is recognized as a form of death. This happens when those with injuries reach the hospital and receive crucial life support, but because of the severity of the injury, the brain ceases to function, and they are declared brain dead. But since they are on life support and still breathing (artificially), circulation to vital organs is maintained for a short period. Therefore, the organs are still alive and functioning and can be donated.
• Family acceptance: Often, this isn't easy for the family. They can see the deceased breathing artificially, which makes them question if they are dead. More awareness of brain death will reduce this confusion in their minds. (To know more about Brain Death, follow this link and watch the short and easy-to-understand film What is Brain Death? https://www.youtube.com/watch?v=FYZ7QSX6UQc
• Family consent: There is no organ donation without family consent. Organ donations require consent from the potential donor or the donor's family. In India, according to the THOTA Act 1994, the next of kin of the patient will decide whether to donate their organs. For any family faced with a tragic death, making decisions, especially when they are not familiar with the concept of organ donation and Brain Death, is very difficult. Therefore, you must inform your family if you want to be an organ donor.
• Allocation of organs: Organs from deceased donors are matched with different recipients' blood groups and sizes who are waitlisted on the hospital and government registries and transplanted into them to save their lives. This allocation process is transparent and is handled by government nodal agencies in each state and by the National Organ & Tissue Transplant Organization (NOTTO) at a central level. It is estimated that over five Lakh people need an organ transplant every year, and barely five per cent receive one. Each one of us can change that with one small decision. Log on to www.organindia.org to read about the organ donation process and pledge your organs. And remember to tell your family about your excellent and noble decision!
If bladder control is impacting your life, here are some helpful tips
While bladder complications are common to most adults, it's unfortunate that people rarely talk about this condition with their loved ones. According to the Urology Care Foundation, more than 33 million adults in the US are affected by an overactive bladder. However, certain lifestyles can be implemented to control and manage the condition.
Here are some of the lifestyle changes that can ease bladder control.
Urinate On A Schedule
Creating a urination schedule can help take control over urgent or frequent trips to the bathroom. Time bathroom visits for every 1-3 hours and keep a log. It trains the bladder to hold urine and reestablishes a healthy routine. Schedule more frequent trips in the beginning and gradually increase the time between bathroom breaks.
Avoid triggers like caffeine and artificial sweeteners that can make you urinate more often. Limit fluid intake before bedtime to help prevent the bladder from filling up overnight. However, adequate hydration during the day is essential, so drink enough water and healthy fluids. Let the schedule adapt as needed. The goal is to urinate at most eight times per day.
Scheduling washroom visits helps retrain bladder muscles while lessening the urge to go and reducing accidents and leakages. Stick to the routine as much as possible for the best control.
Use Adult Diapers or Pads
For those with moderate to severe urine leakage or urge incontinence, adult diapers and pads can provide protection and peace of mind. While some may feel embarrassed about wearing them initially, incontinence products have improved dramatically in recent years. They are now affordable, more discreet, comfortable, and effective at containing leaks.
Adult diapers, also called briefs, provide 360-degree protection and are ideal for heavy urinary incontinence. Pads are less bulky and are suitable for lighter leakage. Choose the absorbency level based on your needs. It's a good idea to have a pad on hand for episodes of urgency or just in case. Replace diapers and pads often to avoid rashes and skin irritation.
Additionally, there are many styles, brands, and materials to choose from, so try different options to see what works best. Some even have odour-controlling properties. You can control and manage leaks confidently and prevent accidents with the right incontinence products. Engage your healthcare provider for recommendations on the best options.
Do Kegels Exercises Regularly
The muscles that control urination can be strengthened through Kegel exercises. Named after Dr. Arnold Kegel, these exercises involve contracting and relaxing the pelvic floor muscles repeatedly. It helps tighten the muscles around the urethra and bladder, improving control.
Start by squeezing the muscles that stop the flow of urine. Hold for up to 10 seconds, then relax for 10 seconds. Aim for at least three sets of 10 reps each day. Build up over time. Proper technique is critical - do not contract abdominal, thigh, or buttock muscles.
Perform Kegels discretely anytime, like sitting at a desk or waiting in line. Use Kegel weights or cones to add resistance. Apps and devices are also available to coach you through the exercises.
With regular practice, Kegels can reduce urinary frequency, urgency, and leakage. Results may take several weeks. Let your doctor know if you have trouble isolating the correct muscles. Physical therapy is an option. Kegels can improve bladder control at any age.
Manage constipation
Constipation contributes to bladder issues, especially leakage and the need to urinate frequently. With constipation, the backed-up stool puts extra pressure on the bladder and gives the urge to urinate even when the bladder is not full.
Making dietary changes is critical for managing constipation. Take plenty of high-fiber foods like fruits, vegetables, beans, lentils, and whole grains. Prunes and bran cereal can help get things moving. Be sure to drink enough non-caffeinated fluids. Exercise daily and take time when using the bathroom. OTC laxatives can provide short-term relief, but long-term use is not recommended.
Manage any medical conditions contributing to constipation, like diabetes or hypothyroidism. See a doctor if home treatments aren't working or there is straining, pain, or bleeding. Addressing constipation takes the pressure off the bladder, improving urine control and flow.
Limit Bladder Irritants
Some foods and beverages can irritate the bladder, causing urgency, frequency, and incontinence issues. Common culprits include:
Limiting the intake of these items reduces bladder irritation. Avoid other dietary triggers you may have, like tomato-based products or pineapple. Eat smaller meals to keep pressure off the bladder. When symptoms flare up, keep a food diary to identify problem items. This allows you to enjoy foods that don't cause problems.
Dealing with bladder control issues can be frustrating, but there are many ways to improve the situation. Incorporating the right lifestyle adjustments helps reduce accidents, urgency, and frequent bathroom trips. Try different approaches, like scheduled bathroom visits, Kegels exercises, avoiding dietary triggers, managing constipation, and using pads or adult briefs when needed. Find the techniques that provide the most relief.
Cover image: Tim Mossholder/Unsplash
Medical expertise and cutting-edge technology come together to offer a different healthcare experience.
In the realm of healthcare, prevention is always better than cure. NURA, a joint venture between Fujifilm Corporation and Dr. Kutti’s healthcare, stands at the forefront of this philosophy, blending cutting-edge technology with medical expertise to offer a smoother and more accurate preventive health screening experience. What sets NURA apart is its innovative AI-enabled screening, a process that marries imaging technology with blood metrics, providing a detailed and comprehensive analysis.
AI Power
NURA’s journey began a decade ago when Fujifilm Corporation invested in AI technology. Over time, they collected a massive database with about 500 million images of different body parts and genders. This data is the foundation for NURA’s AI system, enabling continuous learning and upgrading to enhance diagnostic accuracy.
NURA’s forte lies in its AI-enabled screening, a departure from traditional health checkups. While conventional methods focus predominantly on blood metrics, NURA’s approach integrates imaging technology with AI analysis along with blood metrics. This holistic method provides a more precise and early detection of health risks, giving individuals a proactive advantage. All image results are analysed through AI software and by a physician. AI works as a supporting tool for doctors to identify any abnormality or health risk. The organ-based approach helps Nura to identify health risks in all organs. It ensures that every vital aspect of an individual's health is evaluated.
What's the difference between a screening test and a diagnostic test?
Screening can help you identify health risks that you may not have known about before. Identifying these risks early can aid in preventing lifestyle diseases by making lifestyle changes. In the case of cancer, early detection provides the best chance of receiving effective treatment.
A Diagnostic Test is a medical examination that helps confirm a suspected condition or illness, often prescribed by a medical practitioner to someone who displays symptoms. It can be a follow-up to screening or a preliminary step in the diagnostic process.
Efficiency and Comfort
NURA stands out from other centres because it uses a very low amount of radiation (0.09 gray). This significantly reduced radiation exposure ensures safety without compromising on result accuracy. For context, the average individual is exposed to about 3 mSv (millisieverts) of radiation from natural sources over the course of a year. A single chest X-ray exposes the patient to about 0.1 mSv of radiation compared to a CT scan’s 10msv for one scan. NURA has decreased their CT radiation to levels comparable to an X-ray. This is well below the safe limit for radiation exposure during disease treatment.
Another feature of NURA’s screening process is the absence of mandatory fasting. By incorporating innovative tests like Hb1Ac, NURA provides accurate readings without inconveniencing individuals with fasting requirements. This calibration ensures reliable results, allowing for a more comfortable and efficient screening experience.
In a world where time is of the essence, NURA's thorough screening takes only 120 minutes, unlike regular checkups that may take hours. This includes in-depth health analyses and consultations with doctors, making the entire process swift and hassle-free. The serene environment at all NURA centres ensures individuals feel at ease throughout their screening journey.
A Holistic Approach For All
For senior citizens, preventive health screening becomes even more critical. As the body ages, its ability to fight diseases weakens, making early detection paramount. NURA's comprehensive method can help seniors by combining organ-based screening and AI analysis. This allows them to address health risks before they become a problem. Regular screening can help us find diseases early when they're easier to treat with minimal invasion.
Based on gender, we have only one package which covers from head to toe and includes Blood and imaging. Once guests visit Nura, we start with Vital checks followed by Blood Metrics, Oral care, Eye retinopathy, Hearing test, CT, Dexa Scan, Mammogram and Colposcopy. All details are reviewed by the Radiographer, Radiologist, AI tool, and Gynaecologist and shared with the doctor to give final closure that is explained to guests in details. Each report is explained by a physician, says Abhay Kumar, Business Head of NURA.
In addition to its comprehensive screening packages, NURA offers genetic screening. Genetic screening helps us understand a person's genes and their risk for diseases. It's a once-in-a-lifetime test. This is best for people with a family history of cancer or lifestyle diseases like heart or kidney problems, or those who have a sedentary lifestyle. NURA identifies genetic changes, helping people take preventive actions to reduce the risk of future disorders.
NURA’s innovative approach to preventive healthcare, driven by AI-enabled screening and a commitment to patient comfort is a paradigm shift in the way we approach health. NURA combines technology, blood metrics, AI, and medical expertise to empower individuals to improve their well-being in a proactive manner.
For more details, please visit: https://www.nura.in/
Note: This is a promotional feature
How important are support groups and training programs for primary caregivers and why? This is what an expert had to say.
Mangala Joglekar has been a counsellor and social worker for over 25 years. She initiated the Memory Clinic in Deenanath Mangeshkar Hospital, Pune under the Neurology Department and also runs the well-known Alzheimer’s Support Group, Pune. As part of Alzheimer's Month, we bring you a short Q&A with her on the importance of support groups and caregiver training.
What is the biggest benefit of caregiver support groups and why should caregivers join them? Why do you recommend them to caregivers and what is the biggest benefit?
Answer: There are many benefits. Caregivers gain valuable information about caregiving, maintaining the quality of life of the person with dementia (PwD), and referrals for resources. They also have the opportunity to network with other caregivers, receive emotional support and guidance, and develop problem-solving skills. E.g., our support group provides information about our programs, and caregivers can communicate with each other 24/7 through the WhatsApp support network and monthly meetings. Together, these advantages create a supportive community that addresses various caregiving challenges, offers recommendations for assistance at home, connects caregivers with family doctors who make home visits, when required, provides guidance on nutrition and addresses communication difficulties. Caregivers often experience emotional lows and require support, and our groups become like a second family to them. This is especially important as they may be socially isolated during this journey. It gives them the courage to navigate this difficult path, which can be challenging to walk alone.
Tell us about the Alzheimer’s support group and other dementia initiatives you run.
Answer: I operate the Memory Clinic under the Neurology Department at Deenanath Mangeshkar Hospital in Pune and independently manage the Alzheimer’s Support Group, Pune. To the best of my knowledge, it is the only professionally run support group in Pune.
What makes dementia caregiving so challenging and what distinguishes it from other illnesses?
Answer: Dementia caregiving is distinct due to the nature of the disease itself. Cognitive abilities decline, and patients require increasing levels of support. Unlike other illnesses, dementia caregiving is an extended journey, lasting potentially for decades, with an uncertain duration. It is especially challenging as the patient loses the ability to engage in a give-and-take relationship. Spouses, who often share many responsibilities, are deeply affected.
The caregiving role expands for the caregiver spouse to include managing financial matters and other domestic responsibilities that may have been divided earlier. Behaviour issues are common in dementia and can make caregiving very challenging, leading to stress, emotional strain, and even depression-like symptoms for caregivers. The inability to control the situation compounds these difficulties. These factors set dementia caregiving apart and emphasize the importance of joining a support group.
Is dementia training important for family caregivers and not just professionals?
Answer: Yes, dementia training is crucial for family caregivers. Training provides valuable insights and pointers into Dementia and Alzheimer's that ease the caregiving journey. It ensures caregivers understand what they are dealing with and they are not alone and offers guidance, emotional support, and tips on seeking help.
Caregivers often neglect their own needs, which can lead to health problems. Training helps caregivers realize the importance of self-care. At our Alzheimer's Support Group, training programs typically last two days but continuous support and information-sharing occur through support group meetings and WhatsApp. Caregivers can always find answers and assistance within these groups.
Note from us: You can access training programs for family caregivers at various ARDSI centres and Dementia care centres across the country. Please see a resource list below but kindly call them to check the latest information and training schedules.
Could you share some caregiving tips for situations like fussing at mealtimes, aggression or other challenging behaviour for caregivers who may be reading this?
Answer: The most important thing for caregivers is to accept the situation. And then to equip themselves with knowledge about the ailment to understand it better. Avoid arguments and lectures when dealing with challenging behaviours. Instead, focus on positive communication. Seeking advice and assistance is essential, as even experienced caregivers benefit from guidance. No one is born a caregiver. Remember, caregiving is a skill that can be learned, and it's okay to seek help and advice from others.
Do you think it makes sense for caregivers to avail of dementia daycare to provide respite and a different environment for the person with dementia if it's accessible and affordable?
Answer: Yes, dementia day care offers essential respite for caregivers and benefits patients by providing a different environment with stimulating activities. Research shows that patient behaviour often improves in such settings. Caregivers learn how to handle their responsibilities better, resulting in more peaceful relationships, important for both the person with dementia and the caregiver.
Have you witnessed positive changes in caregivers after they've received training and guidance from your support group?
Answer: Absolutely, we've seen remarkable transformations in caregivers after training. For instance, a daughter-in-law with a strained relationship with her mother-in-law became a more positive caregiver through counselling and support. She now shares advice on our WhatsApp platform for others. A husband who had bad communication with his wife has become a better communicator after receiving counselling and knowledge that this is a long-term situation and his way of communicating with his wife, who has dementia, can be very challenging for the entire household. These success stories highlight the potential for positive change and improved caregiving relationships. Change does not happen overnight, and is time-consuming. However once caregivers accept that the person with dementia is not going to change and the change has to come within themselves if they are taking on the responsibility, they can deal with things differently.
For support group and caregiving training:
Alzheimer's Support Group, Pune
mangal.joglekar@gmail.com
Alzheimer’s And Related Disorders Society of India, Calcutta Chapter
Administrative Office
Phone: +91 08232014540/ 9331039839
Email: ardsikolkata@yahoo.co.in
Website: www.ardsikolkata.org
Scarf, Chennai
Phone: 7358588822
https://dementia.scarfindia.org/
ARDSI Hyderabad
ARDSI Bangalore
https://dementiabangalore.in/whatwedo.html
From our archives: How to make the best of online support groups
Have you been part of a Dementia Support Group? Please share your experience with us in the comments below
Dementia can be a challenging condition to manage, not only for the person affected but also for caregivers. Dementia daycare centres designed specifically for persons with dementia can provide much-needed respite and offer specialized care and attention for persons with dementia in a safe and stimulating environment that can help maintain their cognitive and physical abilities. Here’s a complete guide:
For many caregivers of persons with dementia, the challenge occurs in balancing their personal needs, such as a job or childcare while caring for the person with Dementia. Very often, the person with Dementia may also be in an environment without any interaction or stimulation or a sense of community not available at home.
While there are Dementia daycare centres and other similar services offered in India, their numbers are few and the information about them is sparse. Often caregivers feel they aren't doing their "duty" if they send the loved one to a daycare. Here's a complete expert guide on how Dementia Day Care Centres help and where can you find them.
Why are Dementia Daycare Centres Important?
Nilanjana Maulik, Secretary General of ARDSI – the Alzheimer’s and Related Disorders Society of India, Calcutta Chapter says that ideally there should be dementia daycare centres in each locality of every city. "Right now in our Kolkata centre, people come from far away to attend our daycare program and they are unable to attend every day because of the distance. That's why we need more centres. Daycare centres highlight the essence of meaningful engagement. At the centre, people living with dementia stay meaningfully engaged. They start the day with a purpose and have a lot of interactions and the emotional and social aspects of their life are addressed here. Their caregivers get respite and an opportunity to live their life well. Daycare centres also offer their loved ones a chance to live their lives well."
Dementia daycare programs can provide valuable support to both individuals with dementia and their caregivers, agrees Dr Radha S Murthy, co-founder and managing trustee of Nightingales Medical Trust (NMT). NMT has been running a daycare for people with dementia (PwD) since 2005.
What To Look Out For When Selecting a Care Centre
Ms Maulik says people should keep in mind the distance from home and the ambience of the centre in terms of its physical and social environment, safety factors, hygiene, activities structure, staff, training, and compassion. Whether the centre looks into individual preferences such as in terms of food or offers a timing that suits the caregivers is important. Two other biggies to watch out for are how they deal with emergencies and the cost factor. "Doctors should be recommending daycare centres in their prescription and let family caregivers know how dementia daycare centres are beneficial and encourage them to try it out.
"Seeking guidance from healthcare experts, dementia support groups, and social workers can aid in identifying appropriate choices and successfully navigating the journey to access dementia care services," Dr Murthy adds.
Here's a handy checklist for a good dementia care centre:
- Secure entrances and exits to prevent wandering, with adequate lighting to reduce confusion and falls, and electronic monitoring for residents' safety.
- Handrails and non-slip flooring in common areas and bathrooms.
- Clear policies for handling challenging behaviours and emergencies.
- Transparent communication with families about policies and procedures.
- Regular evaluations and quality assurance measures to maintain high standards of care.
- Skilled and trained staff, including nurses and caregivers, experienced in dementia care.
- A low staff-to-resident ratio to provide personalized attention.
- Regular staff training in dementia-specific care techniques and communication.
- Structured day-to-day routine to lessen disorientation and anxiety, as well as activities to engage residents both physically and mentally.
- Enclosed outdoor areas or sensory gardens where residents can enjoy fresh air safely.
- Group activities like music therapy, art therapy, and cognitive stimulation activities.
- Opportunities for social interaction with peers.
- Sensory rooms with calming sensory stimuli like soothing music, aromatherapy, or tactile objects.
- Dementia-friendly design with visual cues to aid navigation, and circular or looped layouts to prevent residents from getting lost.
- Quiet areas for relaxation and reflection. Familiar, homelike decor with reminiscence aids, such as old photos and mementoes.
- Support with bathing, dressing, grooming, and meal preparation.
- Adaptive equipment and devices to aid with mobility and self-care.
- Access to medical professionals for regular check-ups and management of health conditions.
(Checklist: Nightingales Medical Trust)
When Is The Right Time to Find A Centre for your Loved One
Ideally from the early to moderate stage, says Maulik. "But a daycare that mixes both is a tough scenario. Lots of people in the early stages such as people with Mild Cognitive Impairment (MCI) don’t want to be part of it. So what we do at the Kolkata centre is that they don’t come as someone who has to be looked after. They come as volunteers to take care of the other people who need help and this way they feel that they are doing something useful."
Different Types of Dementia Care Centres
Memory Clinic for Assessment and Diagnosis: Memory care units are often designed to address the needs of individuals in various stages of dementia.
Daycare: Often designed to cater to the needs of the individual based on their abilities and interests, focuses only on mild and moderate stages.
Home health care services: To facilitate individuals help monitor symptoms, perform check-ins, and provide frequent communication to reduce avoidable hospital readmissions. Focuses on all the stages of dementia.
Residential care: To facilitate those with different stages of dementia with a personalized care plan, for continuous care support, a safe and supportive environment, and Respite care.
Palliative care: To provide compassionate end-of-life care, focusing on comfort, dignity, and quality of life.
Support groups: Families receive education, counselling, and support to help them understand and cope with the challenges across all stages of dementia. (Information: Nightingales Medical Trust)
There are also residential dementia care homes available in India. A care home is essentially a place where someone moves into (or when someone moves their loved one) when they need help and support for their day-to-day care, says geriatric psychiatrist Dr Soumya Hegde. It is a familiar concept in the West, and placement in these places is generally covered by insurance policies or the government. This is not the case in India where families have to fund their care. "When a loved one is affected with Dementia, the decision to move them to a care facility is made only when the behaviour challenges make it difficult to continue providing care at home or when there is no family member available to supervise care," she adds.
Read more on this here: All You Need To Know About A Dementia Care Home
Financial Support and Options Available for Dementia Care Services
Taking care of elderly people in India can be a big financial burden due to the high healthcare costs and the absence of social security. Geriatric care is an unpredictable and indefinite process that requires a significant amount of financial resources. The most reliable care facilities are usually quite expensive. For example, caring for someone with Dementia at some facilities can cost around Rs 1,500 to 2,000 per day. Here are some sample costs but do check for any changes.
The cost of the dementia day care centre at Nightingales Medical Trust is Rs 500/daily and Rs 12,000/month. At ARDSI Kolkata, daycare charges are Rs 700/day. Dementia day care centre at A.S.H.A Delhi is Rs 15,000/month.
According to Dr Murthy, families looking for financial aid with dementia care services in India may be able to access aid with the associated costs, though the availability and eligibility criteria for these options can vary. Here are some potential sources of financial support:
- Government Health Programs
- Insurance Coverage
- Central Government Health Scheme (CGHS)
- State Government Health Schemes
- Senior Citizens' Savings Scheme (SCSS)
- Non-Governmental Organizations (NGOs)
- Financial Aid for Economically Weaker Sections (EWS)
- Medicines and Treatment Assistance
- Tax Benefits
Home or Dementia Day Care: What works better?
"One could provide stimulation at home too but sometimes it can be difficult. Setting up a structured environment in a home may be tougher. Daycares provide a better structure with a variety of people coming in-- from students to interns and volunteers from various backgrounds. The person with dementia is exposed to a variety of stimulation whether cognitive, social or physical. Given that family members are working these days, at a daycare center, safety is taken care of vs. a house where a single caregiver may be trying to manage other household chores too. Besides care at home is provided on a one-on-one basis compared to daycare where care is in a group and activities are done among the group. Of course, all this is applicable if the person with dementia enjoys the daycare centre and wants to be engaged in a group. If not then home is a better environment." -- Nilanjana Maulik
For a list of Dementia daycare centres, Residential care centres, Helplines, and other support systems, please click below.
Dementia Resources Across India
— With inputs from Reshmi Chakraborty
Cover image: A fun session at ARDSI Kolkata
Dementia Daycare Centres; Residential Centres in India; Support Services & Helplines
Nightingales Medical Trust, Bangalore
The Nightingales Medical Trust (NMT) is a professionally run non-profit organization catering to the care of persons with Dementia and Alzheimer’s. Dementia Daycare centres are present in RT Nagar and Jayanagar in Bangalore, and Jubilee Hills in Hyderabad. These provide orientation treatment, physical exercises, social activities, cognitive rehabilitation, and stimulation activities. Residential Care at present at Kasturinagar, Kothanur, and Kolar near Bangalore.
Demclinic is India’s first cognitive assessment platform for the elderly and is an initiative of the Bangalore Chapter of Alzheimer's and Related Disorders Society of India (ARDSI) and Nightingales Medical Trust (NMT).
24-hour Helpline - 080 42426565
https://www.nightingaleseldercare.com/demclinic.html
AdvantAGE Senior Care, Bangalore
AdvantAGE Senior Care, situated in Indiranagar, Bangalore, is a palliative care centre which also offers care to persons with Dementia and Alzheimer’s among other illnesses.
Contact Number - +91 98444 95527/+91 96633 77762
Website - www.advantageseniors.org
Dwitiya Life Care Clinic, Bangalore
Their Dementia Day Care Programme includes brain stimulating activities, fine motor training, group and outdoor activities etc.
Dwitiya Life Care Clinic
Contact Number - 9886 202030
Udbodh Day-care centre, Kochi
Udbodh is considered the first Dementia Friendly city project in India and is under the Centre for Neuroscience (CNS), Cochin University of Science & Technology (CUSAT). The dementia day care centre offers aroma therapy, music and reminiscence therapy as part of cognitive stimulation, along with a memory cafe. It is currently free of cost for persons with dementia.
Phone +91 99467 12125
https://www.facebook.com/udbodhprajna
A S.H.A (Affectionate Secured Home for Alzheimer's), Delhi
Hope Ek A.S.H.A, has a full-fledged day care and residential care centre in Delhi, named A.S.H.A (Affectionate Secured Home for Alzheimer’s) for persons with Dementia.
Contact Number - 011-4141- 8666, 011 - 3550-2216, 99104-94958
Email address - info@hopeekasha.org, hopeekasha2001@gmail.com
Website - https://www.hopeekasha.org/
Dignity Foundation, Mumbai
They operate four Dementia Day Care Centres, each in Chennai, Mumbai, Pune and New Delhi. The Daycare centre is operational for the entire day. Members are provided with safe pick-up and drop facilities along with lunch and tea at the centre.
Dignity Lifestyle Trust at Neral, near Mumbai provides residential Dementia care.
Contact Number for Daycare centers:
Pune: +91 9152017120
Chennai: +91 44 7966 1728/ +91 63800 80496/ +91 98403 95943
Delhi NCR: +91 9152017120
Mumbai: +91 915 2017 120
Residential Centre: +919637623025 / +917083226025 / +917030602591
Website:
Daycare - https://www.dignityfoundation.com/
https://www.dignitylifestyle.org/
ARDSI Kolkata
ARDSI Calcutta launched the daycare center in 2008 to provide benefits of better and specialised care to the persons with dementia and respite for the family members. It is open six days a week and the core time is 10am to 4pm.
Contact: +91 08232014540
DEMCARES, Chennai - 24 × 7 Care Home
Contact Number - 7358588822
Website - https://dementia.scarfindia.org/
Athulya Assisted Living, Chennai
Contact Number - 98849 45900
Email id - enquiry@athulyaliving.com
Website - http://www.athulyaseniorcare.com/
Website - https://www.athulyaliving.com/dementia-care.php
Jagruti Dementia Centre as part of their Rehabilitation Centre, Pune
Email - jagrutirehabcentre@gmail.com
Contact Number -91 98222 07761
Website - https://www.jagrutirehab.org/index.php
Kites Senior Care, Bangalore
Contact Number - 99800 67000
Website - https://kitesseniorcare.com/
Smruthipatham Dementia Day Care Centre, Thrissur, Kerala
Contact details: 085920 07762, 099950 29268
smruthipadhamgvr@gmail.com
Nikisa Dementia Village, Bangalore
Contact Number - 011-4141- 8666, 011 - 3550-2216, 99104-94958
Website - https://carefordementia.in/
ARDSI Comprehensive Dementia Day Care Centre, Ernakulam
Contact Details: 4842775088
ardsicochin@gmail.com.
Therapies and services at most of these places usually include reminiscence therapy, memory stimulating activities, sensory and motor skill activities, music therapy, physical activities like ayurveda Treatment, yoga & exercise, and emergency management. Physiotherapy, psychotherapy, music therapy, art therapy cognitive and auditory stimulation therapy are also included.
Important to note: Kindly call these places and do your due diligence as information on rates and service availability may vary with time.
Other Helplines
National Helpline for Senior Citizens: Toll-free helpline number 14567
HelpAge India : All-India toll-free number: 1800 180 1253 .Contact them for help and also to reach any local numbers.
The Dementia India Alliance Helpline: 8585990990
https://www.dementia-india.org/index.html
Dementia India Alliance (DIA) is a not-for-profit, family caregiver centric national organization registered under the Societies Act on 2nd May 2023. The primary purpose of the DIA is to offer every form of practical assistance to persons with dementia, their family caregivers and healthcare professionals who help in managing the affliction. DIA intends to provide vital services through strategic programs including the following:
· · National Dementia Support Line
· · Online memory clinic (Demclinic)
· · Training of caregivers and healthcare professionals from all over India
· · Model day-care and residential care centres
The DIA is committed to raising awareness about dementia and challenging the stigma associated with the condition - through community outreach programs, educational workshops and events.
You can avail of the services by becoming a member. Cost of Individual Membership is Rs 1,000 (Rupees One Thousand only) for a tenure of 4 years.
Heard of the Netherlands's Hogeweyk dementia village? India may soon have something similar in a few year's time.
The Alzheimer’s and Related Disorders Society of India (ARDSI) in Kolkata is planning to start a dementia village near Joka in Kolkata to provide a comfortable home to individuals living with dementia. This concept is popular in Europe and was first introduced in the Netherlands in 2009. You may have heard of the care facility called Hogeweyk. It was a concept developed in 1993 after exploring how individuals would like to live if they were diagnosed with dementia. Traditional nursing homes were not the preferred choice. Instead, a "dementia village" or a place where residents could live a normal life, have the freedom to be outside, socialize with other residents, and enjoy what’s going on in the neighbourhood was the chosen option.
Aged care is a crucial issue worldwide, and Hogeweyk is one of the most innovative care facilities in the world. The residents all have severe dementia and require 24-hour care. But that doesn't mean they are confined to their homes. Hogeweyk is a self-contained and safe environment that provides residents with a sense of normalcy through its restaurants, cafés, shops, gardens, and outdoor spaces.
With twice as many care staff as residents, the carers can provide individualized care, enabling residents to lead a life as close to normal as possible. The carers dress casually and the residents are under constant surveillance to ensure their safety. Residents can participate in daily activities, assist with cooking and cleaning, shop at the grocery store, visit the salon, or dine out at restaurants in the village.
“You don’t want to be locked in for the rest of your life, you don’t want to live the rhythm of the organization. You want to make your own choices. You still want to go on living, but you need support,” Jannette Spiering, a founder of the Hogeweyk was quoted in a recent report in the New York Times.
Why is this relevant?
Because India, with its increasing dementia problem may need such spaces. A recent study gauged that dementia prevalence in India is 7.4% among adults over the age of 60. About 8.8 million Indians are currently living with dementia. ARDSI, Kolkata chapter intends to start a similar village, though much smaller in size. “The Hogeweyk is huge, the size of ten football fields," Nilanjana Maulik, secretary of the Kolkata chapter of ARDSI said. "Here we are starting small. We have to plan the space very carefully so that people living with dementia can roam about without getting lost. The space will have everything that they would need to lead a normal life. They should be able to visit a temple or a grocery store, have a haircut, go to a bank, watch a movie, go for a walk, and interact in a community. All this, of course, will be make-belief with caregivers with suitable attires manning these facilities to give them a sense of familiarity and freedom.”
Maulik is a firm believer in the concept of well-trained staff at dementia facilities and feels there should be a constant upgrading of their training or new care strategies. "It's important to recruit a diverse background of caregivers to ensure there is diversity of languages as well. A person with dementia from Kolkata may have a language issue in a care facility in the southern part of the country but to have staff from other parts of the country can solve that problem."
ARDSI's Hogeweyk-style project will begin soon with fundraising starting this September 2023. Architects who are sensitized to Dementia will be involved in designing. To make it truly inclusive, Maulik says the plan is to make the village accessible to all persons living with dementia, irrespective of their socio-economic status. “Those who can afford it can have a room to themselves, those who can’t, can share living spaces. Nobody will be turned away for lack of money.”
We hope the concept comes true and there are safe yet non-restrictive spaces for persons with dementia across the country soon.
Cover image: The Hogeweyk; Source: Twitter
Are you a caregiver to a loved one with dementia? What do you think of a concept like Hogeweyk? Would you try out a similar facility in India if it develops?
Menopause still remains a subject of silence in India. Here’s why we need to understand menopause and talk about it.
“I wanted to be alone, away from everyone,” says Beena Bhuvandas, 69, from Mangalore. She knew her menstrual days were nearing their end and struggled to identify the emotional and physical changes that were happening to her. She found herself easily irritated and experiencing heavy bleeding. Happiest being alone, Bhuvandas isolated herself without any outside distractions such as television or newspapers. Fortunately, her older sister offered her the emotional support she needed during this time. However, when her husband retired and was home more often, Bhuvandas recalls feeling annoyed with communicating with him, which she believes was a result of her emotional temperament during the perimenopausal years.
"I cry at the drop of a hat these days," says Sayantani (name changed on request), 49, a media researcher from Mumbai. She has also been experiencing insomnia, severe gut issues and bloating problems, which her doctor has attributed to the bodily changes she is undergoing during perimenopause. "Exercising and meditation have helped bring in some equanimity but even with that I'm floundering," she says.
“Little things made me very anxious during perimenopause. My periods were okay but my emotional temperament was fidgety,” says Nisha Dennis, 50, from Kozhikode, Kerala. She had difficulty sleeping and would quickly wake up at the slightest sound. Confused about what exactly she was going through, Nisha's daughter, a medical student, gave her an understanding of the symptoms of menopause. A subsequent doctor’s visit provided much-needed relief and understanding.
What Is Menopause? What Are Its Symptoms?
The menopause years are far from a breeze for most women. Menopause naturally occurs in the Indian female population from 45-50 years onwards. As women age, the number of mature eggs in their ovaries decreases and ovulation becomes less consistent. While no more monthly periods after menopause may seem appealing, it brings enough challenges. Menopause causes changes in the levels of estrogen and progesterone hormones in the body, leading to symptoms such as heavy or irregular bleeding, insomnia, hot flashes, night sweats, urinary urgency, vaginal dryness, irritability, and mood swings, among others.
Perimenopause or premenopause is the early period when the body starts transitioning into menopause. This phase can last from 12 months to a few years. Due to ovarian diseases like ovarian cancer or endometriosis, some women may even undergo a hysterectomy during this time, inducing an early onset of menopause. In such cases, gynaecologists administer hormone therapy to help relieve symptoms.
Vaginal dryness during menopause may contribute to fallouts like sexual dysfunction. “Oestrogen reduction combined with low calcium and Vitamin D may lead to osteoporosis or the weakening of bones. All women should take calcium and Vitamin D supplements at least a few months a year unless other medical concerns exist,” says Dr Aditya Raj MBBS, MS Obstetrics and Gynaecology (OBGYN), All India Institute of Medical Sciences; (AIIMS) Raipur, Chhattisgarh, advising further.
Post Menopause Care
There are many physical changes that a woman goes through after menopause. “These can start from the external appearance such as weight problems, skin changes and key health issues like cardiac health, bone health and brain health," says Dr Anbu Subbian, Gynecologic Oncologist and Robotic Surgeon, Kovai Medical Center and Hospital, Coimbatore. "Gynaecologic issues may include bleeding after menopause which could be a potential symptom of cancer and would need urgent medical attention.”
Dr Subbian, a strong advocate of strength training and exercise for women suggests that many health check-ups can be done to ensure better health. These would include Diabetes and Hypertension screening and health check-ups that would identify vitamin and mineral deficiencies along with bone strength. Decreased Oestrogen at post-menopause makes women susceptible to heart diseases. "Early detection of chronic health diseases and cancer should be done through annual visits to the doctor."
It's important to remember that each woman goes through different symptoms, hence there is no homogenous experience of menopause.
Impact Beyond The Body
70 per cent of Indian women were not familiar with the symptoms of menopause and 62 per cent of women respondents did not want to bother their families about their health concerns, according to a survey done in September 2022.
It is only recently that there has been much talk online, in the media and on social media on menopause and its impact on women and the silence around it. The verdict is unanimous: Women often downplay their pain and physical ailments and when they do talk about their pain, such as the negative impacts of menopause, they’re not taken seriously enough due to the ignorance of others.
The impact of menopause on women in the workplace is substantial, as revealed in a new report published in Time Magazine, in April 2023. It notes that the U.S. economy is suffering an annual loss of $26.6 billion due to reduced productivity and increased healthcare expenses associated with managing menopause symptoms. Conducted by Mayo Clinic, the study analyzed data from more than 4,400 women aged between 45 and 60. About 11 per cent of the women stated that they had missed work in the past year due to menopause symptoms like hot flashes and difficulty sleeping.
While there is no Indian study yet on it, Dr Subbian admits that menopause has an impact on women's careers in mid-life and may affect work performance.
“It certainly has an impact with insomnia being one reason. Poor focus, fatigue, and brain fog can add up to the mental strain apart from the physical stress that menopause can add,” she says. Dr Subbian also feels raising awareness is key since many men and families still ignore the topic as 'women's issues'.
”Having that conversation with family and having them on the same page is vital. Families can and must provide the much-needed support and understanding during this phase,” she asserts.
Being Aware
Educating patients about menopause is crucial because it's a natural process, not a disease. Stigma and discrimination around women's health can hinder progress in many ways and thus we should have healthy discussions to raise awareness about menopause.
Dennis received support from her daughter and husband when going through menopause, helping her feel sorted and calmer.
It's time to speak openly about menopause, not just in India but globally. If dealt with the right way through healthy habits, a good diet and exercise, this big physical change could manifest into a new you too.
“So many women I’ve talked to see menopause as an ending," TV host, author, and actor Oprah Winfrey was once quoted saying. "But I’ve discovered this is your moment to reinvent yourself after years of focusing on the needs of everyone else. It's your opportunity to get clear about what matters to you and then pursue that with all of your energy, time and talent”.
-- With inputs from Reshmi Chakraborty
How have you/how did you deal with your menopause years? Do you think we need to speak about this important transition in a woman's life more? Share your comments with us below or mail us on editor@silvertalkies.com
How do thoughts impact our lives? Here's a deep dive into the mind's influence.
Every individual is intimately familiar with the concept of thought, as it's a constant companion from waking to sleeping. Thoughts govern our day-to-day actions and hold immense power and influence. Renowned experts categorize thoughts into nine broad types: Unnecessary, Necessary, Positive, Logical, Toxic, Negative, Creative, Critical, and Elevated.
As we navigate our bustling lives, we may need to dwell upon necessary, logical, and creative thoughts to fulfil our routine activities. However, it's crucial to tread carefully around negative and toxic thoughts. This article will delve into the nuances of positive and negative thoughts and their impact on our lives.
The Strength of Positive Thought: The Story of Arunima Sinha
Positive thoughts have an indomitable power that can often yield extraordinary results. A classic exemplification of this is the life of Padma Shri awardee Arunima Sinha, whose story resonates with the strength of positivity and determination.
Born in Sultanpur, Uttar Pradesh, Arunima was a national-level volleyball player who, at 21, suffered a horrific incident. She was thrown out of a train by thieves, leading to the amputation of her leg. Despite her dire circumstances, she refused to succumb to self-pity. Instead, she channelled her energy into scaling Mt. Everest, becoming the first Indian female amputee to do so less than two years after her accident. Her story is a testament to the power of positive thoughts and the mind's resilience.
The Impact of Negative Thoughts
Conversely, negative thoughts can lead to adverse effects. Dr B M Hegde, the retired Principal of KMC Manipal, shares an account of a patient who, out of fear, developed diabetes, a condition her husband suffered from. Despite being reassured that diabetes is not contagious, her lingering negative thoughts ultimately led to her developing the disease.
Negative words also hold significant power. This concept is illustrated in a practice by a tribe in the Solomon Islands. They would gather around a tree they wished to cut and verbally abuse it for a month, leading to the tree's natural death. This peculiar phenomenon shows the potential destructive power of negative words.
Thoughts Influence Physical Matter
Dr. Masaru Emoto, a Japanese scientist, conducted experiments that reveal the power of thoughts and words on water. By labelling glasses of water with different words like 'Love You, 'Hate You', and 'Ignore You', he showed how the molecular structure of water can be influenced, reflecting the sentiments of the words.
It's worth noting that our bodies are made of 70 per cent water. If thoughts can impact water's molecular structure, imagine the influence they can have on our bodies, emphasizing the importance of maintaining a positive mental state.
Here's a YouTube video on Emoto's experiment: https://youtu.be/5cyQVu_8EFc
How Thoughts Shape Our Destiny
An individual holds an average of 10 to 20 thoughts per minute, which can drastically increase under emotional distress. Maintaining a balanced mental state can prevent undue strain and enhance our quality of life.
From thought springs feelings, which shape our attitudes and eventually our actions. With repetition, these actions form habits, defining our character and shaping our destiny. Thus, it's clear how thoughts can directly impact our lives.
Tips for Countering Negative Thoughts
It's essential to promptly dismiss negative thoughts as soon as they arise. Techniques such as chanting "OM" 21 times a day, practising 6-4-9 Pranayama, or cultivating positive affirmations can significantly help in this endeavour.
In conclusion, understanding and effectively managing our thoughts can improve mental health, productivity, and overall quality of life. It's crucial to cultivate a positive mental state and ward off negative thoughts, empowering us to reach our maximum potential.
Calling our Members to Write for Us!
Silver Talkies Members get a unique chance to get published with us. We welcome travelogues, family recipes, memoirs, oral history accounts, short stories, poems, humor and personal essays, tips on living well and if you are a qualified subject matter expert then your thoughts on your chosen topics as well. Email us at connect@silvertalkies.com to know more!
Padma Shri Dr M. R. Rajagopal is a pioneer in the study and practice of palliative care in India. He founded Pallium India, a non-profit that provides palliative care. Dr Rajagopal has contributed to the amendment of the NDPS Act of India (2014), the development of a Government policy on Palliative Care in Kerala (2008) and the National Palliative Care Strategy (2012). He is the author of Walk with the Weary: Life-changing Lessons in Healthcare, where he shares his thoughts, experiences and suggestions. Excerpts from a lengthy interview with Silver Talkies.
Reshmi Chakraborty: What does your book Walk with the Weary: Life-changing Lessons in Healthcare address?
Dr Rajagopal: In my book, I point out the failure of the Health Care System to address suffering. Very often, health care adds to suffering. The fact is that disease and death come into every life, and being prepared would mean the reduction of suffering. If you refuse to think about illness and suffering, saying we will cross the bridge when we come to it, why think negatively, you don't know what to do when it happens and many a time, the profit-making part of the Health Care Industry will exploit this fact and add to your suffering. This is my message, and through my experiences in the book, I needed to convey that.
RC: What is palliative care, and does it apply to all illnesses?
Dr Rajagopal: First, Palliative Care is the prevention and management of serious health-related suffering. Second, it is not only about the end of life. When there is suffering, you are supposed to address it. Third, it's not only about cancer.
RC: Why is there a common perception that Palliative Care is only associated with cancer?
Dr Rajagopal: This is partially due to a historical incident. A nurse in the UK, Cicely Saunders, who later became a doctor, found that the medical system rejected cancer patients. She found that people dying from cancer were left without treatment and started looking after these people. That's how it all started. For many years, Palliative Care solely focused on cancer. This historical origin also meant that cancer hospitals were often the first to start Palliative Care. The first hospices were primarily focused on caring for cancer patients. An oncologist in Mumbai started the first hospice in India called Shanti Avedna Sadan. Following this, the definitions started including every type of suffering. Even now, a little bit of that history still haunts us. But we now know that one doesn't get care only if they have cancer but deserves care if they have suffering.
RC: Your book mentions that Palliative care is not just about the end of life. One can go through Palliative Care when pain management is required, get better, and continue to live one's life.
Dr Rajagopal: Absolutely. In 2014, the World Health Assembly, which is the decision-making body of the World Health Organization, passed a resolution asking all the member countries to integrate Palliative care into all health care across the continuum of care, which is from the time of diagnosis to the end, at the primary, secondary and tertiary levels of healthcare delivered. This is what is globally accepted.
RC: Do you think that as a community, we refrain from talking about death though it has been part of our ancient texts?
Dr Rajagopal: We talked about this in Hindu, Buddhist and Jain cultures and accepted death. But now, we choose to ignore these facts; we've learned to ignore the wisdom we gained over centuries. I understand the importance of this; being 75 years old, I know I could die today or survive many more years. So, when I know my time is limited, I focus on what is meaningful. I want to live in this time doing things I want to do, not just waste it. Thinking about death is a considerable strength that adds meaning to one's life. As we become more death-denying, we lose these opportunities. A death-accepting society is important. In 2022, the Lancet Commission on the Value of Death published its report. Death literacy is something strongly recommended in this document. The last two generations have been 'death illiterate'. Death is not a monster to be feared but a reality to be accepted.
RC: What does death literacy mean?
Dr Rajagopal: It essentially is death being discussed again since we've stopped talking about it and stopped thinking about it. It was a part of our culture when there were extended families and children grew up seeing death. (Editor's note: Chapter Two, The First Death, in Dr Rajagopal's book illustrates this)
That is not happening anymore because nuclear families have no deaths happening there; even if it does happen, children are not a part of it, so you grow up as a death illiterate. This literacy can be brought back only by bringing death back into life. There is a movement called 'death café' in the USA, where you take a friend to a café and discuss death, and a third person joins the discussion. After a while, a large group joins this discussion. Most people who think about it do not have the opportunity to talk about it. A few years ago, we conducted a program called 'Let's have tea and talk about death'. We said that anyone was welcome to join. We expected around 25 people to show up, but the hall was packed, and there were standees throughout the program. I'm implying that many people in the community have death on their minds, but they have no school to go to to achieve this literacy. So, when you provide an opportunity, they come along. Death literacy, therefore, means building into the unfamiliar areas of death, thinking about it, talking about it and accepting that it is an inevitable consequence of life.
RC: How accessible is Palliative care around the country?
Dr Rajagopal: If we have to go by the data, less than 4 per cent of the population has access to pain relief alone. If other symptoms and psychosocial support are considered, maybe less than 2 per cent of the Indian population can access this. Kerala is doing better in this case, but Kerala has only 3 per cent of the Indian population. Even in Kerala, with its community-based palliative care system, access is grossly inadequate.
RC: What are some of the misconceptions around palliative care you've encountered over all these years?
Dr Rajagopal: Misconceptions have mostly been on the part of the professionals, which get transmitted to the public. For example, people believe that palliative care is only for those expecting death or those who have cancer, that it is to make people doped and unable to function towards the end of life, and that pain relief is dangerous. One more misconception is a thought that palliative care is about giving up. The health care system propagates a myth that you must fight even impossible battles, which means that you never come to accept death; this futile fight will mean that you will spend your remaining days in hospital corridors, not holding the hand of a loved one or not visiting a place you've always wanted to go to.
RC: Could you share an instance where people have accepted their end and where palliative care has played an important role?
Dr Rajagopal: Once, at my clinic, a man in an advanced stage of cancer was banging his head against a wall in agonising pain. The scalp broke, and blood splattered on the wall. People tried to stop him. As I moved toward him, his wife, an elderly woman, caught me by the sleeve and said, "Please kill him, as I cannot bear to see this." Apparently, he had even tried to jump out of the 5th-floor window because he couldn't bear the pain; she had screamed and gathered people to drag him back to the bed. Eventually, when we managed his pain, he asked me in his rural dialect, "You have taken the pain away, so could you take the disease away too and cure me?" I had to do the difficult task of talking about incurability.
The pain was controlled, but he took some time to process it. In a subsequent conversation, I asked him what he would like to do with the limited time left. He thought for a while and said he wanted to visit the school he had studied in. He had only had a primary school education. He went there, walked around the classrooms, sat on one of the benches and walked across to one of the dried-up streams where he and his friends would wash their plates after lunch. He pointed to a hill and said that he used to climb it. On his way back, he told his son he was at peace. I am not quite sure what connected him to that school. Maybe he had some of his best memories in that school.
It is not just about treating the pain, vomiting or ulcers but also about understanding people as people, finding out what is important to them, and walking with them through that journey. It was important for this man to visit his school, just as important as it was for a woman to tell me she didn't mind if I kept her in the ICU or put her on a ventilator but to keep her alive until her son could arrive. She wanted him to see her alive. It's a different connection in both cases. The man had accepted his fate. Even the woman had accepted it, but her connection with her son was the most important thing to her. It is about accepting people as they are, accepting that they may have different values, respecting those values and facilitating or re-establishing these connections and helping them to hold on to their values in their last moments.- Dr Rajagopal
RC: Thank you for those two instances. Please tell us about your work with Pallium India.
Dr Rajagopal: We envision an India where palliative care is integrated into all health care. The bulk of it will have to be by influencing the health care system where every doctor, nurse, pharmacist and physiotherapist understands the principles of palliative care and makes it part of their work. The National health policy 2017 includes palliative care as a part of primary care. From 2019, all of this is part of the MBBS curriculum. From 2022, it is also a part of the nursing curriculum. We may be closer to realising this wild dream than we believe possible. Will that be enough? Definitely not. What is most needed? You. The most important thing is for the public to be aware and accept the need.
RC: Where is the addiction misconception you talked about stemming from?
Dr Rajagopal: Unfortunately, two-thirds of all cancer pains and a small percentage of other pains can be relieved only with opioid medicines or derivatives of opioids like morphine and similar drugs. This means that we must use them, and they all have an addictive property which is negligible if used by people who study them safely and effectively. This is what has been achieved over 40 years by the Western European countries, over a quarter century in Kerala, or in a low-income country like Uganda. A balance between abuse prevention and proper use has been attained in all these places. Unfortunately, things went out of hand in the US about 50 years back. So, when this issue of trafficking of addictive substances in the USA began, there was a natural backlash. Historically, opium was abused for money and political reasons. In response to the global war on drugs, India created a draconian law called the Narcotic Drugs and Psychotropic Substances Act in 1985 which drastically prevented the use of opioids for pain relief.
Interestingly, it was only legal opioids that stopped. The law had minimal effect on illegal trafficking. Suddenly, the use of opioid derivatives stopped for all practical purposes. India has changed the law now but not changed public and professional perceptions enough.
RC: What has changed after the law changed in 2014?
Dr Rajagopal: Earlier in the 1990s, when I needed morphine, I needed to go to several government departments to access it. In the old system, you needed different licenses for different departments. All licenses would have to be valid at the same time. But by the time you got one license, the other would expire. It was a catch-22 situation because each was given by a different agency and had a short validity period. Now, once the institution is approved as a recognised medical institution, no licenses are required, and medicines can be ordered and delivered. But the documentation is still necessary, and a drug consumption statistics report needs to be submitted to the drug controller. This is important because we must realise that pain comes under suffering, and even addiction is suffering. So I must use it safely and effectively. We call it the Principle of Balance.
Dr Rajagopal's book is available on Amazon and in bookstores around you. To know more about Pallium India's work in palliative care, visit: https://palliumindia.org/
From our archives: A guide to palliative care
Our skin requires care at all times, especially as we grow older. Here are some care tips for mature skin and home remedies to go with it.
As we age, our skin can go through some changes that need a little extra care. If you're over 50 and wish to keep your skin healthy and glowing, it's essential to follow some care tips and natural remedies to keep it looking fresh. Remember, taking care of yourself can make you feel better in both the body and the mind. Here's a look at some care tips for mature skin:
Drinking water throughout the day can help keep your skin elastic and supple. You can also get extra hydration points by consuming fresh fruits and vegetables with high water content, like watermelon, cucumbers, and oranges.
Indian women have long relied on oils for skincare. Oils like coconut, almond, and olive oil can be excellent moisturizers. They contain essential fatty acids that help restore the skin's natural barrier, lock in moisture, and improve skin texture. Massaging a few drops of oil onto the face and body before bedtime can enhance skin hydration and suppleness. And no, this isn't restricted to women. Men are welcome to try too!
It's essential to cleanse your skin regularly, regardless of your age. However, it's best to use gentle cleansers that won't strip away your skin's natural oils. Avoid harsh soaps and opt for mild, pH-balanced cleansers, as they effectively remove dirt, grime, and makeup without drying out your skin. Remember to cleanse your skin twice daily, in the morning and evening, to allow it to breathe and rejuvenate.
Moisturizing is crucial to combat dryness and minimize the appearance of wrinkles and fine lines. Moisturizers for mature skin contain beneficial ingredients such as hyaluronic acid and antioxidants. Apply moisturizer to damp skin, focusing on areas prone to dryness, such as the face, neck, and hands.
Taking care of the skin by protecting it from harmful UV rays is essential at any age and for any gender. So stock up on the sunscreen! Consider investing in a broad-spectrum sunscreen with a minimum SPF of 30 and reapplying it every two hours when exposed to sunlight. It is also advisable to wear protective clothing such as hats and sunglasses to shield the skin from direct sun exposure.
Home Remedies for Mature Skincare
Try a turmeric and yoghurt face mask for healthy and radiant skin. Mix one tsp of turmeric with 2 tbsp of yoghurt, apply to face for 15-20 minutes, then rinse with warm water. Regular use can even out skin tone and give a natural glow.
Aloe vera gel moisturizes and calms the skin. Apply fresh gel to your face and neck for 20 minutes, then rinse with lukewarm water. Regular use can improve skin elasticity and reduce age spots.
Try a honey and lemon face pack for a healthy glow. Mix honey and lemon juice, apply to face for 15 mins, and rinse. Regular use can rejuvenate skin, lighten dark spots, and make it look healthy and fresh.
Exfoliating regularly keeps skin youthful. Make a gentle scrub with oats, honey, and lemon juice. Massage onto the skin, and rinse with lukewarm water. Enjoy fresher, smoother skin.
It's a great idea to establish a skincare routine, regardless of your age, across all genders. Keeping your skin hydrated, cleansing it gently, and moisturizing it regularly is essential. Additionally, using natural home remedies can improve the health and appearance of mature skin. Taking care of your skin is an act of self-care that has long-term benefits. Love your skin. Love yourself!
You may also like to read: Makeup tips for mature skin
All images courtesy: Pixabay
Is there a skincare routine you live by? Let us know in the comment section below
Close, positive relationships can give you the best gift- a happy, healthy life.
A decades-long Harvard study has revealed what makes us happy in life. It's not money, muscles (though fitness does help things along), or even winning an Oscar. Instead, your positive, close relationships and social fitness determine your happiness and longevity.
Robert Waldinger, the current director of the study, a psychiatrist at Massachusetts General Hospital and a professor of psychiatry at Harvard Medical School, had this to share:
"This 75-year study's most important finding is this: Positive connections keep us happier and healthier. Period."- Robert Waldinger
Sometimes, the most straightforward answers solve the most complex questions, don't they?
What Is The Study About?
The Harvard Study of Adult Development has been following hundreds of lives for 84 years, tracking more than 700 men, including their spouses and descendants, from the late 1930s to the present. The study started while the participants were teenagers and continued until they were 80.
The longitudinal study followed two groups of men over the last 80 years to identify the psychosocial predictors of healthy ageing. There are two groups of participants: The Grant Study, composed of 268 Harvard graduates from the classes of 1939-1944 and the Glueck Study group, which comprises 456 men who grew up in the inner-city neighbourhoods of Boston.
The study subjects went on to work in various professions, including bricklayers, doctors, and factory employees.
Fun fact: One of the original subjects was John F. Kennedy Jr., who went on to become President of the United States.
The study's current director is Robert Waldinger. The associate director is Marc Shulz, PhD, a practising therapist with postdoctoral health and clinical psychology training at Harvard Medical School.
What the study revealed
The Final Word
The study directors Waldinger and Schulz have co-written a book, The Good Life: Lessons From the World's Longest Scientific Study of Happiness (Published in 2023). Contrary to popular belief, they say it is not monetary success, professional success, physical activity, or a balanced diet that helps with a prolonged and happy life. Instead, it is comfortable, healthy relationships. So take stock of your relationships, they advise.
"Perhaps every year, on New Year's Day or the morning of your birthday, take a few minutes to draw up your current social universe and consider what you're receiving, what you're giving, and where you would like to be in another year."- Study directors
You can find out more about the study here: https://www.adultdevelopmentstudy.org/
What do you think of the study? Have happy, healthy and meaningful relationships created a difference in your life? Tell us how you have nurtured them and a few secrets of your own. Comment below or email us at editor@silvertalkies.com, and we would love to update this article with your thoughts!
Cover image: Pixabay
Our member Dr Anil Kumar Chawla on the importance of mindfulness and how to practice it.
Mindfulness does not mean a state of full mind. We often say, 'Be mindful.' What does this mean?
Be mindful of what you say or do, which means be carefully aware of what you say or do. Mindfulness means to be consciously aware or knowingly aware.
What do we need to be aware of? Being aware of what we see, say or do and even a step further back. Being consciously aware of one's thoughts for some time or all of the time is called mindfulness. Mindfulness can become a way of life. Through mindfulness, the mind, which is often chaotic, is brought to a state of calmness, stillness and peace.
Here is a practice exercise for mindfulness.
Sit comfortably and relax your body, keeping the spine straight. You may close your eyes and keep a gentle smile on your face.
Step 1: Become aware of the noises in the surroundings. Accept them and let them be.
Step 2: Become aware of the breath as the chest expands or retracts. Accept that and let it be.
Step 3: Become aware of the fine tingling sensations in the body, especially at the tips of the fingers, toes, and face. Accept them and let them be.
Step 4: Become aware of the thoughts crossing the mind's space. Watch them as they come and go, without calling them good or bad or giving importance to any of them as they merely pass thoughts on the mind's screen. They will pass. Allow them to pass. Keep watching.
Step 5: Notice that if you don't take any interest in them or give no thought any importance by following them, the number of thoughts will gradually decrease, and at one time, you will be free of them.
Step 6: Notice the absence of all thoughts, of an empty mind space. Notice that when no object is in any form in the mind space, you are still a witness. Notice this stillness, and you may fall in love with it.
Step 7: Realise now that you are not what the thoughts or any words say or can describe. Realise now that you are before and beyond any thoughts or comments. Realise that you exist even in the absence of any thoughts, words and all the acquired concepts and notions of who you are or have been told who you are. Realise now that you are pure, witnessing awareness and nothing else.
Step 8: Notice the calm and peace that exists now. Notice the absolute stillness when nothing else is there, and only you are there as pure existence itself.
Step 9: Having realised this state, stay in it for some more time and often visit it until you become familiar and comfortable with it.
Step 10: Gradually become aware of your body and surroundings and slowly open your eyes.
You just practised mindfulness. How do you feel?
Further analysis of this exercise can be as follows:
1. Here I am, and there are the thoughts I can observe. There is a distance between me and my thoughts.
2. What I can observe that I can not be. I am thus not my thoughts, not their content, not any meaning that they may have. I notice that I am none of that.
3. I, therefore, see myself as an observer, watcher, knower, knowing awareness or conscious awareness or, more simply, pure consciousness itself.
4. Nothing touches or pollutes pure awareness, be it good or bad thoughts. While observing, I find many thoughts besides good and evil. There are wasteful thoughts, meaningless thoughts, negative thoughts, recurring thoughts, etc. They are all automatic thoughts, none that I decided to engage in purposefully.
5. 80 to 90 per cent of thoughts arise from the memory of the past as experienced by us. Suppose we make a conscious decision not to entertain thoughts of the past. In that case, we can reduce our burden of thinking by 80 to 90 per cent.
6. I find that when a past strand of thought or visual experience has started, the chain is continued by the addition of the future, either as fear of what might happen or plans of how to avert the possible suspected bad happenings. I find that this chain of intertwined thoughts, when it continues for some time, becomes overwhelming for the individual and further promotes fear, stress, tension and depression etc.
7. You notice that practising mindfulness or conscious and disinterested observation of thoughts leads to a massive reduction in automatic thoughts. This is because thoughts are shy of disinterested, non-judgemental observation and under such direct observation, they tend to shrivel, reduce and disappear, revealing a still, thought-free state of mind which is heaven that one has found the key of and visit it often or keep staying there, entirely in natural peace and the joy that accompanies such peace.
8. Just as thinking, thinking, feeling and following every thought and emotion intently and seriously has become a habit that we have acquired, mindfulness also becomes a habit. Then nothing disturbs you or your peace of mind. Peace follows you as your shadow never leaves you.
9. Mindfulness is worth considering as a tool in your armamentarium, useful in daily living.
10. May all be attracted by it, practice it and benefit from its salubrious effects. Amen!
11. One effect you realise is that you are the very subtle consciousness, invisible to the naked eye, and you are not just the visible body that people call you and the one that will perish. The subtle consciousness you now notice that you are won't die, just as it hasn't changed a bit through infancy, youth and old age. This authentic and constant 'I', the same through all states of physical existence, neither changes nor dies.
Hurray! Let's say hello to immortality!
Do you practise mindfulness? Tell us about the calm and peace it has brought to your life.
Images courtesy: Pixabay
Calling our Members to Write for Us!
Silver Talkies Members get a unique chance to get published with us. We welcome travelogues, family recipes, memoirs, oral history accounts, short stories, poems, humour and personal essays, tips on living well and if you are a qualified subject matter expert, then your thoughts on your chosen topics as well. Email us at connect@silvertalkies.com to know more!
Education levels in childhood impact late-life cognition in Indian women finds a new study.
How one grew up in childhood, the level of nutrition and education level may impact cognition as an older adult, especially for an Indian woman with less education, says a study by researchers from the Universities of South Alabama, Southern California, and Michigan and the International Institute for Population Sciences in Mumbai, with data from the Longitudinal Aging Study in India (LASI).
The data suggested that women may have poorer late-life cognition than men due to differences in education and early nutrition, proving that gender inequalities continue into old age.
What is LASI?
The LASI is a full-scale national survey of scientific investigation of the health, economic, and social determinants and consequences of population ageing in India. It surveys over 73,000 older adults aged 45 and above across India's states and union territories. LASI will be conducted every three years for the next 25 years.
What's the connection between education and cognitive health?
According to the findings, education during youth and early adulthood may be essential for maintaining cognitive health later. Engaging in late-life cognitive activity is important to prevent Alzheimer's disease (AD) and other dementias.
Older women typically have weaker cognition than older men in many low- and middle-income nations. Research has suggested that gender variations in academic achievement may contribute to this discrepancy.
Research says early socioeconomic nutrition and schooling could account for up to 74 per cent of the cognitive disadvantage faced by women. It typically takes nine years of study to make up for this shortfall.
Why do we need to know this?
Because discussions on gender equality in India tend to be around women of a younger age. Indians over the age of 60 will double by 2050, constituting almost 19.6 per cent of the total population, and it is time to look at this disparity with an age-agnostic lens.
"Much of what is known about gender inequality in India has focused on women at younger ages like childhood, adolescence, and reproductive ages. Relatively less is known about gender disparities at older ages," writes Urvashi Jain, PhD, an Assistant Professor of Economics at the Mitchell College of Business, University of South Alabama, in Gateway to Global Aging.
"This has been partly due to the lack of suitable datasets focusing on ageing and partly due to a larger proportion of the young population. Demographic changes underway in India, however, project that the country will soon have to contend with population ageing, as the proportion of those aged sixty and older is set to reach 19% of the total population by the year 2050. Hence, we need to know more and understand the unique challenges faced by this population, especially paying attention to questions at the intersection of ageing and gender inequality." Jain says in her article.
As most of us know, India's female literacy rate lags behind the male literacy rate. According to a study by the National Statistical Office, India's country-wide female literacy rate is 70.3%, while the male literacy rate is estimated at 84.7%.
The difference in cognition between older men and women is minimal for people with at least a middle school education in states where women and men are treated more equally. Older women in areas with fewer opportunities may require more education to make up for the lack of cognitive stimulation they get through employment and social interactions.
How could such data help policy?
Older women with lesser levels of education are a vulnerable sub-population due to poorer levels of health, especially cognitive health, and should receive special attention. Jain writes: "As per the Dementia in India 2020 report, the number of dementia cases among Indians aged 60 and older is projected to reach 14 million by 2050. Identifying at-risk groups is bound to become a public health priority – gender and education level will play a key role here."
Image used for representation purposes only.
Courtesy: Unsplash
An analysis of negative thoughts that pull us down and the power of positive ones.
The word thought needs no introduction, as every one of us experiences thoughts every moment. Thought is energy. It flows towards the intended person/direction. There are three types of thoughts -- Positive, Negative, and Neutral. We need not be concerned about Positive and Neutral thoughts. But we have to be concerned with Negative thoughts. Hence my topic today is how to manage Negative thoughts for a better life.
Let us see how thought works on a person effectively.
We have Padma Shri awardee Arunima Sinha's remarkable life story. She was born on 20-7-1989 in Sultanpur (UP). At 21 in 2011, she was a National level Volleyball player. She had to travel to Delhi by Train in the general compartment for a job. A group of people surrounded her in the fully packed compartment to snatch her gold chain. She resisted first, then had to fight them. But they overpowered her and threw her out of the compartment. No co-passenger came to her rescue all the while. She fell on the next track, and right then, another train passed over her left leg. Sinha had to spend the whole night in that condition as nobody rescued her. The following day she was taken to a hospital. Her left leg had to be amputated as gangrene had set in. The hospital did not have anesthesia, and Sinha boldly underwent amputation without it. During four months of hospitalization and helplessness, Sinha decided to live life without self-pity and stop being a burden on her family. In 2013, within two years of the mishap, she was able to scale Mt Everest -- the first Indian female amputee to climb it! She has won many awards, including the Padma Shri in 2015. Sinha's story shows the power of the mind and positive thoughts.
Let us see how negative thoughts work in our lives with a few examples.
Dr. B M Hegde, Retired Principal of K M C Manipal, narrated his experience treating a diabetic patient in his talks. The patient's wife used to question whether she would become diabetic. Despite Dr. Hegde explaining that it is not a contagious disease, she harbored that intense fear for a long time, and she finally got that! Many people develop such psychosomatic aches/diseases from entertaining negative thoughts for long.
A Tribe in the Solomon Islands has a practice of surrounding a tree which they want to cut and hurl abuses at that tree for up to 30 days. As a result, the tree dies naturally. This practice is mentioned in the movie Taare Zameen Par. The teacher, played by Aamir Khan, says abusing an innocent child may harm his future. This is the power of negative words!
A Japanese scientist, Masaru Emoto, conducted several experiments on water to show the power of words.
Take three glasses of water and keep them in different rooms. Paste three paper notes with the words -- Love you, Hate you, and Ignore you -- on each. As a miracle, water in the glass with love you shows a wonderful, perfect geometric molecular structure as was visible from photographic techniques. Whereas the other two glasses did not have any organized formation of molecules.
An average person holds 10 to 20 thoughts in a minute. After seeing a depressing scene, a thriller movie, or a big fight, thoughts per minute may go beyond 150 per minute. You may recollect many emotions running in your mind, which may sometimes lead to a severe headache. Consider the strain on our minds by these additional thoughts on us! We should develop a technique to retain a state of mind with as minimum thoughts as possible for a pleasant lifestyle. When a negative thought comes to our mind, it should be immediately cut off. There should be no delay, as confirmed in the stories from Puranas --- which explain once the curse is pronounced, it can not be withdrawn! So this is the easiest way of avoiding karma phala due to this negative thought.
Practice telling yourself and imbibing positive affirmations, saying I am a peaceful soul, 11 times. This practice will miraculously change people's attitudes towards us from negative to positive. This no doubt transforms us too into peaceful persons in a matter of a few months.
These are a few tips to counter negativity creeping into our minds through unwanted thoughts and a guaranteed solution to have a conducive atmosphere around us.
Images courtesy: Unsplash
Do you have anything else to add? Do share your thoughts in the comment below. Read Mr. Rao's feature on Transactional Analysis here.
Calling our Members to Write for Us!
Silver Talkies Members get a unique chance to get published with us. We welcome travelogues, family recipes, memoirs, oral history accounts, short stories, poems, humor and personal essays, tips on living well, and if you are a qualified subject matter expert, then your thoughts on your chosen topics as well. Email us at connect@silvertalkies.com to know more!
September is considered World Alzheimer's Month. According to the World Health Organization, over 55 million people worldwide suffer from dementia, of which Alzheimer's is the most common form. Here's a handy guide from Silver Talkies.
Also Read: Five Tips To Keep Your Brain Active
Also Read: Dwelling With Dementia: Tips On Making Your Home Safer
Also Read: Things You Must Be Prepared For As A Dementia Caregiver
Have you been or are you a caregiver to a person with Dementia? Share your experience, thoughts and suggestions with us below, or email us on connect@silvertalkies.com
Confused about the difference between Dementia & Alzheimer's Disease? Here's an easy explainer.
Dementia is on the rise in India, and with the increase in life expectancy, growing further. In India, where people are living longer and the population is ageing, it is estimated that over 5.3 million people suffer from Dementia, with Alzheimer's disease being the most common cause. According to the Dementia in India Report 2020 issued by the Alzheimer's and Related Disorders Society of India (ARDSI), this number is expected to increase to 7.6 million in 2030.
What is Dementia?
Dementia is "a condition, typically chronic, characterised by a progressive, global decline in cognition including memory, learning, orientation, language, comprehension and judgement owing to disease of the brain," according to a report by ARDSI. Only 2 per cent of instances begin before age 65, and older persons are most affected. With each additional five years of age after then, the prevalence doubles. One of the main factors contributing to disability in later life is Dementia.
The second most typical form of dementia is vascular dementia, which develops due to microscopic bleeding and blood vessel obstruction in the brain. Mixed dementia is characterised by the simultaneous occurrence of brain alterations associated with different forms of dementia. Numerous other illnesses, some of which are treatable, such as thyroid issues and vitamin shortages, can also result in dementia-like symptoms.
What is the difference between Dementia and Alzheimer's Disease?
Memory loss, confusion about time and space, withdrawal, developing delusions, and insomnia are just a few symptoms that go by the umbrella label of Dementia.
The cause of these Dementia symptoms could be a number of diseases like Alzheimer's Disease, Lewy Body Dementia, Vascular Dementia, and Fronto-temporal Dementia. So Dementia is a general term for a group of symptoms, and Alzheimer's is one of the diseases that cause these symptoms. Alzheimer's is the most common type of Dementia, accounting for about 60-70% of all Dementia. The second most typical form of dementia is vascular dementia, which develops due to microscopic bleeding and blood vessel obstruction in the brain. Mixed dementia is characterised by the simultaneous occurrence of brain alterations associated with different forms of dementia. Numerous other illnesses, some of which are treatable, such as thyroid issues and vitamin shortages, can also result in dementia-like symptoms.
Watch this video from Dementiacarenotes, one of the best Dementia resources in India, for a very clear explainer.
Dementia Caregiving
The experience of providing care for a family member who has Dementia is challenging in many ways, and it undoubtedly changes one's life. It is also not inexpensive. According to a 2013 study in the Indian Journal of Public Health, the yearly household cost of caring for a person with Dementia in India can be as high as Rs 2,02,450 in urban regions and Rs 66,025 in rural areas. This also covers indirect costs like the caregiver's reduced productivity or opportunities. Also include the price of the hospital stay, prescriptions, and consultations. Given this context, more study and innovation are required in dementia therapy, caregiving, and caregiver support.
As Dementia progresses, a person's physical and mental faculties deteriorate and can impact their judgment, behavior, and sense of time and place. Hence, it becomes imperative to adapt the house to these changes, make it safe to live in, and safeguard the person from potential falls and injuries. A four-step process can help you prevent any accidents and worries.
* Assess the house thoroughly to identify potential hazards
* Remove all potentially dangerous material/ substances from reach
* Make suitable changes across the house to make it accident-free
* Install an emergency plan and update it regularly
Read more about how to keep an older adult with dementia safe here.
Dementia caregiving can last many years, draining the caregiver emotionally, physically, and financially. Caregiver burnout is a reality, and carers need to know the various stages of Dementia for proper care and support. Depression is higher in Dementia caregivers compared to other caregivers, and a study has shown that one-fifth to one-third of carers had a significant psychological illness, says Dementia Care Notes. Caring for a Dementia patient at home comes with several challenges, including the need to keep their brain stimulated for a better quality of life. The 2011 World Alzheimer's Report says that routinely providing individualized cognitive stimulation to those with mild to moderate stages of Dementia can produce short-term improvements and may reduce the decline in cognitive function. Here are some simple activities you can try out at home.
Caregiver Support
Seeing a loved one decline into Dementia can be heart-wrenching. It can also mean that someone from the family has to take on the role of a caregiver. The task is challenging, rewarding, and exhausting simultaneously, and several caregivers feel the need to connect with others in the same situation. Becoming part of a Dementia Support Group can help you learn to navigate the situation better and give you a peer group dealing with similar issues. A dementia support group aims to provide caregivers with an environment of support and a platform to share their feelings, whether in person or online. Groups help the caregiver understand and cope with the complexities of the disease, providing them with a supportive atmosphere where they can express the stress of caring for their loved ones with Dementia. Here is more on how support groups can help.
Why are support groups and self-care important?
Caregiver burnout is a state of physical, emotional, and mental exhaustion. It can occur when caregivers don't get the help they need or try to do more than they can physically, financially, or emotionally. It may manifest through stress, fatigue, depression, and anxiety. Experts say that paid caregivers, outsourced help, and support groups go a long way in helping manage caregiver burnout. It is essential for the caregiver to regularly take time out for themselves to ensure they get regular exercise and indulge in activities they love.
Good to know
The Dementia Innovation Readiness Index 2020, created by Alzheimer's Disease International, the Global Coalition on Aging, and the Lien Foundation, lists Bengaluru as one of the top 30 global cities in its index. The degree to which cities are ready to innovate in terms of strategy, diagnosis, detection, treatment, care, and support for Dementia is described as "dementia innovation readiness."
If you have an older loved one at home with Dementia, educate yourself about the progressive nature of this condition, plan out in advance and be an aware caregiver working towards making your loved one's life as comfortable as possible.
Share your experience of caring for a loved one with dementia in the comments below.
Cover image courtesy: Unsplash
Online interactions and virtual activities have been found to improve the social, physical and mental well-being of older adults, research finds.
A year ago, during the second wave of Covid, when we were still staying in, we shared a fun read of museums around the world you could tour online from your couch. We meant it as a joyous and manageable way to add a feel of culture and travel to your life when the world was still shut. Guess what? Now we have research that says touring museums virtually can be good for your health too!
A new study in the research journal Frontiers in Medicine says one virtual excursion to the museum each week followed by a discussion could promote social involvement and improve older adults' physical and emotional wellbeing.
The study was conducted by researchers from the University of Montreal, Canada. They investigated whether a three-month cycle of weekly virtual museum tours (Montreal Museum of Fine Arts in this case) increased feelings of social inclusion, wellbeing, quality of life and reduced physical weakness among older persons.
The researchers chose two parallel groups of 106 senior citizens from Montreal, Canada, to participate in a randomised controlled study. Half of the participants attended weekly online museum visits followed by an informal discussion. In contrast, the other half did not engage in any museum or art-related discussion or activity before or during the three-month study period.
Wondering what happened next? Here's what the results showed.
Compared to those who did not participate in the guided excursions, those who did observe enhanced feelings of social inclusion, wellbeing, and quality of life and lessened physical weakness.
"This study shows that with adequate infrastructure, age-friendly access and technical support, digital technology can benefit the mental health and wellbeing of older people, The Guardian quoted Prof Yang Hu of Lancaster University in a report on the study.
Surprised? We at Silver Talkies certainly aren't. Since we've gone virtual during the lockdown, our community members have stayed occupied attending art workshops, virtual classes, interactive online meetups, and many new and engaging activities. The result has been a lack of isolation, a chance to revive dormant hobbies, introduce a new skill in their lives and even new friendships for many of our community members!
The Silver Talkies Community is a space created exclusively for 55+ adults. So whether you are a homemaker or a retired professional, an introvert or an extrovert, you will always find yourself in the company of like-minded individuals. To know more about the Silver Talkies Club and us, click here.
Covid-19 has made many older adults feel isolated. Going online, meeting people through workshops and classes and getting a chance to learn something new and informative has been a way to stay interactive for many older adults. We hope Covid-19 is on its way out, but as the University of Montreal study and our experience show, online activities and interactions for older adults are here to stay.
In 2021, 43.1 per cent of elders said that elder abuse is prevalent in society. Here’s a deep look at what is elder abuse and how could it be prevented.
There is an interesting perspective in Helpage India's 2021 report on elder abuse that's focused on the pandemic. 61.4 per cent of older respondents said that the ‘work from home/study from home’ routine of their family members affected their day-to-day routine. It was a sharp contrast with the perspective of their family member/caregiver. 71.6 per cent of them said it did not affect the elder’s day-to-day routine.
Dr NN Prem, Chief Consultant Geriatric Medicine, Department of Geriatric Medicine, Jaslok Hospital, Mumbai, talks of this difference in perspective when talking about the increasing incidents of elder abuse. We need to understand abuse from the perspective of both the caregiver and the elder, he says.
"It's the complexity of relationships. The younger generation needs to look at the elders' viewpoint. Sometimes the issues come from both sides. Both generations need to understand that there has to be a middle part as sticking to your ground means that the tough situation drags on, there is no open communication and it may lead to an event of abuse."
What is elder abuse?
Elder abuse is a term referring to any intentional or negligent act, whether by the caregiver (family or paid attendant) or any other person that may cause harm to an older adult. It is not limited to any social strata or class and goes beyond physical abuse. Sometimes both the older adult and the caregiver may not be aware that the behaviour is abusive, a key reason why awareness about elder abuse is important.
Dr Prem lists out the various types of elder abuse that are common:
Self Neglect: Self-neglect is a state where the older adult neglects every aspect of care. They start living in conditions that can be harmful to their health. It can be a sign of depression, grief or even dementia. Neglecting personal hygiene, failing to seek medical help, avoiding self-harm, and inability to manage activities of daily living, all fall under this. But when does self-neglect get classified as elder abuse? When it is a failure to fulfil a caretaking obligation by the caregiver to ensure the older adult’s overall wellbeing.
Physical abuse: This includes physical assault, restraining or confining the older adult, roughly handling the vulnerable older adult, feeding them forcibly or withholding food from them. "Inappropriate use of drugs is also an abuse," Dr Prem notes. "If they are restless at night, giving them an overdose of sedatives without asking the doctor, for instance.” He cautions that physical abuse can be easily morphed (disguised) and signs of abuse are often passed off as bruises from a fall or self-harm by the person behind the abuse.
Emotional abuse: Terrorizing an older adult with threats of harm, abandonment, and verbal abuse by yelling, humiliating and ridiculing, all these are signs of abuse. "It is very common to ridicule the older adult as having been a failure and though this often comes out of frustration, it can have a huge emotional impact," Dr Prem adds. "It could also be ignoring the elderly person completely or isolating them from their friends or activities they love." Abuse reports show us that emotional abuse is often the main form of abuse.
Sexual abuse: Apart from sexual assault or inappropriate touch, sexual abuse can also be about exploiting a vulnerable older adult in other physical ways and disrespecting their dignity.
"For example, undressing a person who has dementia without any dignity. Whether the person is bedridden or not, there is still a person inside and everyone needs to respect that. There are times when older adults have been left undressed against their wish or have been changed openly without a cover. All these constitute significant elder abuse," says Dr Prem.
Financial abuse: Exploiting a vulnerable older adult financially is very common. These may include misuse of the older adult's checks, credit cards or cash. Forging the older adult's signature, identity theft, preventing them from accessing their own money or assets. Undue pressure on the older adult to secure loans, forcefully make a will or financial transaction, and any similar coercion related to money, all could be forms of elder abuse.
Prevention & Safeguarding Older Adults
Prevention & Safeguarding Older Adults
Older adults need to secure themselves first, believes Dr Prem. “Make sure you have a home and at no point just name everything to the children. If you make a Will, try to equally distribute whatever you want and make sure you secure yourself and your spouse first.”
Caregiver stress often contributes to elder abuse. “As geriatricians, we need to understand what amount of stress the caregiver is under. We always talk about prevention and we could do that by addressing caregiver stress at an earlier point.
Here are a few pointers toward caregiver stress that could be looked at to prevent elder abuse at a later stage.
The history between the older adult and the caregiver matters a lot. For instance, in some cases the older adult could have been an abusive parent or spouse to the caregiver and the frustration and anger of that history could turn to abuse.
“It’s important to protect the elder and it is also important to create awareness about caregiver stress and try to prevent it as that often leads to abuse,” Dr Prem notes.
How to notice elder abuse and what to do about it?
Keep checking on the elder, advises Dr Prem, whether you are part of the elder’s home, a friend, relative or a neighbour. Call the elder or visit often if possible so that you become a trusted confidante. Offer to stay with the older adult if they are comfortable so that their primary caregiver may get a break. Watch out for the elder’s state of hygiene, clothes and communication. For instance:
Do they seem happy to live in their home or the care home they are residing in?
Would they like to live elsewhere?
Does their condition seem to deteriorate further each time you see them?
Very few older adults would openly say they are being abused, fearing retribution or out of shame, love or guilt but constant communication could help. If you think the situation demands an intervention, you could speak to a trusted source. Also, look up our guide here on reporting abuse.
Dr Prem adds a word of caution to this:
If you have established that there is elder abuse, do not try to confront the abuser yourself without gathering support. Find strength in numbers as doing it impulsively might put the older adult in danger. For instance, if you suspect a family caregiver of abuse, other family members need to be aware of the situation and the older adult needs to be convinced that she/he would need alternate care.
If you suspect self-neglect, keep checking in with the older adult and make sure they are always connected to their medical services. If you're an older adult reading this and unhappy with the care you're receiving, try to speak up. Talk to someone you trust.
For Caregivers
Elder Abuse reports often point out that it begins at home. According to 2021’s report, the main abusers were sons and daughters-in-law.
It can be exhausting and challenging to care for an older adult. It is especially draining if it is without much help or support or requires you to put your work or activities on the backburner. Since such situations can often lead to abuse, Dr Prem suggests preventive tips if you're a caregiver.
Take immediate steps to relieve your stress and burnout, whether it's meditation, whether it's doing deep breathing exercises, or Yoga, among these.
Please learn techniques to get your anger under control.
* Make sure that you get enough rest because the lesser you sleep the more you're susceptible to irritation and anger.
* Have a healthy diet, get regular exercise, and take care of your own medical needs.
Find a support group for caregivers for the elderly as sharing your concerns and experiences may be might lead to solutions, which you thought were not there.
If you're not able to tolerate whatever is happening, you need to seek mental health support as by doing that you will take a step towards providing better care for the older adult.
Elder abuse is a sad reality in our society. Yet, as we create awareness and empower elders, we could try to address it from the root and take a balanced view on what causes it.
Silver Talkies has written extensively on Elder Abuse through the years. Click here to read.
Images are used for representation purposes only.
Gayatri Mantra can add to your wellness quotient. Read on to know more.
In the Vedic tradition, Gayatri Mantra, made up of 24 syllables, is considered to be the highest form of knowledge. However, it does have a greater significance beyond religion and spirituality.
Did you know chanting Gayatri Mantra comes with an array of health benefits, especially for older adults? A study conducted by the Department of Nursing at Diponegoro University, Indonesia shows how mindfulness with Gayatri Mantra can be an effective complementary therapy in reducing geriatric anxiety, the global incidence of which is 6.9 per cent according to data released by the National Center of Biotechnology Information (NCBI).
Gayatri Mantra can make older adults environmentally aware and the strength of this mantra can help them define how their day would be, based on weather forecasts, the slugs, the butterflies, the birds and the pattern of clouds, believes environmentalist Hamsini Murthy.
Health benefits of Gayatri Mantra on older adults
Calms your mind, reduces anxiety and phobia: When you chant the Gayatri Mantra, you start with ‘Om’. When you pronounce ‘Om’, it sends a vibration via your lips, tongue, palate, back of your throat and skull. This along with the other syllables of the Gayatri Mantra effectively calms down your mind and helps you to concentrate and focus, thereby curbing the levels of your anxiety, panic and phobia, sometimes common psychological issues among older adults.
Tackles stress-induced damage: Not just anxiety, chanting of Gayatri Mantra helps older adults beat the damage caused by oxidative stress - a disturbance in the balance between the production of reactive oxygen species (free radicals) and antioxidant defences which also enhances tissue damage among those with Diabetes Mellitus. Besides, the recitation of the Gayatri Mantra is also known to reverse the adverse impact of constant stress on your body.
Keeps depression away: Gayatri Mantra is known to stimulate the brain, enhance focus, concentration and de-stress. It is also known to stimulate the functioning of the vagus nerve - a common approach to treating depression and even epilepsy reveals a study published in the International Journal of Yoga. Also, the chanting of this mantra stimulates the pineal body (a small endocrine gland), enabling the release of endorphins and other relaxing hormones, thereby keeping depression at an arm’s length among older adults.
Keeps up heart health: As you chant the Gayatri Mantra, it slows down your breathing, thereby helping in synchronising and regularising your heartbeats. A study published in the British Medical Journal shows, that this synchronised beating makes the functioning of the heart steady and enhances baroreflex sensitivity (a mechanism that helps keep blood pressure in check). These are indicators of a healthy heart that keep heart disease at bay.
Amps up the working of your nerves: Chanting Gayatri Mantra exerts pressure on your lips, tongue, vocal cord, palate and the connecting region in and around your brain. This creates a resonance that helps in strengthening and stimulating nerve functions. And how does it help older adults? It keeps their memory sense intact and efficiently supports their balance and cognitive functions.
Reduces asthma flare-ups: If you’re asthmatic, chanting Gayatri Mantra could do wonders. The mantra chanting involves deep breathing and holding breath for a short period which enables strengthening your lungs and can be therapeutic in providing relief from the symptoms of asthma.
Glows up your skin: Worried about dull, wrinkled skin? Chanting Gayatri Mantra can be a saviour. The vibrations generated while reciting the mantra improve blood circulation on the face and also help your skin to get rid of toxins. Besides, deep breathing oxygenates your skin and makes it glowing and toned.
How Gayatri Mantra can make your day better
Environmentalist Hamsini Murthy highlights how chanting Gayatri Mantra can enhance the day to day well-being of older adults and help them establish a connection with nature.
How do you benefit from nature while chanting?
The bliss of solar energy: You get to gaze at the Sun and enjoy the health benefits of solar energy. You may also pour water facing the Sun. This will act as a prism breaking the light into seven colours lighting up the Chakras or parts of the body which benefit from each colour.
“When you do this exercise every day, you realise the sun doesn’t always rise at the same spot every day. Each day you face the Sun at a slightly different angle,” says Murthy.
The bout of fresh oxygen: It’s the time when the air around you is changing. The plants change their breathing cycle giving you a fresh burst of oxygen. “If you wake up in the darkness and spend the half-hour enjoying the change in light and waking up of birds, you will instantly feel the change of atmosphere around you,” says Murthy.
Learn more about winds: The winds don’t always blow in the same direction. Here, in India, it blows one way for half the year (southwest) and the other way for half the year (northeast) and the chanting makes you experience that.
Record Science Lessons from nature: The Earth doesn’t look and smell the same throughout the year. The dusty summers, the dewy winters, the decay in autumn, the wetness of the rainy season along with smells of seasonal flowers and insects could be wonderful science lessons to record and chanting of Gayatri Mantra daily helps you absorb them. It also reflects the change in the colour of the sky, and the shapes and shades of the clouds daily.
Gayatri Mantra is interesting in ways beyond religion and spirituality. It can help you age well with a sanctified link to nature. Do you chant the Gayatri Mantra or any other powerful chant? Share your experience with us in the comments section below.
Transitional care can be big support on the road to recovery for both the patient and caregiver. Here’s why it is the need of the hour.
When 68-year-old Nirmala* was diagnosed with pneumonia recently, she was rushed to the hospital by her family members. Her condition was under control within a couple of days but she faced poor mobility and needed continued antibiotic administration. This did not require hospitalization but Nirmala did require nursing care and the help of an active rehabilitation team.
Such rehabilitation needs after hospitalization are often tough for caregivers to manage at home. This is when transitional care steps in. “This is something which cannot be managed at home by caregivers who are not formally trained and patients like Nirmala can be transferred to another facility where such a service is provided. This is what we refer to as transitional care. It is a system whereby a patient’s care is continued beyond the hospital to another facility. This may be rehabilitation, physiotherapy, or nursing needs,” says Dr. Steve Paul, Consultant Geriatrician, Apollo Hospitals, Bannerghatta Road. He believes that though it is extremely essential, especially in senior care, the concept of transitional care or intermediary care is barely known in India.
What is transitional care?
The exact length of hospital stay is often unpredictable in eldercare. Even after a patient is stable, there may be unresolved issues. “In our system, currently the burden falls on the family, and patients are discharged home early before a complete rehabilitation is possible or the hospital stay is prolonged, impacting the financial resources, which may be already depleted,” Dr. Paul notes.
Transitional care ensures that the treatment continues beyond the hospital to an intermediate facility until the patient is fit for discharge.
How does this help the patient and caregivers?
How does it help the management of care?
In India, the responsibility of care usually falls on the family who may have their challenges of work and time despite the best intentions. “Transitional care can ensure that older adults continue to receive supervised care closer to home, thereby facilitating the participation of the family,” says Dr. Paul.
When does a patient need transitional care?
Patients preparing to be discharged undergo a comprehensive geriatric assessment. This multidisciplinary team evaluation assesses their independence in performing their Activities of Daily Living (ADL) and instruments of ADLs. If determined to require further physiotherapy support or nursing needs, (such as IV medications/wound dressing requirements), they are transferred to Intermediary Care (IC) which works as Transitional Care. Patients who require to be supervised for a week for catheter or stoma care also benefit from this until a possible ‘discharge to home plan’ is made.
What is the typical duration of stay and comparative cost with the hospital?
In India, private hospital beds can cost upwards of Rs 10,000 per day inclusive of room rent and clinical costs. Transitional Care beds cost between Rs 5000 to Rs 7,000 for standard packages.
What’s next for Transitional Care in India?
Options to introduce transitional care need to be explored further in our country. Smaller clinics with 20-50 beds could be attached to the main hospital for receiving patients deemed fit for IC. An assessment team comprising of a geriatric physician, trained nurse, social worker, and physical and occupational therapist should evaluate the patient a week before the planned discharge.
Challenges to developing this system would be ill-equipped peripheral centers, dearth of trained professionals, lack of faith of the patient’s family in the transitional care center, and non-availability of medical insurance for non-hospitalized services.
Here’s a list of some of the Transitional Care providers in India
KITES Senior Care: KITES Senior Care is a Geriatric care Specialist brand and the first of its kind providing comprehensive ‘out of hospital care’ for elders both in their care facilities and in the comfort of the elders' home. Based in Bengaluru, KITES Senior Care has two centers with over 70 beds under its management in HBR Layout, North Bangalore, one providing transitional/rehabilitative care & palliative care and the other one being a dedicated dementia care facility.
KITES Senior Care’s transitional and rehabilitation care program covers a gamut of ailments and issues. These include post-hospitalization care, knee replacement rehabilitation, cancer care, hip joint replacement, post-CABG, post-COVID care, post-stroke rehabilitation, Parkinson's care, skilled nursing care, respite care, and supervised nursing care.
KITES Dementia Care Facility provides daycare and residential care for persons with Alzheimer’s and other forms of dementia. The program includes a memory clinic, cognitive retraining, and other allied services.
Whatever the condition/ailment, the KITES team ensures coordination and continuity of care for elders once they are out of the hospital.
At their care facilities, KITES offers varied services such as a structured care plan, 24X7 medical supervision, nursing care, nutrition, physiotherapy, geriatric counseling, and emergency management, among others.
Founded by senior doctors and healthcare professionals in 2016 with a vision of being trusted care partners to elders and their families. “Everything that we do at KITES Senior Care leads to enhancing the quality of life of the seniors who are under our care, be it at our centers or in the comfort of their own homes. Our processes and protocols, infrastructure planning, hiring, training, upskilling, all revolve around delivering superior care for seniors”, explains Mr. Rajagopal, Founder, and CEO of KITES Senior Care.
Know more here: www.kitesseniorcare.com
Contact here: 99800 67000
Aaji Care: Based in three locations across Mumbai in Andheri and Thane, with a fourth facility opening in Pune, Aaji Care was set up by Prasad Bhide to enhance elders’ quality of life. Aaji Care’s Transitional Care facility is offered at their assisted living facility/geriatric care centre called Aarambh. It is a long term care centre for the elderly with irreversible medical conditions, psychological conditions and post-operative care. The facility also acts as a bridge between the hospital and home for seniors who require medical intervention but do not need a hospital stay. At Aarambh, their physiotherapy needs, dietary needs, counselling and various aspects of caregiving are monitored, making rehabilitation easier in a friendly, community-oriented environment instead of an institutional facility. Patients are assisted in activities of daily living at every level, based on the requirement. The centre caters to patients with Dementia, heart disease, stroke, Parkinson’s Disease and post-operative care.
“We design activities and a daily routine for patients, including social interaction which works as a real medicine for many of them. They watch their peers eat, do activities, feel inspired to do the same, and often recover in that environment,” says Dr. Ruchi Raichura, Medical Administrator, Aarambh elder care home run by Aaji Care in Mumbai.
Dr. Raichura shares the case study of a patient aged 79 who came to transitional care in a hypoglycaemic state after a hospital stay. With constant care, interactions, and activities around her, she was feeling better enough after a month to feed orally, communicate, have the catheter removed, and walk with support, signifying how transitional care helps in the overall improvement of care.
Know more here: www.aajicare.in
Contact here: 9920018184
Porvoo Transition Care: Located in Saket, New Delhi, it is a 16-bed facility providing critical care and post-operative care to patients requiring long-term support. The offerings include critical care, post-operative care, nursing care, physiotherapy, chemotherapy, immunotherapy, hormone therapy, diet and nutrition, diagnostics and radiology, in-house pharmacy, and more.
Brinnova Care: Located in Banjara Hills, Hyderabad, Brinnova Transitional Care and Rehabilitation Centre is a 50-bed facility that offers neuro rehabilitation, cardiopulmonary rehabilitation, and orthopaedic rehabilitation, geriatric rehabilitation, oncology rehabilitation and palliative care. It also covers physical, occupational, speech therapies, post-operative rehabilitation and psychological counselling.
HCAH SuVitas: Located in Hyderabad and Bengaluru, HCAH SuVitas brings in 50-bed transitional and rehabilitation care facilities in both cities. They specialize in inpatient rehabilitation for patients from neurology & neurosurgery, orthopedics, cardio sciences, and early-stage oncology. It also treats victims of stroke and road accident survivors with brain injuries and polytrauma.
Sukino post-operative care: Located in Bengaluru, Sukino’s post-operative rehab center focuses on geriatric care and management of bed-ridden older adults. It offers general nursing, wound management, IV infusion therapy, fluid management, administering oxygen, nebulization, bed sore care, tracheostomy care, BiPAP/CPAP management, stoma care, and specialized feeding (Ryle’s Tube, PEG), and more.
Have you tried any transitional care facility in India? Share your experiences with us in the comments below.
Cover image: Photo by Dominik Lange on Unsplash
Urinary Tract Infections can be common among older adults. Here's what to watch out for.
Are you 60 plus and facing issues like frequent, urgent need to urinate, painful and burning urination, or the constant feeling of a full bladder? Do you feel consistent pressure or pain in your abdomen or lower back that doesn’t go despite applying sprays to get relief from pain? These signs are often commonly observed among older adults but rarely do they go for a diagnosis to detect the cause behind these symptoms, which is a major concern, believe doctors.
Did you know that more than 10 per cent of women over age 65 report having a Urinary Tract Infection (UTI) - an infection in any part of the urinary system, the kidneys, bladder or urethra, according to a study conducted by National Center For Biotechnology Information (NCBI). Not just that, the incidence of UTI increases to about 30 per cent in women over age 85. Even male older adults tend to experience more UTI as they age. And the above-mentioned symptoms are the early signs of UTI among older adults.
“Men suffer from urinary tract obstruction due to a prostate issue that is most commonly Benign Prostatic Hyperplasia and this, in turn, causes the more recurrent UTI in older adult males. Also, men associated with diabetes have an increased risk of infection because there is a loss of bladder tone and enhanced susceptibility to infections. In post-menopausal older adults women anatomic factors affecting bladder emptying such as cystoceles, urinary incontinence and residual urine are most commonly associated with recurrent UTI,” says Dr Manohar Bhadrappa, consultant Urology and Renal Transplant Surgeon at Manipal Hospital Sarjapur, Bengaluru.
Why do older adults women and men suffer from increased UTI
* Anatomical variations in the urinary system: People with benign prostate hyperplasia are more likely to have UTI due to stagnant urine in the bladder.
The red flags that you must watch out for:
Older adults often tend to ignore the signs of UTI which lead to delayed diagnosis. This is why Dr Bhadrappa believes that it is essential to spot the day to day red flags. Poor urinary flow, as well as incomplete emptying and frequent urination both day and night, could be an indication of UTI among older adults, he highlights.
“It is important to look for the symptoms of urinary tract infections in older adults. Caregivers should identify a sudden increase in the frequency of urination and an urgent need for urination in older adults. Further, lethargy, loss of appetite, fever, reduced mobility, irritation and agitation, and nausea and vomiting are some of the red flags for underlying urinary tract infection. If an older adult complains about painful urination, pelvic pain, and change in colour of urine, the caregiver should immediately consult with the doctor,” adds Dr Bhadrappa.
Ways by which you can prevent UTI among older adults
The underlying conditions that increase the risk of UTI among older adults
There are several underlying medical conditions that may increase the risk of UTI in adults, says Dr Bhadrappa. “These conditions may either increase their exposure to bacteria (for example increased risk of UTI in postmenopausal women due to E.coli) or affects the muscles or the nerves that control urination. These diseases are Diabetes, Alzheimer’s disease, and Parkinson’s disease. Benign Prostate Hyperplasia also increases the risk of UTI in men. Diabetes and as well any previous urological surgeries can increase the incidence of UTI.”
Timely recognition of the signs, intervention and following the preventive measures can make it easy for older adults to tackle UTI and also keep the underlying conditions in check.
Image courtesy: thatbaldguy/Pixabay
Logotherapy can help you find the meaning of life. Here's how
What is the meaning of life? Human beings have tried to find an answer to this question for a very long time. But human beings are the only creatures who can question their own existence. Studies have shown that having a sense of meaning is not just for philosophical or theoretical purposes but has a positive impact on our health-protecting us against Alzheimer’s, disabilities, cardiovascular problems and impairment.
A recent study by researchers at the University of California San Diego medicine found that those who had meaning in their lives were healthier and happier which also contributed to better physical and mental well being. Over the last three decades, the meaning of life has emerged as an important question in medical research too, especially in the context of an ageing population. The medical community has recognised that meaning in life is a clinically relevant and potentially modifiable factor that could be targeted to enhance the well-being and functioning of patients.
The study also says that there are two kinds of people. One in which a person considers the path to searching for meaning as the path to meaning itself and the second is the one who desperately tries to find meaning but gives it up out of despair.
In order to help people find meaning in life, Viktor Frankl, who was an Austrian neurologist and psychiatrist created the Logotherapy concept. ‘Logo’ is a word that comes from the Greek word ‘logos’ which means meaning. The second part of the work ‘therapy’ refers to treating an illness, condition or maladjustment.
Logotherapy is based on the principle that the main motivational force of human beings is to find purpose or meaning in life. Frankl’s experience of life inside the Nazi concentration made him believe that man has the capability of resisting and braving the most terrible conditions.
In 1942, Frankl, his parents, pregnant wife and brother were all arrested and sent to the concentration. They were made to do laborious work and had to undergo untold and severe torture suffering to such an extent that Dir. Frankl almost killed his father by giving him morphine with the intention of relieving his suffering. All of his family members had died by the time he was freed from the concentration camp. He was totally devastated and wanted to give up on his life, but he realized that he had a purpose to live which was to spread awareness about logotherapy. In a matter of nine successive days, Frankl wrote the manuscript for the book which became one of the most influential books of the 20th century called ‘Man’s Search for Meaning’. One major question that Frankl tried to find the answer for was why did some prisoners give up and die while some were able to deal with the inhuman conditions in the camp? He found that those prisoners who had something to live for survived and those who did not have anything to look forward to in the future gave up their lives.
Some of the principles of logotherapy have great importance at an older age. Here we list some of these:
1. One of them is that every situation, however dreadful has some meaning in life. This meaning needs to be discovered by the individual through developing a conscience and understanding our own values. Frankl immediately had decided after he entered the camp that he was not going to die by suicide like others. Because he had a purpose to live, he upheld the dignity of his own life. For Frankl value is something that a person chooses of his own volition and meaning is the actual choices that a person has made.
2. He says that meaning could be found in our day to day lives through doing what gives our life meaning and fulfilment. We don’t need anything or anyone to do something special for our lives to have meaning. It can be seen that in old age, seniors suffer from depression, anxiety and a feeling of despair as there is no reason or purpose to live. But as Frankl says finding meaning is up to us and no one can do that for us. For example, Abid Surti took it upon himself to save water by repairing leaking faucets of every home in Mira Road.
3. Frankl tells us that we need to go beyond ourselves and follow activities beyond the self which is an important message for seniors. Sometimes, we see that seniors are engulfed in their own physical issues about what they are not able to do, rather than what they can do.
4. Frankl thinks how we respond to suffering is up to us. During one of the marches in the concentration camp in the bitter cold with German soldiers beating them at the slightest mistake, a friend mentions to Frankl that he wished their wives could see them. Frankl immediately starts thinking of his wife, the good times they have had together, his love for his wife and his longingness to see her. Through thinking about these things, he completely shuts himself off from the painful situation that he is in. He says that those who have inner riches or a rich intellectual life can retreat from their terrible surroundings and turn their attention towards something deeper which holds meaning for them, and not the camp influences alone.
5. Despite all the pain and suffering that Frankl and other prisoners had to go through, the kind of person they became was the result of an inner decision. Am I going to be bitterly ruminating about difficult times I have had or am I going to reflect on my situation to see what I could learn from it?
Frankl’s theory developed from his own practice and hence logotherapy is something he lived himself. Giving meaning to one’s suffering enables us to not only reflect on it but also can make us compassionate towards other beings.
What are your views on Logotherapy? Do you agree/disagree? Share your thoughts in the comments below.
Images courtesy: Pixabay
Glaucoma is the second most common yet treatable cause of blindness. At the age of 60 years, 1 out of eleven people is likely to have glaucoma. On World Glaucoma Week, here’s how to safeguard yourself against this silent ailment.
Lalitha Ramakrishnan realized something was wrong with her vision when she couldn’t see the vehicles coming from the left side and only spot them when they were in front of her. This alarmed Ramakrishnan enough to visit an ophthalmologist. Unfortunately, the diagnosis was Glaucoma, a condition that damages the optic nerve. The doctor also revealed that she had lost 85 percent of her vision in her left eye. Over the years, after surgeries and a lifelong prescription of eye drops, Ramakrishnan has learned to manage her ailment. Now at 94, she reads the newspaper every morning, watches television to her heart’s content, and has only stopped knitting because of her age and not eyesight.
Ramakrishnan was lucky to have caught it on time because Glaucoma can result in vision loss and possible blindness. It occurs due to high intraocular pressure or the pressure of fluid inside our eyes.
In some cases, early-onset Glaucoma can be hereditary, like with Ramakrishnan’s daughter Viji Venkatesh. Venkatesh, 68, has about 25 percent vision in her right eye and about 95 percent in the left eye. Having ignored the fact that glaucoma can be hereditary, Venkatesh too realized it when she was tripping and falling down often because she could not judge the ground level correctly and felt uncomfortable in dim light. “Glaucoma has no symptoms in the early stages and could have affected much of your optic nerve permanently before you notice any visual problems,” she says.
Today Venkatesh is an advocate of preventive and early detection measures that should be part of one's mandatory health check-up to avoid Glaucoma. Region Head, South Asia, The Max Foundation, she has a huge social media following and does not fail to spread awareness about Glaucoma on every Glaucoma Awareness Week. She continues to be regular with her follow-up visits to the surgeon, even a decade after diagnosis.
What is Glaucoma?
Glaucoma impacts the optic nerves impairing the peripheral vision initially, leaving only a small central vision. However, in extreme cases, this may be impacted too leading to blindness. And it isn’t a rare condition. There are 12 million people affected with glaucoma in India. Of this, 1.5 million people are blind.
Glaucoma can go unnoticed in the initial stages as it is painless and manifests only in later stages when extensive damage has already occurred. Only in very few cases, one may experience symptoms like sudden ocular pain, progressive loss of vision, frequent headaches, seeing halos around lights, or feeling pain and pressure around the eyeball along with nausea and vomiting.
“In more than fifty percent cases, Glaucoma is detected during general OPD or routine check-ups,” says Dr. Meena Gopinath Menon of Sankara Eye Hospitals, Bengaluru.
Who is at risk?
People above the age of 40 are more prone to glaucoma though it could happen to a younger person too. The risk increases with age and factors like family history, medical conditions like diabetes, hypertension, hypothyroidism, and myopia. Because of the silent way it can creep up on you, Venkatesh calls glaucoma a vision thief.
“If you haven't had an eye test in the two years, make it your priority to do so. It is quick, painless, and may just save your sight.”- Viji Venkatesh
Once diagnosed with glaucoma, she convinced her whole family to undergo a check-up. Her younger son showed very early signs of the disease. “Today he has regular check-ups done post laser surgery which has arrested any possible further deterioration.”
Treatment Options
The onset of glaucoma cannot be prevented and the damage caused is irreversible. But the good news is that its progression can be curtailed through timely treatment and you can lead a normal life. “Depending on the severity of the condition, administration of eye drops, laser surgery, or invasive surgery may be recommended”, adds Dr. Menon.
“My treatment began with laser surgery and a regimen of drops but the pressure kept increasing so I underwent Trabeculectomies (invasive surgery) in both eyes and additional corrective surgery in my good eye. As of now, I have no treatment underway.” Venkatesh shares.
Dr. Menon recommends a comprehensive eye examination comprising of dilation of pupils once every two years for people above 40 and every year for people above 60. People with Glaucoma may be asked to get an eye check-up done every three or six months depending on the severity of the condition and compliance with medication.
Impact on day-to-day living
With the peripheral vision getting impacted the objects appearing on the sides may not be visible and this can lead to mishaps if not careful. Hence Dr. Menon advises glaucoma patients to not venture out alone in the dark. One should also avoid driving.
With small lifestyle changes and with some help from family and friends, one can manage to lead a normal life even with glaucoma.
Sharing her experience Venkatesh, who is on the move constantly because of her work says, “My eyes do tire easily and I continue to trip and fall. Unless I am very careful I am unable to bear the glare of bright lights and gleaming floors and glass doors are a pain to navigate. I have consciously slowed down my gait and have no qualms of being a slow mover. I keep my hands free to hold on to rails on escalators and stairs. Other than this I go about all my business pretty well. I read, work on all my devices and take photographs!”
Acknowledging and informing others about your condition is the foremost and most important step of dealing with glaucoma, says Dr. Menon. The second step is following the recommended medication regimen. “With these two taken care of, you can continue to live your life fully even with glaucoma. I have patients who continue to do wildlife photography and crochet work.”
Image courtesy: Cover image by Tobias Dahlberg & CommsEditors101 from Pixabay
Do you maintain a regular eye check-up routine or lead a normal life with Glaucoma? Do share your experience for the benefit of others in the comments below.
What's better than adapting to the apt weight loss guide for a healthy New Year.
Weight loss is something that we all crave for staying hale and hearty, irrespective of our age. As we try out various ways and our minds are often clogged with myths related to weight loss, most of these ways may not work. That gets worrisome and even more if you are an older adult.
In her latest book - ‘The Don’t Diet Plan’, author, nutritionist and weight management consultant Kavita Devgan lists down practical ways of weight loss. She also shatters the myth that to lose weight you need to starve, follow fad diets, unscientific ways, techniques or machines or pills. “It is painless and not at all complicated to lose weight if you have the right information and you know the right rules to do so. Weight loss need not be a punishment at all,” says Devgan who shared with Silver Talkies simple and natural strategies to weight loss that have worked over the years.
According to Devgan, weight loss is something that’s very individual. “You must understand that the way your body will respond to the particular regime that you are following will be very different from that of anyone else. You’ll have to understand what works for your body. A lot of factors matter here. Gender matters as men lose weight differently as compared to women, younger people loose weight in a different manner when compared to older people. Depending on the age group you are in, you will have to modify the process,” she says.
Weight loss and older adults
What are things that are different for older people when it comes to weight loss? They definitely need to keep more patience than those who are younger. The body will respond but a little more slowly, believes Devgan.
Golden rules of weight loss for older adults
Fix your attitude right: “Your attitude and mindset is important. A lot of older people tend to believe that I am old so it is okay to be overweight as it is slightly difficult to lose weight fast for them. They need to shake this mindset. Everyone can lose weight and everyone’s pace is different,” says Devgan.
Opt for exercise that’s appropriate for you: Exercise has to be very different as you keep growing older... When you are in your 50s or 60s, along with some cardio, you need to add strength training as well. Why? Because your muscular tone and metabolism are going down with age and some strength training will enhance that. Walking regularly is great but you can add a strength training component to it to make it better for your body. some strength
Do not exercise at a stretch: In order to get the best weight loss outcome, you must not exercise at a stretch, say for an entire hour and half or more. You split it into two sections of half an hour each or even three sections of 20 minutes each throughout the day. Also, figure out your exercise personality and choose an exercise that you enjoy. For example, if you’re a social person and you are asked to go for solitary walks or do yoga, you might not be able to sustain that. You may enjoy doing a group fitness class instead.
Get open to exercise variety: Variety in exercise is also important. With variety you won’t get bored and will make use of the various muscle groups of your body making it more fruitful for weight loss.
Pay attention to the food you are consuming: All nutrients are very important for weight loss. For women particularly, calcium and iron are extremely important at all age groups. If you’re deficient in iron there are enough studies that show that you put on a lot of weight.
Including Vitamin D and Magnesium are a must: Vitamin D and Magnesium are two extremely important nutrients for weight loss which are not spoken about quite often. Especially when you cross your 40s and come to the 50s. You need to check Vitamin D counts regularly, take supplements and step out into the sun for sometime during the day. Magnesium is a very important weight loss mineral as it helps to amp up our metabolism which tends to dip as we age.
Your protein intake must be prompt: You must have a very solid focus on the protein intake as you get older. You have to keep checking if you are having enough protein every day. A simple formula is to have 1 gram of protein for 1 kg of your body weight every day. If you are 60 kg, you must eat 60 gms of protein.
How do you do that? Make sure there’s at least one protein source in all the three meals you take in a day. It could be both a vegetarian and non-vegetarian source of protein. For breakfast, it could be eggs, dhokla, cheela or kala chana chaat. For lunch, there should be one big chunk of protein - could be daal, chicken, fish or egg, or curd. Then again add another one protein source for dinner. In addition, one out of the two snacks you take - one in the mid-morning and one in the evening—should be protein. It could be one katori of Greek yoghurt or regular yoghurt with some chia seeds in it or a bowl of sprouts chaat. “In case you feel your energy lacking or you are going for an extra hour of exercise, you can add another protein snack,” says Devgan.
Eat right portions: “Always remember food is your friend. For everyone, different food will be required at different stages of life. Ideally, there’s no food that needs to be completely removed from your diet. Just be mindful of the right portions you eat, and eat more of the good food and less of the food that doesn’t do so much good for your body. However, always consume natural foods and not the ones that come out of packets and cans.”
Do not count the calories and be mindful of nutrition: “When you are looking at food please don’t calculate how many calories it is going to give you. Only understand how much nutrition it would give you and how good it would be for you. Don’t get obsessed about calorie counting and that way you will be able to choose good food,” she suggests.
All About Glycemic Index, Glycemic Load & Fullness Factor
What's the glycemic index (GI)? It is the rate at which the food increases the blood sugar in your body. However Glycemic load (GL) goes a little deeper and gives you a more detailed picture in terms of the fibre count that the food produces in your body alongside giving the blood sugar count, which basically neutralises the high sugar count of a particular food. Thus, it basically tells you how a food reacts inside your body.
Devgan points out: “GL is a better indicator than GI but the problem is that they only rate carbohydrate-based foods. Devgan says that Fullness factor is a new scale dieticians use which is more scientifically driven and well-researched. It rates all kinds of food, be it protein, carbs, high or fat foods. The Fullness factor index tells us how long a particular food will keep you full which is actually the key to crack weight loss. “When a food keeps you full for longer, consciously, you eat less and that helps in weight loss.”
Keep an eye on loss of appetite: As we grow older, our hypothalamus (The hypothalamus is a portion of the brain that contains a number of small nuclei with a variety of functions. One of the most important functions of the hypothalamus is to link the nervous system to the endocrine system via the pituitary gland) gets a little more desensitised. The thirst and hunger signals get muted. This could also lead to dehydration issues. It is important for older adults to make sure they are eating in appropriate quantities. “If you eat less your metabolism drops and you aren’t getting enough weight loss nutrients. You may eat smaller portions but have to keep eating all day,” says Devgan.
Remain hydrated always: Hydration is very important as every enzyme in our system requires water to function properly. The efficiency of every single cell, organ and enzyme will drop with less water. Your metabolism becomes sluggish with less water and your chances of gaining weight increases. Hydration is primarily water and anything additional is a bonus. You could have naturally flavoured water, veggies and fruits with a high count of water. You can’t count coffee cups or tea cups as water as caffeine makes you excrete more and dehydrate. No aerated drinks or processed drinks are included.
Weight loss and importance of raw and fermented foods in your diet
Raw foods and fermented foods are two easiest ways to gain more health, believes Devgan.
In our body, we have more than hundreds of enzymes that do different functions. The digestive enzymes make sure whatever we are eating we are absorbing the nutrients from it and not gaining weight. It also keeps insulin resistance in check. Because of our toxic lifestyle, the enzymes do not get replenished in our system due to stress eating, junk food eating and more. When a certain portion of your diet is eaten raw, these enzymes get replenished. When we eat everything cooked, the ability of these foods to replenish enzymes get restricted.
“Thirty per cent of your daily food should be raw. Two fruits, one-quarter plate of salad or green juice and a bowl of sprouts can meet that.”
Toxic lifestyles and pill-popping make the good bacteria in our stomach shrink and bad bacteria increase to skew the balance. In order to make sure our gut stays well, we will have to make sure we provide good bacteria to our body through our diet in the form of probiotics. Fermented foods like Idlis and dosas are a great source of these probiotics.
Association of the mind with the food we eat
Follow one simple principle: When you eat, you simply eat.
“When we eat we are not doing just that, we do something else along with the process of eating. Either we are talking over the phone or our computer or television is on. That shouldn’t be the case and when we eat we should only focus on eating as that’s the only time when our mind registers the food we are eating. Unless that happens, the stomach will not be ready to perform its functions and the food won’t nourish us. That will impact our health. Spend your meal time mindfully and you will notice the difference within a week,” says Devgan.
If weight loss or the diet dilemmas have been bothering you, following these simple strategies can help you lose weight even in your silver years and help you in healthy ageing.
Featured image: Total Shape
Sound sleep is a non-negotiable biological necessity.
Don’t believe us? Even the experts think so. Professor Matthew Paul Walker, a scientist and professor of neuroscience and psychology at the University of California and a public intellectual focused on the subject of sleep says sleep deprivation is one of the most alarming and significant public health concerns of the 21st century, which, if not attended to, can lead to a major health catastrophe, especially among older adults.
Why? Reasons are plenty and serious enough for all of us to pay immediate attention to.
Adequate sleep is an essential food for robust ageing
Data released by the National Heart, Lung, and Blood Institute reveals that people with insufficient sleep - anything less than eight hours of sound sleep - have a greater risk of multiple health complications, including heart disease, kidney disease, high blood pressure, diabetes, stroke, and obesity.
To add to it, Professor Walker comes up with some interesting facts about sleep deprivation and ageing in his Ted Talk titled ‘Sleep is your superpower’. He says, “With adequate sleep, lots of significant learning activities take place in the Hippocampus of the brain which is your memory inbox. Without sleep we observe a 40 per cent deficit in the ability of the brain to make new memories. Also, as we get older our learning and memory abilities begin to fail and decline and we also discover that our sleep gets worse as we age. Decline in learning memory and sleep deprivation are found to be co-occurring and significantly inter-related. Thus, inadequate sleep is directly linked to Alzheimer’s and Dementia.”
Apart from that, Walker also highlights a 24 per cent rise in heart attacks when we lose just an hour of sleep. Likewise, when one gains an hour of sleep, there is a whopping 21 per cent reduction in heart attacks. Also, with insufficient sleep, there’s a leaping increase in incidence of car crashes, road traffic accidents, even suicide rates.
Sleep can give your body fighting powers. Did you know if one has sleep deprivation for an entire night, one won’t have adequate natural killing cells in their immune system that identify dangerous, unwanted elements in the body and eliminate them? If one’s sleep gets restricted by 4 hours a day, one will observe a 70 per cent drop in natural killer cell activity which is, undoubtedly, a concerning state of immune deficiency.
“This enhances the risk of development of numerous forms of cancer like that of the bowel, prostate and breast. The link between cancer and sleep deprivation is so strong that the World Health Organisation (WHO) has declared nighttime working shifts as a probable carcinogen because of the disruption of the sleep wake cycle they cause,” says the sleep expert.
Lack of sleep has also been found to disrupt a human’s genetic activity - either distort or enhance it.
As we grow older, we often find it difficult to fall asleep. These healthy bedtime habits can help you have a sound sleep
Have a sleep routine: Go to bed at the same time and wake up at the same time, whether it’s a weekday or weekend. The body’s internal clock is designed to a specific sleep-wake cycle, which, if disrupted, can mess up with your sleep and disbalance your circadian rhythm - a natural, internal process that regulates the sleep–wake cycle and repeats roughly every 24 hours. Thus, attempting to catch up on missed sleep on weekends may not be of any use.
Keep it cool: Your body temperature needs to drop down to a certain temperature to fall asleep and continue being asleep. Thus, the ideal temperature of the room where you sleep should be around 18 degrees Celsius and not more than that. A cooler bedroom is always a sleep appetiser compared to a warmer one.
Cut your caffeine and nicotine intake: Caffeine and nicotine are non-inducers of sleep and can keep you awake for very long. Walker says: “Caffeine temporarily blocks the signal from adenosine, a crucial sleep chemical in your brain, which nonetheless continues to accumulate. This pent-up adenosine eventually breaks through, causing a dramatic crash, often at inopportune times. Nicotine, another stimulant, can lead to very light sleep.” He also suggests not drinking too much alcohol before bedtime. While a little of it may help one relax, too much of it can rob one of REM sleep - a kind of sleep that occurs at intervals during the night and is characterised by rapid eye movements, more dreaming and bodily movement, and faster pulse and breathing - which is important for optimal restoration of one’s brain.
Avoid late night workout: While exercise can be a great sleep inducer, you must be watchful of the time of your workout. Late night exercise or an intensive yoga session just before your bedtime can make it harder for your brain to shut down for sleep. Thus, it is better to keep away from your treadmill during the late hours.
Do not eat heavy before bedtime: Heavy dinners can cause indigestion and hamper sound sleep. Also, consuming a lot of fluids before bedtime is not advisable as it can lead to frequent urge to urinate and disturb your sleep. Having light food with moderate fluids at dinner is helpful and won’t disrupt your hours of adequate sleep.
Manage your medication schedule: Certain medications and drugs can mess up your sleep pattern. In case you face trouble sleeping due to your medication dosage, you may consult with your doctor and take your medicines earlier in the day.
Relax before hitting your bed: Engage yourself in some kind of unwinding activities like reading, listening to music and more to help yourself process difficult emotions before bed.
Take a hot bath: A hot bath before bedtime helps your body to drop temperature when you hit the bed, makes you more relaxed and helps you fall asleep soon.
Keep your bedroom dark and gadget free: For sound sleep, it is essential to keep your gadgets and electronic devices away. Put your phones, laptops and other gadgets in a different room before you hit your bed. Ensure your bedroom is dark and noise free. Let go of the alarm clock and sleep well.
Get some natural sun: Exposing yourself to the natural sunlight for about half an hour in a day, especially during the early morning helps in regulating sleep patterns and induce good sleep.
What do you do when you lie down for quite some time and still do not fall asleep. The sleep expert suggests not to lie down on bed for a prolonged duration as that’s an ineffective sleep strategy. In case you don’t get to sleep within 25 - 30 minutes of lying down, you can wake up and do a relaxing activity until you doze off.
Following these simple tips can help you preserve your daily sound sleep and help you age healthy.
All you need to know about the benefits of pulses in your diet.
How well do you know your pulses?
Pulses are nutrient-dense foods rich in protein, carbohydrate, soluble fibre, minerals and polyphenols, that are a valuable addition to everyone’s diet. In this article, let us explore what pulses are, the benefits and how we can incorporate more of them into our diet.
What are pulses?
The term ‘pulses’ refers to leguminous crops harvested solely for use as dry grains (like chickpeas, kidney beans, black gram, lentils, etc). This term excludes crops like green peas and green beans that are also legumes, but are harvested green and are used as vegetables. Leguminous crops used mainly for oil extraction (soybean, groundnuts), also do not come under the definition of a pulse.
What are its benefits?
According to FAO (Food and Agriculture Organisation), pulses are beneficial for food security, health, sustainable agriculture and climate change mitigation. The broad genetic diversity of pulses allows for the selection of climate-resilient varieties, and their nitrogen-fixing ability improves soil quality and produces a low carbon footprint.
Studies have shown that people who eat at least ½ cup of pulses per day have higher intakes of fibre, protein, calcium, potassium, folate, zinc, iron, and magnesium and lower intakes of total and saturated fat. Pulses contain no cholesterol, have a low glycaemic index and have low-fat content – hence they can contribute to fighting non-communicable diseases like diabetes and obesity. Most national dietary guidelines recommend pulses as part of a healthy diet.
Did you know we even have a day dedicated to pulses?
To improve the awareness about the usefulness of pulses, FAO has declared 10 February as World Pulses Day. The theme of World Pulses Day 2020 was ‘Plant proteins for a sustainable future.
How to incorporate pulses in your diet?
Worldwide, there is a decline in the consumption of pulses and people are moving towards animal proteins. Though India also shows this trend, fortunately, many of our staple foods in India, be it sweets or savoury items, are made with pulses. Pulses are a common ingredient of our Indian thali, with the ever-famous dal. Sundal or usli is a traditional evening snack. Blended soaked pulses are used to make pesarattu, khaman and adai, which are used as breakfast items. Our household idli and dosa uses urad or black gram dal. Toddlers are given a cereal pulse porridge. Our besan laddoos, Puran polis as well as namkeens, like roasted channa and moong are also made from pulses.
When grains like rice or millets are combined with pulses, they form a more complete source of protein. So, they are considered complementary foods, each containing the amino acids that are lacking in the other. However, our regular Indian meals tend to be grain-heavy, leading to a host of lifestyle diseases like obesity and diabetes.
One way to reduce the grain proportion in our diet can be to increase the proportion of pulses (along with adding more vegetables) while reducing the proportion of rice or roti in our meals. An example can be to double the quantity of dal (pulse) in our Bisi bele bath or Khichdi while reducing the quantity of grain/cereal in it, thereby boosting the nutrient density of the food.
Not craving Indian? Some interesting ways in which we can enjoy pulses include making chickpea hummus, chickpea/bean mayo, bean and vegetable salad, cooked bean vegetable chaat, bean tikki, among others. These are fusions of international recipes with a healthy twist that can appeal to the generation next.
It is important to note that dry pulses contain some anti-nutrients like phytate, lectins and tannins that can hinder nutrient absorption. However, there are steps we can take to neutralise these anti-nutrient factors and enhance the nutritional quality and bioavailability of nutrients in our pulses. Here are some ways to do so:
National Health Servies (NHS) UK has a ‘5 A Day’ slogan that advises consuming two portions of fruits (160 g), two portions of vegetables (160 g) and one portion of pulses (80g). It can help people easily meet their nutritional requirements.
Incorporating the humble pulse into our diet in both traditional and modern ways can be beneficial not only for our health but also for the health of our planet, without compromising on our palette.
All you need to know about the benefits of telemedicine.
Today, booking a doctor appointment only takes a matter of minutes. Gone are the days of calling the doctor's office and waiting on hold etc. Now, you can simply go online and access services like Apollo24/7, Practo and many more.
Yet, a lot of patients find themselves lost somewhere down the line in this process. It could be that they picked a new doctor or specialist and weren't happy with the consultation or it was hard to get a hold of the doctor at the practice or have any follow-up questions answered — there is no one point of contact they can talk to.
This is where a service like Syncremedies helps bridge the gap between doctors and patients. Not only can you book your regular phone or video consultations with a general physician, but you also have the added benefit of booking a 360-degree, Integrative medicine consultation, by choosing to talk to an Allopathy, Homeopathy and Ayurvedic practitioner all at the same time, to come up with the best possible treatment option.
In addition to this, your case is assigned to a healthcare coordinator from your very first appointment. The coordinator will track everything from diagnosis, regular follow-ups and remotely monitor your progress per the treatment suggested by the doctor.
In the case that the patient needs to see the doctor, the same doctor they've spoken to online during a teleconsultation will be sent to their home for an in-person visit, thus ensuring a continued, comfortable doctor-patient relationship. This continuity in care enhances the efficacy in patient care.
Another very important thing it does is maintain one single, centralized point of contact between the doctor and patient at all times to answer any questions, deal with any new developments in terms of symptoms or the need to run additional tests etc. Syncremedies can execute and deliver on ANY service that the doctor prescribes at the convenience of their home.
Thus, the patient doesn't have to contact different labs and scanning centers for reports, since Syncremedies' cumulates all the reports and makes it conveniently available online and further communicates the result with the doctor so that the follow-up on next steps is handled seamlessly.
In today's rapidly changing medical care industry, positive patient experience throughout the lifecycle of diagnosis and treatment is as important as is the availability and access to expert medical care.
Benefits of Teleconsultation
If you need more information about our service partner, Syncremedies, you can call +918884886567 or visit syncremedies.com
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Find out how journaling can be beneficial for older adults.
When a Mumbai-based 90-year-old eminent business school lecturer was brought to a psychiatrist by his daughter, he was struggling hard with acute anxiety and depression, that too for over a decade’s time. All these started soon after he lost his wife, sank into loneliness and isolation and lost interest in engaging with his family and friends. While he did not want to take any medication or go for counseling, the psychiatrist suggested journaling as a treatment option. And guess what, within a very short period of practicing journaling, the nonagenarian came to terms with his conditions. Now, he has become super active, been able to fight loneliness and got engaged with his family members and is a pro in spending quality time with his grandchildren.
Not just this nonagenarian, a study highlighting the importance of journaling reveals that about 47 per cent of older adults suffering from chronic health conditions like asthma and rheumatoid arthritis and stress-induced mental conditions in the habit of journaling, show a remarkable improvement compared to those who are suffering from similar conditions but are not into journaling. Penning down their stressful experiences appears to bring in a great deal of relief among them.
What is journaling?
Journaling or expressive writing is the practice of writing a diary or journal exploring the thoughts and emotions experienced in life. Dr Santosh Bangar, a geriatric psychiatrist and neuropsychiatrist from Mumbai believes that journaling helps in processing one’s emotions in a positive way and can create an opportunity for self-dialogue. While simply putting down words may not be that effective, but effective journaling can lead to enhanced quality of life among older adults.
“Journaling can be effective for many different reasons. It helps you clear your head, make important connections between thoughts, feelings, and behaviours and even buffer or reduce the effects of stress and mental illness. While journaling is a very popular hobby among older adults in Western countries, it is not that popular among Indian seniors. This could be due to our social and cultural influences. However, I recommend it for every older adult for ample benefits journaling offers,” says Dr Bangar.
Ways by which journaling can help Indian older adults
It can help in preserving memories and enhance memory skills: Memories fading away is a common age-related aspect often observed among older adults. This could lead to various serious consequences and result in a certain extent of stress and irritability, affecting the quality of life. Writing down daily life activities and simply re-reading the past journal entries later on, is a great way to preserve memories.
Older adults tend to lose their cognitive functions of which memory is a vital cognitive process allowing one to encode, store and retrieve information. Loss of memory skills could be due to various factors like lack of adequate sleep, stress, anxiety, deficiency of Vitamin B12 and more. While the loss of memory skills can cause a lot of trouble for seniors in their day-to-day lives, regular journaling can help them remember things and keep their memories fresh.
It can help create a routine for older adults: Having a daily routine is extremely beneficial for older adults as it helps them predict and plan their day. It's also easier to cope with memory and cognitive issues when daily activities are priorly scheduled and predictable. And journaling is a fantastic way of creating and maintaining a regular timetable for seniors.
It can act as stress-buster: Stress is perhaps the origin of most physical and mental health issues in today’s world, especially during the post-pandemic time. Undoubtedly, older adults have been affected the most due to pandemic-induced stress and anxiety. Journaling is a safe and healthy way of helping seniors deal with stress, tackle overwhelming emotions and keep their mental stability in control.
It can help improve coordination skills: Making use of the sense organs on a daily basis is an ideal way to keep the coordination skills up to the mark and mind and body active. Writing is a great way of keeping and improving motor skills, coordination and communication skills of older adults.
Dr Bangar adds: “Journaling has been found to enhance the sense of well-being, reduce symptoms of anxiety and depression, improve working memory, dexterity and creativity, curb stress, preserve vocabulary, provide possible protection against Dementia and add structure to the day. Journaling can also help in physical illnesses which are stress-related like Hypertension, Diabetes, Arthritis and Pain Disorder.”
Tips on starting with journaling if you’re a newbie
All you need is a notebook and pen to start journaling. However, to make it fun and interesting, you may try doing a collection of fancy, eco-friendly, themed notebooks of your choice. To begin with you may choose to write about your day to day experiences. Here are some suggestions:
There are ample reasons why journaling could be the best hobby option during your silver years. Please do try it out and let us know about your experience at connect@silvertalkies.com or in the comments below.
Shwetha Ravishankar writes about how homecare is making accessibility to healthcare convenient and affordable for older adults.
Today, India has the second-largest global population of ageing citizens, and this number is expected to rise further by 2050. Nevertheless, India still largely lacks the basic infrastructure and expertise to support the health and welfare of the elderly.
According to a recent survey across the country, for most Indian senior citizens the biggest concerns are access to reliable healthcare and affordability. In addition to this most aged people do not receive the dignity of care that they deserve.
This is where a service like Syncremedies Healthcare comes in with their @Home Care Program that offers a comprehensive suite of services that take care of your healthcare needs right in the comfort of your home.
Ease of Mobility
Lack of physical infrastructure can become a major deterrent for the elderly. There are just a few functional care homes or public ramps that are available for older citizens who are unable to move, like those who need wheelchair access. This scenario is applicable in both their own homes and in public spaces, like roads and malls. Syncremedies offers medical equipment purchase and rental services. The range of equipment includes wheelchairs, special beds, walking sticks and so much more.
Right Care for Specific Diseases
When it comes to specific geriatric diseases, there are not many experts out there that can provide quality assistance. From mental health to Dementia and Alzheimer’s Disease, among others. In such cases having a caretaker or a nurse at home to care for senior citizens becomes imperative. With services across India, Syncremedies’ expert team of doctors and trained caretakers offer unparalleled support to the elderly for any medical condition.
Inadequate Access to Emergency Medical Care
One of the major fears for most senior citizens living by themselves is how to get access to medical care if required, especially at night. With more elderly care services like Syncremedies available now, it is now easier to access physicians online for immediate medical care.
Change in Family Structure
Nuclear families are the norm these days, which adds to the complexity of elder care management. Especially in the case of non-resident Indian (NRI) children who live far away and are constantly worried for their aging parents.
Signing up for an elder care service is easy but managing it from afar can be very difficult since the many sub-agencies that take care of different services like nurse care, caretaker, physiotherapists, often do not talk to one another which creates a break in communication.
Syncremedies is one such seamless service that houses their @Home Care Program under one centralized operation which ensures that you always have one point of contact person who is managing the various healthcare partners involved.
The team of experienced doctors at Syncremedics is expert who offers their diagnosis along with assistance from allied services essential for therapeutic compliance such as Nursing care, Diagnostic tests, Medication delivery, medical equipment, and yoga.
Recognizing that everyone’s needs are different, they offer customized plans for each of their clients.
Services Offered:
If you need more information about our service partner, Syncremedies, you can call +918884886567
An annual preventive health screening can help you prevent non-communicable diseases which are the top killers in India. Here's why and how.
While annual preventive health screening is a common concept in Japan and a mandatory to-do for the citizens, in India, not much importance is given to it. This has adverse consequences. A 2018 World Health Organisation (WHO) report shows that Japan is ranked number 1 and has the world’s longest life expectancy at 84.2 years. This is attributed to the regular health screening - a way of life and part of the culture in Japan. When compared to this, India, where the attitude towards preventive health screening is quite poor, is ranked number 125 with an average life expectancy of only 68 years - a difference of over 15 years of quality life!
Not just life expectancy, the lack of awareness about the importance of preventive health screening in India has greater associated concerns. The Lancet’s Global Burden of Disease Report, 2020 reveals that Cardiovascular Diseases (CVD), Respiratory Diseases like Chronic Obstructive Pulmonary Disease (COPD), Stroke and Cancer are the top killers in the country. When compared to similar data from 2009, there has been a remarkable shift from communicable or infectious diseases to non-communicable, lifestyle disorders in terms of the death burden. Non-communicable diseases like CVD and Cancer progress slowly, are often irreversible, cannot be completely cured but are well-controlled.
For these diseases, prevention is better than cure and regular preventive screening can not only help us identify the early risk of developing these diseases but also allows us to take steps to overcome them before they reach an irreversible state.
Here’s how preventive health screening can benefit those suffering from non-communicable diseases which are also the top killers in India.
Cardiovascular diseases - In Cardiovascular Diseases and Ischemic Heart Disease and Heart attacks, the problem is due to a slow build-up of cholesterol-laden plaques along the walls of the coronary arteries. This leads to a narrowing of the blood vessels and a decrease in blood supply to the heart muscle/myocardium. When there is a sudden critical decrease in blood supply, it leads to a heart attack. Preventive health screening can help us identify these plaques early, even when they are as low as 10-20 per cent and help us initiate measures to reverse the build-up of these plaques such as diet control, exercise, stopping smoking and alcohol, reducing stress and high blood pressure, controlling diabetes and overcoming obesity.
Diabetes - Diabetes Mellitus is a harbinger of many diseases. A person with poorly controlled sugars is at risk for injury to multiple organs in the body such as the eye, the heart and blood vessels, the kidney, the brain and the nerves. It also reduces a person’s immunity making him/her prone to infections. The HbA1c or Glycosylated Hemoglobin levels tell us how a person’s sugar control is over the last 3 months. Also, the fat-muscle distribution with the overall fat content gives us a good idea of their diet and activity level which in turn impacts an individual’s sugar control. Preventive screening for diabetes especially in people with a family history of the disease can help them understand their risks and create lifestyle modifications thereby decreasing their risk of developing Diabetes in the future. In proven Diabetics, screening gives them a good idea of areas of focus for achieving better control of their sugars, thereby avoiding complications.
Cancer - Cancers in India mostly prove to be fatal because most cancers are diagnosed late. Early diagnosis of cancers often results in curative treatment and improved survival. Delayed diagnosis results in a decreased chance of survival and also a heavy financial, physical, emotional and social strain. Current Indian healthcare checkups are not yet focused on cancer screening and this adds to the burden. A shift in this attitude can help roll back the rise of cancer as a leading cause of death in India.
Dr Tausif Ahmed Thangalvadi, Medical Director and General Manager of NURA gives us a detailed understanding of how NURA’s advanced technology-enabled preventive health screening can deal with the common non-communicable diseases in India.
Cardiovascular diseases - We use a low dose CT scan to measure the amount of Calcium deposited in the Coronary Arteries and calculate the Heart Calcium score. This helps us infer the amount of plaque build-up in the arteries and estimate whether the person has a risk of a heart attack. A zero score means the person has healthy coronaries and minimal risk of a heart attack. The higher the score, the higher the risk. This method allows us to non-invasively detect calcium deposits of even as low as 10-20%. We also use the Lipid profile to check cholesterol levels in the person’s blood thereby being able to better advise them on their diet and exercise level. The same is done by our Visceral Fat test, which shows the amount of fat deposited around our organs internally and can be a risk for organ injury in the future. Knowing their visceral fat level can motivate people to work harder to reduce their risk. The procedure for Heart Calcium score and Visceral Fat Score is a CT scan and for lipid profile is a routine blood test.
Diabetes - We use the HbA1c to check for one’s sugar control over the last 3 months. As all diabetologists will tell you, it is a better test to monitor sugar control rather than routine fasting and postprandial blood sugar. This is a routine blood test. We also measure the Fat Mass Index (FMI), which is an indicator to measure one’s fat mass relative to his height. It is more accurate than the Body Mass Index (BMI) and also a more specific indicator of a person’s health status than BMI. This helps to calculate the average calorie requirement per day thereby helping the guest plan their diet better. We use the DEXA scan to measure the muscle-fat ratio and their distribution to help one do focused exercises for areas that would help make the greatest difference for them. The more muscle we have, the better is our glucose utilisation thereby resulting in better sugar control.
Cancer - At NURA, we screen for four important cancers for men, namely Oral, Lung, Colon and Prostate. And for five important cancers in women - Breast, Cervical, Oral, Lung and Colon. We screen for each of them in the following manner:
Oral cancer: We use white and blue light to take images of the oral cavity and our artificial intelligence (Ai) enabled equipment picks up all suspicious areas. This is further checked and validated by our in-house dentist before the report is issued.
Lung Cancer: We use an ultra low dose CT scan (using only 0.2mGy) to image the lung and look for any suspicious nodules or lesions. Our Ai enabled CT scanners can pick up even the smallest lesions with accuracy thereby ensuring that nothing is missed.
Colon Cancer: We use a FIT kit (Fecal Immunochemical Test Kit) to collect a stool sample from the guest and look for any signs suggestive of colon cancer. This helps us to identify any early risk which may then need a referral to a specialist.
Prostate Cancer: We use the internationally accepted blood test for the prostate-specific antigen to diagnose any risk of prostate cancer which is the 2nd most common cancer in men across the world. It is a simple blood test.
Breast Cancer: The gold standard for diagnosing breast cancer is a mammogram but many women hesitate as it is often painful. At NURA, our sweet fit paddle technology allows women to experience the mammogram with the least amount of pain and help screen for breast cancer. All women must get themselves screened regularly for breast cancer which is the most common cancer in the world.
Cervical cancer: It is the 3rd most common cancer-specific to women. At NURA, we do a colposcopy and capture images of the cervix. The Ai enabled equipment allows us to pick up areas of concern. This is then checked by a gynaecologist and validated before the report is issued. This has been proven internationally to be better than a pap smear and a direct visualisation with the naked eye.
Dr Thangalvadi adds: “Preventive Health Screening is no doubt an essential concept to nip the non-communicable diseases at the bud and at NURA, we try to make appropriate use of Japan’s advanced technology to ensure the patients have a safe, accurate, comfortable and quick experience.”
Visit NURA’s website for more information and register for your preventive health screening slot booking for healthy ageing.
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Wendy Mitchell was diagnosed with early-onset Dementia in 2014 and now spreads awareness about it. She shares her solutions for living with Dementia.
Wendy Mitchell’s bestselling book co-written with journalist Anna Wharton, Somebody I Used To Know, begins with a fall. Mitchell is out on a run, in the hope of clearing the fog that seems to be settling on her mind and the unexplained fatigue. She suddenly falls, despite no bumps or obstructions in the path. It starts a chain of checkups and tests to figure out what’s going wrong until she’s diagnosed with Early Onset Alzheimer’s. It’s a shock for Mitchell, an active administrator at the British National Health Service. She’s a woman who has the nursing roster at work memorized and is everyone’s go-to person for problem-solving. And she is only 58 at that time.
Bizarrely, the diagnosis was also a relief, Mitchell told Silver Talkies during a live talk from her home in UK. The memory lapses had continued, with Mitchell trying to stay on top of things with Post-It notes at work and reminders scribbled all over. “It gave a name to what was happening to me; actually, put an end to all the uncertainties, all the ifs, buts and maybes, and I could continue to live my life.”
Mitchell, now 65, spreads awareness about Dementia across the world. “So often when people hear the word dementia, they go into a state of depression, believing it to be the end. And that’s what happened to me because nobody told me any different. Due to the stigma associated with Dementia, people forget there’s a beginning and a middle. So much life still to be lived, albeit differently. And with help and support, I was determined to continue living life and having adventures no matter what other people thought.”
Dementia hasn’t affected Mitchell’s ability with words, and she has used that to her advantage. She begins each morning playing Words with Friends on her iPad. She stays in touch with the outside world through her social media accounts. Twitter is where she can have “silent conversations” with the world each time she feels lonely. Mitchell writes a blog called Which me am I today. She calls it her memory journal, in which she notes down all the feelings, triumphs and challenges she has had. “I can type words quicker than I can think and speak them because that part of my brain hasn’t been affected yet,” she tells us, showing a sheaf of papers where she has written down the words she needs to speak.
Mitchell asserts that everyone’s experience of Dementia is different. For instance, some people can still cook and feel hunger, which she cannot. In her daily endeavour to outmanoeuvre Dementia, Mitchell has incorporated simple solutions that, for now, work for her. She shared some of them with us.
When the noise and sounds of the city started affecting her, Mitchell, who lives alone, moved to a quieter village. But she had to ensure her house looked different from the others and didn’t accidentally walk into a neighbour’s house. A DIY person at heart, Mitchell stuck two forget-me-not tiles on each side of her front door to make it known to herself that this house was hers.
Simple but innovative ideas continue throughout Mitchell’s home and life. For example, her tiny kitchen had two doors that confused her as she couldn’t remember where they lead to. “My solution was to get my screwdriver out and take the doors down. So I can now see exactly where each door leads to without getting confused.”
Vision is often affected in some people with Dementia, says Mitchell, as the brain doesn’t interpret the information correctly. For example, going down the stairs can be challenging if the edge isn’t marked because it can look like a slide or an escalator. Likewise, mats in doorways that are black can look like a hole in the floor. Wall-mounted television sets, when switched off, can seem like a gaping black hole. A Bed & Breakfast that Mitchell visits put a red pillowcase over the TV – a simple solution to block out the black.
‘The easiest way to find out if a room or area is Dementia friendly is to take a black and white photograph. If the shades of grey, the contrasts, are marked, you’ve probably got it right.”
Mitchell writes in her book about how she loved to bake. But she can barely feel hunger now and has to set an alarm to remind herself to eat. She suggests that if a person with Dementia is sitting with the plate of food untouched, there could be many reasons.
The food could be on a plate of the wrong colour – like white rice on a white plate; or it could be food that looks complicated. “I find I can’t cut through now if the plate is of the wrong shape. So I prefer to eat out of a bowl because with a plate, everything just gets shuffled off, and I make a mess.”
One of the most important points she makes is to allow a person with Dementia to do things as long as they can. “For the kindest reasons in the world, people want to wrap us up in cotton wool and start doing everything for us. But if we don’t do something day after day after day, we forget!” Mitchell’s two very supportive daughters would help her put on her coat before leaving the house. “Then I began to realize when they weren’t there, I was struggling to put it on.” That’s when she asked her daughters to stop. Instead, Mitchell says, however hard it may be, families should enable people with Dementia to stay independent as long as possible. “It gives us the feeling that we can achieve something because Dementia strips away so much from us.”
Like many others, Mitchell took time to accept her diagnosis. July 31, 2014 is embedded in her mind as the day she was diagnosed with Young Onset Alzheimer’s. Mitchell’s book juxtaposes her life with memories of the person she was. As she loses her ability to cook and her job at the NHS, she struggles to understand and accept her condition. Apart from her determination to not let Dementia take over, her involvement with the Alzheimer’s Society, spreading awareness about it and meeting others with Dementia is what slowly turns things around.
Mitchell says support groups always help. “Never be alone with Dementia because it’s a very lonely place. Find other people that are going through what you’re going through.” She insists it’s essential for caregivers too. “Look after yourselves because otherwise, you can’t look after us.”
You can find the complete talk with Wendy Mitchell for Silver Talkies Live here.
To know more about Dementia and associated resources in India, see the links below:
If you think fitness is an affair only for youngsters, these health-conscious older adults will prove you wrong. Daily workouts, weight-lifting, gymming or living on a strict diet – these 60 plus fitness enthusiasts offer stiff competition to many youngsters! We reached out to senior citizens who have taken fitness as their lockdown mantra and have set examples of fit and healthy living.
From 103 kgs to 79 kgs in a couple of months, this 71-year-old’s fitness journey is inspiring
Delhi-based 71-year-old Surinder Nayyar’s day begins with a walk for 45 minutes followed by suitable Yoga exercises and Pranayam for the next 30 minutes. A little later in the day, he works out for about 20 to 30 minutes while browsing fitness videos for senior citizens on YouTube. He spends about two hours daily on his fitness routine.
A senior Central Government official, Nayyar suffered a ligament tear in 1967 during a wrestling match. It led to him quitting the sport and a lifelong knee problem. After retirement, he continued working with the government as a consultant, choosing to avoid knee replacement surgery. It led to restricted mobility gradually until lack of exercise led to a weight increase of 103 kgs. That’s when Nayyar quit his consultant role, decided to have knee replacement surgery and focus on fitness.
After post-surgery physiotherapy, Nayyar’s daughter advised him to join Fittr, an online fitness company in India to manage his body weight. After an extensive fitness regime and protein-based quantitative diet, Nayyar now weighs 79.8 kgs and has reached his goal in a few month’s time.
Nayyar says: “I’ve experienced a wonderful difference because of my ongoing daily routine. I feel so young and people who saw me earlier take my advice now on controlling body weight. I’ve become a fitness coach for many seniors now and that’s such a feel-good factor.”
He also lives on a strict diet chart prepared by his dietician daughter-in-law. His protein-based quantified diet contains 1491 calories. He eats apples, eggs and poha for breakfast, dal, sabji and roti for lunch and snacks on eggs, apples and almonds in the evening. Dinner is the same as lunch and all food proportions are quantified.
The health-conscious Nayyars (Image Courtesy: Facebook)
Nayyar is often accompanied by his wife, Trilochan Kaur Nayyar in his daily workouts. “Doing the exercise together makes it an enjoyable experience for both of us and it doesn’t feel dull,” says Nayyar. Watch out how the Nayyar couple keeps themselves fit here.
Nayyar believes seniors must remain fit in order to enjoy good health. “Only if you are healthy, you will be able to enjoy the worldly pleasures. Connect with a good fitness coach and dietician and focus on your fitness under expert guidance right from today.”
This 72-year-old walked 10,000 steps in one and half hour during the lockdown
South Delhi-based Jyoti Saxena, 72, took to fitness about a decade back. She joined a gym for daily workouts, trained with a personal trainer, did weight lifting and squats and reduced her weight from 80 kgs to 70 kgs in about 15 month’s time.
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“In 2010 I had gained too much weight and experienced severe pain in my knee joints. At that point of time, I wasn’t using my left knee at all and started limping. It is then when I decided to join a gym, control my body weight, get back in shape and become healthier once again. Since then there has been no looking back. I subscribed to fitness magazines, joined fitness communities and continued doing regular workouts till I could lose considerable weight,” says Saxena.
Saxena was diagnosed with some chronic conditions including TB in her abdomen and renal anomalies some years back. She started losing the ability to do rigorous workouts but did not give up. “I do daily yoga and Pranayama and try to remain as active as possible doing moderate exercises. During the lockdown, I completed walking 10,000 steps in just about 90 minutes’ time. I have joined several pandemic relief platforms, have shared my experiences with larger audiences online and have tipped them off on the importance of remaining fit and active across various forums. At present, I am on a high protein diet with 2 gms of salt and 5 gms of white butter and controlling my carbs intake as well,” she says.
This sexagenarian has achieved full range movement of upper arms, thanks to her lockdown fitness regime
Bangalore-based Kanchana Arni who is a Silver Talkies Club Member was facing issues with her upper arm flexibility and difficulty in bending her elbows until she registered for the online fitness classes organised by Silver Talkies in collaboration with Growing Young, a preventive healthcare company focusing on senior wellness.
A glimpse of Silver Talkies’ online fitness class for seniors
“While just a year back, before the pandemic-induced lockdown I experienced unbelievable pain in moving my upper arm, had issues with my muscles, movement and lifting. I felt stiffness while putting on clothes and sometimes pain as well. However, after a year’s fitness class, my pain has vanished and I can move my upper arm and bend my elbows without flinching. I am able to do the full range of movement of my upper arms now. I have also joined the yoga classes organised by Silver Talkies, experiencing significant overall well-being and would not like to miss out on my daily dose of fitness ever,” she says.
How has your fitness journey helped you in your older years? Please share your experiences with us below in the comments section. If you want to know more about the online fitness and yoga sessions organised by Silver Talkies for 55+, visit our Facebook Page or write to us at connect@silvertalkies.com.
Shwetha Ravishankar, content marketing consultant at Syncremedies, tells us how the concept of Integrative Medicine as offered by Synceremedies is impactful and beneficial.
Syncremedies has introduced the novel concept of “Integrative Medicine” consultations, online and in person. Here, the patient’s ailments are addressed by expert doctors from three streams of medicine, namely Ayurveda, Homeopathy, and Allopathy. The team of doctors after learning the patient’s ailment history, discuss among themselves about the best cumulative treatment plan, keeping the patient’s successful and speedy recovery at the forefront.
Integrative medicine is healing-oriented rather than disease-focused. Integrative medicine promotes the combination of mind, body, and spirit to regain the body’s natural equilibrium to achieve health. The five most common advantages of integrated medicine cited by patients and practitioners include:
Being healing-oriented
Integrative medicine’s focus, like the ancient systems of Ayurveda, is about wellness, vitality, and healing, rather than focusing just on the disease. It begins with the assumption that there is an imbalance or an energy blockage that leads to the manifestations of illness and disease. Restoring the body’s natural state of equilibrium can help bring back balance and promote health.
Focus on the mind, body, and spirit
Too often patients go to doctors with multiple symptoms affecting multiple organ systems and see different practitioners for each of their problems. Integrative medicine puts the focus on how various symptoms can be connected and search for the root cause, rather than treating individual symptoms. Apart from suggested treatments, it’s also based on the patient’s ability to adhere to recommendations such as cultural dietary restrictions and an exercise program.
Emphasizing the therapeutic relationship
There is a new focus on the doctor-patient partnership, which makes us stop and take a closer look at how the clinician’s role changed? Are there better ways to handle health issues that can only be managed, not cured? The integrative partnership guides and advises patients regarding treatment options. Together, the doctor and patient decide on the best plan of action. In the case of management of chronic diseases, attention is placed on meeting the patient where they are at the time. By addressing obstacles to lifestyle changes and sticking to treatment plans, the likelihood of success with the recommended therapy increases.
Personalized medicine
Recommendations may vary in integrative treatment plans according to each individual’s unique case. In customizing treatment plans to meet individual needs, doctors scrutinize and evaluate alternative therapies the same way as traditional therapies. Integrative assessments are highly personalized. Patients are asked about everything from environmental exposures to personal relationships. All factors are considered when determining a treatment route and thus its success.
Using all appropriate therapies
By combining traditional allopathic treatment options along with mind-body therapies, such as yoga and meditation, a treatment plan is developed that utilizes the least invasive therapies first. Attaining a sense of ‘wellbeing’ becomes especially important in cases where cure is not always possible.
BOOK AN APPOINTMENT:
If you have an ailment or condition that you’ve been suffering from for a while now, maybe it is time now to book an appointment with our Integrative medicine experts.
Contact us at +91 8884886567
Email us at: contactus@syncremedies.com
Please note that this is a promotional feature.
Shwetha Ravishankar, content marketing consultant at Syncremedies tells us how Syncremedies is bringing the best possible medical care to your doorstep, especially at the trying times of a pandemic.
Unlike most other things that we go online for, from grocery shopping to apparel and more; healthcare has always been an in-person experience due to comfort, confidentiality, and easy access. But that quickly changed between 2020 and 2021, thanks to the COVID-19 pandemic.
Most people, especially the older adults have either stopped visiting their physicians, diagnostics centers, and pharmacies in person or have reduced the frequency of their visits. Reasons are that they may not be easily accessible at the time of the pandemic or they’re simply afraid of exposure to and contracting the virus.
In order to facilitate easy access to healthcare, Syncremedies has stepped in to provide a host of services like tele/video doctor consultations via Whatsapp or on the phone and at-home doctor consultations, among others to bring the best possible medical care at your doorstep– thus bridging the gap between quality medical care and accessibility.
The program is designed with a comprehensive suite of services available both on an episodic basis and an annual subscription program. Here are some of our services that you can avail from the comfort and safety of your home:
With this kind of dedicated, end-to-end care and doctors with a vested interest in your health focusing on disease management rather than just an episodic interaction, you won’t have to worry for your healthcare needs during the time of a health crisis. To add to its suite of top-notch, innovative services, Syncremedies has become one of the pioneers in introducing the novel concept of integrated medicine online. It is a 3-doctor panel consisting of a Homeopathy, Allopathy, and Ayurveda doctor who will have a joint consultation with the patients in order to better serve them and put them on the path to full recovery. Integrated medicine is for anyone who appreciates a holistic approach to their health or is looking to explore alternative medicine to better serve their health issues.
In addition to its regular services, Syncremedies has developed COVID-19-specific services to help the elderly during this time.
COVID-19 swab sample collection
ICU setup at home
COVID-19 at-home care kits
Mental Health Counselors
Syncremedies Vision for the future
Syncremedies is eager to meet and engage with senior citizens by hosting health camps in apartment complexes, assisted living communities, create informative health talks both webinars and in-person, set up health pop-ups specific to one kind of ailment like diabetes, heart disease, etc. It is also looking to expand its services to other metropolitan and tier 1 cities across the country.
To know more about Syncremedies, its services, and what it has in its pipeline, check it out at Syncremedies.com or call at +91 8884886567. You can also email at contactus@syncremedies.com. Follow Syncremedies on Facebook for daily health tips, news, conversations, and more. Also, sign up for its monthly newsletter, In-Sync for a chance to meet the team, read about the latest in health and wellness, useful tips, quick and nutritious recipes, Ayurvedic know-hows and so much more.
Please note: This is a promotional feature.
Image Courtesy: Syncremedies
Here are a few online tools that can help you track and find vaccination slots and centers easily.
If you have not taken the jabs of the Covid-19 vaccine yet or are waiting to get your second jab, you must be aware that booking a slot for the vaccination is not at all easy. With the increasing dearth of vaccines in the country, the slots are either filling up quickly or are not available at all. Booking an appointment via the Cowin portal has become a game of the fastest fingers first. In order to make your job easier, Silver Talkies has collated a few online tools that can help you track and find vaccination slots and centers easily.
Please note that all users will still have to go to the CoWIN platform to book an appointment at a nearby center. These trackers make it easier by showing you the availability by Pincode.
WhatsApp MyGov Corona Helpdesk: Launched in March last year, this chatbot can help you locate the nearest vaccine centers in a simple manner.
All you need to do is:
Covid-19 Vaccine Tracker For India: This is an open-source vaccine tracker that monitors the nearest vaccine appointment availability. Once the slots become available, this tracker sends email alerts to the users.
All you need to do is:
The Google Sheet will monitor your request on a daily basis and send you email alerts at 8:00 AM every day, informing you about the availability of vaccine slots in and around your areas.
FindSlot.in: This website will easily guide you to navigate through Covid vaccine center tracking. It uses Cowin open API and lets you seek vaccine centers according to your city or PIN Code or by entering your state and district to find the nearest center for a covid vaccine. You will not be able to book a slot on this site but can quickly track availability.
Getjab.in: This website can help you get email alerts on open vaccination slots in your area.
You will have to sign up and ask for notifications on vaccine slot availability in your district. All you need to do is enter your name, district, and email ID and you will receive an email about when the slot is available.
Facebook Vaccine Finder tool: Available in 17 languages, this tool has been rolled out by Facebook in partnership with the Government of India. It helps you to find the location of the nearest vaccine center and their operational hours as provided by GOI. Here, you can also find walk-in options for older adults or those who are 45+. It will give you a link with which you can register on the Cowin website and schedule vaccination appointments too. All you need to do is visit Facebook India mobile app to get access to the vaccine finder tool.
PayTM alerts: Paytm has also launched a ‘Covid-19 Vaccine Finder’ tool, which is integrated inside the app to help citizens check the availability of vaccination slots for a specific date. The tool is available on the PayTM app store. Users need to enter postal codes or district names, and select their age groups. In case of unavailability, click on the ‘notify me when slots are available’ option to get real-time alerts.
Telegram Alerts: You can also get vaccination slot alerts through the messenger service Telegram. To receive the alerts, you need to install the Telegram app from Google Play/App Store and then click on the link when you select the district where you are looking to get vaccinated. Make use of these tools, book your slot and get your jabs without delay.
Here’s all you need to know about NURA bringing the best of Japanese high-end technology-enabled preventive health screening to India.
Preventive healthcare that includes the measures taken for disease prevention plays a significant role in determining one’s health condition, especially among older adults. It considerably reduces the potential risk of conditions like Cardiovascular Diseases and Cancer which are the top killers in India. Studies show that preventive health screening also increases life expectancy without increasing costs. A preventive health checkup aids in detecting diseases at an early stage and helps in avoiding or slowing down disease progression to help you age better. Eventually, it reduces healthcare costs as, through timely check-ups, one can avoid costly medical services.
Despite the obvious benefits that preventive health check-ups provide, it is still not common practice among Indians. Reasons vary from lack of awareness on the importance of preventive healthcare to existing misconceptions and scare about the same. It was no different for Chitra Nair, a Bengaluru-based creative professional working in the senior care industry until she visited NURA, a collaboration of Fujifilm Healthcare & Dr Kutty’s Healthcare, bringing the best of Japanese high-end technology-enabled preventive health screening to India.
“Thanks to my 120 minutes long health screening experience at NURA, all my apprehensions of taking the much needed yet dreaded annual health screening turned into a pleasant and comfortable exercise,” says Nair.
Nair was at ease right from the time of booking the appointment and coordinating with NURA’s front desk executives. They followed up, sent reminders and promised her a wonderful experience. The experience at NURA for a medical appointment felt more like a Zen-like spa and Nair drifted into a sense of calm as she walked in and was guided to her scheduled tests.
“At no point in time did I have to check on which room I had to go next, who I had to meet or wait to be attended to. All of this is what makes the usual annual health screening an uphill task. The CT scan which I usually find extremely scary and oftentimes pushed aside because of the high radiation was surprisingly relaxing and quick. The final consultation with the doctor was extremely clear and broken down to easily understandable jargon. It is because of the hand holding right from the onset of the process, the top-notch hospitality by each and every team member at NURA and the cutting edge AI features smoothly integrated to make a comprehensive health screening feel absolutely stress free, quick and accurate that I would highly recommend a health screening at NURA, especially for senior citizens,” she adds.
Conceptualisation of NURA in India and its impact
According to the World Health Organisation’s 2014 Global Health Statistics, Japanese people have an average lifespan of 84 years and are known to have the longest life expectancy in the world. While men have an average of 80 years and are 8th in the world, women are number one at 87 years old.
“One of the reasons behind Japanese longevity is its prevention culture that is achieved through the nation-wide annual health screening for cancer and other lifestyle diseases. This does not exist in India and hence, we decided to launch NURA, the Japanese way of advanced full body health screening center in India. Our aim is to increase the survival rate by early detection and provide this service extensively across over 100 centers,” says Mr. Masaharu Morita, New Business Manager, FUJIFILM (Tokyo).
Over the last three months since its inception in India, NURA has observed people being able to see the inside of their bodies through AI-enabled imaging and not just via the usual blood tests, realise the importance of preventive health screenings to stay away from future risks and make lifestyle changes to bar the progression of diseases. “Around 10 to 20 percent of the guests who opted for a preventive health screening at NURA till now were found to have some kind of health abnormalities and were put on treatment,” says Morita.
Why is Japanese tech-enabled preventive health screening important?
Screening helps you identify previously unrecognised health risks. Japan’s rate of early detection of lifestyle diseases like cancer compared to India is a proof of how adopting Japanese technology of preventive health screening can lead to early detection and reduce India’s burden of these chronic conditions.
Morita says, “In India, cancer tends to be detected only in the more advanced stages. On the contrary, early detection in Japan due to mandatory annual preventive screening shows better survival rate. The Japanese survival rate from Cancer is 70 per cent and it is less than 30 per cent in India. NURA uses the latest Japanese ultra radiation CT that is equivalent to a chest X-Ray or a round trip from India to the USA or exposure to one week of natural radiation. NURA’s breast cancer screening equipment can detect very early stages of cancer by 3D digital Mammography and AI technology with confirmation by a doctor and the procedure is not painful unlike other procedures.”
NURA also conducts heart calcium scoring through ultra low radiation CT imaging which visibly identifies the risk of a heart attack. Heart attack is the leading cause of death in India and its risk rate has become higher with the Coronavirus pandemic. NURA’s heart calcium scoring enables you to detect your heart calcium score visibly before and after the pandemic and helps you to stay safe.
All that NURA offers
A 120 minutes screening program that lets you stay in control of your health: NURA’s screening program helps you address concerns you might have about your health. They test for the most common cancers and lifestyle diseases in men and women so that you are not caught off guard by an unforeseen health risk. The screening does not require you to fast.
Their advanced imaging technology lets them do more with less: The AI-assisted devices from Fujifilm allow them to deliver intelligent scanning and predictions at ultra-low doses of radiation. This means that you’re always screened using optimal amounts of radiation, allowing for safe and regular screening.
Gender-specific screening packages: NURA’s packages include tests for the most common cancers and lifestyle diseases in men and women.
Reports that are easy to understand: You receive a comprehensive health report on the same day that is easy to read and you won’t need a doctor to decipher for you.
Interiors you’d love to spend time in: NURA is an annual health screening center for asymptomatic people and is very different from a hospital or a diagnostic center where ailing patients come in. NURA treats you as a guest in a hotel with luxurious facilities and personal assistants going around with you throughout your entire screening journey. Expect short waits and an infection control environment.
Digital health records: You get to access your health records anytime through the NURA website or app.
Independent opinions you can trust: NURA doctors provide you with an objective diagnosis based on AI-enhanced screening tests. The general physician explains the report organ by organ, it’s easy to understand.
Excellent post-screening support: Their strong network of partners helps you complete the cycle of care.
If you are a wellness enthusiast, who believes that prevention is better than cure and wants to detect an anomaly at the earliest, visit NURA to experience preventive health screening in just two hours’ time. Your experience is likely to be luxurious, hassle-free, painless and tech-empowered. Visit NURA’s website (https://nura.in/lp/thenuraexperience/) and register for your slot booking. See how time flies while getting your vitals checked.
Please note that this is a promotional feature.
Image Courtesy: NURA
Here’s a quick guide from Silver Talkies on Covid-19 resources to help you tackle India’s second wave.
The second wave of Covid-19 pandemic in India has once again triggered fear, panic and anxiety. However, we must realise that while 15.6 million Coronavirus cases have been reported in India as of now, 13.5 million have recovered as well. It is time to remain positive, rational, safe and keep a handy list of appropriate resources needed to tackle the virus. Here’s a quick guide from Silver Talkies.
Here’s a state-wise list of Covid-19 helplines that you can use to report and seek help for any kind of pandemic-related issues.
Andhra Pradesh 0866-2410978
Arunachal Pradesh 9436055743
Assam 6913347770
Bihar 104
Chhattisgarh 104
Goa 104
Gujarat 104
Haryana 8558893911
Himachal Pradesh 104
Jharkhand 104
Karnataka 104
Kerala 0471-2552056
Madhya Pradesh 104
Maharashtra 020-26127394
Manipur 3852411668
Meghalaya 108
Mizoram 102
Nagaland 7005539653
Odisha 9439994859
Punjab 104
Rajasthan 0141-2225624
Sikkim 104
Tamil Nadu 044-29510500
Telangana 104
Tripura 0381-2315879
Uttarakhand 104
Uttar Pradesh 18001805145
West Bengal 1800313444222, 0332341260
Union Territory (UT) & Helpline Numbers
Andaman and Nicobar
Islands 03192-232102
Chandigarh 9779558282
Dadra and Nagar Haveli and Daman & Diu 104
Delhi 011-22307145
Jammu & Kashmir 01912520982, 0194-2440283
Ladakh 01982256462
Lakshadweep 104
Puducherry 104
Source: Ministry of Health And Family Welfare, Government of India
Some Covid control room numbers from metro cities that you must keep handy
Pune: State Call Center: 011 – 23978046, Helpline: 104, Pune Control Center : 020 – 26127394
The helpline email ID for Coronavirus: ncov2019@gov.in
Source: PMC
Delhi: 011-25073502, 011-25073505, 011-25073507, 011-25073508 (Kapashera, Najafgarh and Dwarka subdivision)
Source: District South West Delhi website
Bangalore: 104, 1075, 080-46848600, 080-66692000, 9745697456, 080-1070 (SEOC),
9980299802 (maintained by Department of Information and Public Relations). Last week BBMP introduced a helpline number 1912 that offers direct Covid19-related assistance.
Source: Government of Karnataka website
Kolkata: CORONA ( COVID 19 ) HELPLINE: 011-23978046 OR 1075
KOLKATA COVID 19 HELPLINE:033-22143526, 23412600
STATE CONTROL ROOM: 1070
COVID QUERY: 1800313444222
CONTROL ROOM: 033-23571075, 1083, 3636
CURFEW PASS: https://coronapass.kolkatapolice.org/
Source: CAG office, Kolkata
Mumbai:
Source: BMC
Chennai: Toll-free: 1800 1205 55550
Covid-19 symptoms helpline : 044 2538 4520
Volunteering & Emergency Travel Pass : 044 2538 4530
Source: Greater Chennai Corporation
Hyderabad: GHMC: (Email ID – ghmc.covid19@gmail.com), 9154686557, 9154686558, 915468654902
Secretariat: 040-23450624, 040-2345073503
Food: 9154170990, 915417099104
Ration: 994868249505
Civil Supply: 040-2344777006
Police Help Line: 901020362607
Accomodation and Food: 9702385140, 9701385138, 917799775008
Collectorate -Hyd: 040-23202813
Source: Government of Telangana website
Resources on Hospital Beds Availability
Delhi
Out of 20,351 total hospital beds available in Delhi, including both government and private hospitals, only 2,151 are vacant until today. Click this government website to get the entire list of hospitals, current bed status and their contact numbers: https://coronabeds.jantasamvad.org/beds.html.
Pune
For getting a bed and checking the status of bed availability in a private or government hospital in Pune, you may call the following numbers: 020 – 25502106 / 25502107, 020 – 25502108 and 020 – 25502109 / 25502110.
Bangalore
In order to get the detailed status of available Covid-19 beds, click here: https://apps.bbmpgov.in/covidbedstatus/
Kolkata
Out of 8169 beds available in Kolkata, 4453 are vacant until today. For the entire list, click here: https://www.wbhealth.gov.in/uploaded_files/corona/Vacant_bed_status_as_on_21.04_.2021_.pdf
Mumbai
Out of 29,004 hospital beds available in Mumbai, 22,160 beds are already occupied and 6,844 beds remain vacant until today.
Click here to get the detailed updated status: https://stopcoronavirus.mcgm.gov.in/assets/docs/Dashboard.pdf
Hyderabad
For a list of Regular isolation beds, beds with oxygen, ICU ventilator beds available in govt and private hospitals, click here: https://health.telangana.gov.in/
Chennai
According to the data shared by the state health department, out of the 4,363 beds, suspected Covid patients occupy 714. In five hospitals which includes, Rajiv Gandhi Government General Hospital (RGGGH), Stanley Medical College (SMC), Kavery Medical Centre and Hospital (KMCH), Omandurar Government Medical College, and King Institute of Preventive Medicine and Research across the city, 1542 beds are vacant as of April 18. For detailed status, click here: https://tnhealth.tn.gov.in/
Steps one must follow cross the country to seek help for Covid-19 care
1. Know your municipality ward: go online to check this as per your area
2. Keep your Aadhar card details (best is a photo) handy on your phone
3. Keep handy on phone the COVID positive report/CT report
4. Keep handy on phone, the COVID war room no. of your respective municipality wards
5. When you call the number, a designated municipal official, either the PRO or the doctor on duty, will guide you thereafter
6. Seek help early
Did you ever link joint pain with eating the right kind of food? Our expert Bhavani Swaminathan, nutritionist, member of Indian Dietetic Association and a Certified Diabetes Educator tells you how a good diet can help you ease it. Swaminathan is the founder of AAKANKSHA: Desire For Wellness, an organisation that helps individuals to eat intelligently and lead a healthy lifestyle. She is currently pursuing a PhD in Diabetes Management.
Bhavani Swaminathan
When there is an unexplained joint pain and stiffness, which does not have any apparent cause, this can be a symptom of the onset of arthritis causing inflammation of joints, pain, stiffness & disability. There are more than 100 forms of arthritis. Let us understand the main reason behind this problem. The issue of arthritis does not develop in a day or within a short period. It starts with a minor health issue initially, which is when the food is left undigested.
Food is fuel, and the food we eat supplies nutrients to each cell of our body. The digestion process starts from our mouth when we start chewing the food. If we consciously chew each piece of food at least 15-20 times, then half the digestion happens in the mouth itself. Now the partially digested food travels through the oesophagus and enters the small intestine and gets digested completely. The remaining undigested food moves down through large intestine and is thrown out of the body. The digested food gets assimilated and supplies nutrients to every cell of the body. If the digestion does not happen properly, then the undigested food remains inside and starts spreading toxins in the body. These toxins called ‘ama’ obstruct the joints and their movements.
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Today is World Cancer Day and here is all that a geriatric cancer caregiver must keep in mind while taking care of an elderly loved one.
When his wife got diagnosed with metastatic colon cancer at the age of 63 in 2017, West Bengal based Pranab Basu was 69 and became the sole caregiver to his wife for around two and a half years till she succumbed to the condition. Basu was retired and could devote time to taking care of his wife but being managing everything single-handedly at an older age resulted in burnout and emotional toll.
Bangalore-based Rajendra (name changed), 29 and his sexagenarian mother have been taking care of his 78-year-old father battling throat cancer since 2016. Managing expenses for the prolonged treatment over the last five years has been a major challenge for him.
The patients in the above cases suffer from geriatric cancer. By 2026, geriatric cancer is projected to be as much as 20 per cent and is anticipated to be one of the leading causes of morbidity and mortality in India, reveals the latest population-based survey. A report brought out by the University College of Medical Sciences, New Delhi has highlighted that caregivers for a majority of older adults suffering from cancer are their family members, trying hard day and night to take care of their elderly loved ones until their last day, often with very little help and support. On World Cancer Day, experts and caregivers of geriatric cancer patients share their challenges and coping advice with us.
Challenges faced by geriatric cancer caregivers
Basu who is now a volunteer certified counsellor for geriatric cancer caregivers and is associated with Eastern India Palliative Care Kolkata and various other caregiver support groups says: “Geriatric cancer or cancer at 60 plus by its nature is extremely challenging as it comes with a number of co-morbidities like Diabetes, Hypertension, Thyroid and more that makes the condition more complicated and caregiving tougher. It is as challenging as being forced to manage not one but many conditions at the same time. It leads to confusion and helplessness among caregivers, stress, anxiety, worries, frustration and a constant feeling of guilt about not being able to make the appropriate decision or take the best care of the elderly loved one. Above all, the lack of courage to see your loved one writhe in pain and yet not being able to help them much.”
Apart from emotional burnout, the other major barrier that hits most geriatric cancer caregivers is the burden of long-term expenses. “Taking care of the finances is no less tough compared to taking care of the loved one with cancer. Cancer treatment is not short spanned but extends until the last day of the one fighting it. Also, very few medical insurances are designed for supporting cancer treatments and in this area, there are lots to be done to make cancer treatment affordable for the middle class,” adds Rajendra.
Things a geriatric cancer caregiver must keep in mind
Bhavana Issar, CEO and founder of Caregiver Saathi, an organisation that creates an ecosystem of well-being and healing for a primary caregiver, enlists the top things that a geriatric cancer caregiver must be aware of.
Keep in mind the dignity and independence of your loved one: It is a must for a caregiver to connect with their loved ones and include their opinion in the care decisions on a regular basis, lend an ear to their wishes, unfulfilled desires and more.
Become their support system: One of the primary responsibilities of the caregiver is to build a physical and emotional infrastructure so that they feel supported and encouraged. Also, recognizing the emotional needs of the loved ones, as each person is unique.
Be mindful of your own wellbeing: Unless the caregivers remain healthy, both physically and mentally, they will not be able to carry on their role adequately. Caregivers are often seen to experience compassion fatigue, impatience or frustration. Being in touch with other caregivers, getting guidance on caregiving, learning how to be a caregiver and practicing how to process one’s emotions are critical for any caregiver.
Maintain effective communication with your loved one: One of the most significant residues of caregiving is regret or the feeling that one hasn’t done enough. So, making sure that the caregiver and the loved one who is being looked after are in regular authentic communication with each other and other family members is essential.
Seek help when required: Caregivers need to remember that it’s okay to take help. Caregiving does not need to be endured alone. Sometimes the help comes from extended family, sometimes from professionals and sometimes from others who have walked similar journeys.
Some tips that will make life easy for geriatric caregivers
Planning to take the first dose of the Covid-19 vaccine? Here’s all you must know before it.
India has begun its second phase of Covid-19 vaccination rollout from March 1 for regular citizens targeting older adults. In the last 10 days, over 24.4 million doses of vaccines have been administered across the country and 4.36 million Indians have been already completely vaccinated. While Indian seniors have started registering and queuing up for a jab at the vaccination centres many are still facing issues and have a lot of queries around it. Here is a collated list of tips to help seniors go through a hassle-free vaccination process.
Tips one must be aware of
For those with some specific conditions
“While it takes hardly a few minutes to get vaccinated, the whole procedure may require around 5 to 6 hours. Also, I did not experience any pain or any side effects immediately after the vaccination but after around 10 to 12 hours, I developed a painful lump around the site of the injection, had a mild temperature, felt a little dizzy and very weak which lasted for the next two days. Overall it went well and I am all set for my second dose after 28 days,” says 53-year-old Mousumi Chatterjee from Bengal who has recently taken her first jab.
Common side-effects that you may develop after the first jab include injection site pain, injection site swelling, injection site redness, injection site itching, stiffness in the upper arm, weakness in the injection arm, body ache, headache, fever, malaise, weakness, rashes, nausea, and vomiting.
Difficulty in breathing, swelling of your face and throat, a fast heartbeat, rash all over your body, and dizziness and weakness could be some of the severe allergies post-vaccination, but the chances are very rare for these.
All you need to know about the Covid-19 vaccination drive in India.
India rolled out her first mega Covid-19 vaccination drive on January 16, the ‘world’s largest vaccination drive’ until now. Latest reports reveal that around 2.24 lakh healthcare and frontline workers have been vaccinated in the first two days of the drive. According to the National Expert Group on Vaccine Administration for Covid-19, older adults above 50 years are on second priority to get the jab right after frontline workers. Keeping in mind the various queries and confusion that a senior citizen may have about the first of its kind Covid-19 vaccine, Silver Talkies reached out to Dr Arvind Kasthuri, Professor and Coordinator, Senior Citizen Health Service, Department of Community Health, St Johns Medical College, Bengaluru to get his expert opinion on everything we need to know about the vaccine before opting for it. Excerpts below.
Dr Arvind Kasthuri
Q. At present, how many Covid-19 vaccines are available in India? What do we need to know about them? Are there any other upcoming vaccines?
Dr Arvind: At the moment we have two vaccines in India – COVISHIELD and COVAXIN. There are 7 other vaccines in various stages of development, but these will take time to get approval for general use.
COVISHIELD is based on the Oxford University/Astra Zeneca vaccine and is built on a weakened version of a similar virus which causes the body to provoke an immune response. COVAXIN uses an unactivated version of the COVID-19 virus, which will provoke the body to mount an immune response.
Both the vaccines are considered to be safe, and they produce an immune response when given to people. COVAXIN has yet to publish the efficacy data, which means the data on how many people got COVID infection after getting the vaccine compared to how many got it when they were not given the vaccine. The Government, therefore, is releasing COVAXIN on a “trial” mode, where those who get it will be monitored actively for a few weeks after they get the vaccine. COVISHIELD is considered to be about 70% efficacious in this context.
Q. What is the rollout plan for the Covid-19 vaccine in India?
Dr Arvind: The rollout plan is to first target healthcare workers, followed by those above 50 years of age and those below 50 with chronic disease. The healthcare worker rollout began on January 16 and is expected to take a month or so. In this time, the vaccine will be made available to healthcare workers who register with the government health authority. Both vaccines are available, with COVISHIELD being supplied to some districts and COVAXIN to others.
In a given location, the healthcare workers cannot choose which vaccine they receive and the vaccine that is supplied to them will be offered free of cost. If a healthcare worker opts not to receive the vaccine, he or she will have to wait till the vaccines are available in the open market, when they can buy them.
Q. How many vaccination centres will be put up across the country?
Dr Arvind: Vaccines will be offered through both government and private hospitals. For instance, 273 such vaccination centres have been identified in Karnataka, including 6 in Bengaluru on Day 1 and this is likely to increase in the weeks ahead.
Speaking of Karnataka, at the moment, the centres are largely government hospitals (with the exception of St John’s hospital, the only private hospital to be identified on Day 1), but large private hospitals and medical colleges are likely to be identified as vaccination centres in the days ahead. Each centre has been given a clear guideline as to how their infrastructure and logistics must be handled. Each centre will have one or more vaccination booths, with each booth vaccinating a maximum of 100 individuals in a day.
Q. Where do senior citizens stand in terms of priority? Could you please give us a rough estimate of the different criteria that should decide on the priority among older adults to get vaccinated?
Dr Arvind: As stated earlier, the first phase is targeting healthcare workers and frontline workers. Those above 50 years of age including seniors, will be targeted next. At the moment, there is no guideline developed as to who within the group of seniors will receive higher priority – older adults, those with comorbidities or other considerations. We anticipate clarity on this in the weeks ahead. It is better to wait and watch what the government plans.
Q. Please throw some light on the dosage of the vaccination. Will it be different for senior citizens compared to the children and the youth?
Dr Arvind: The dose of the vaccine is 0.5 ml given intramuscular, on the left shoulder. It is given in two doses, 4-8 weeks apart. It is currently not recommended for those below 18 years of age, but the dose will not be different for those who are above 50 years.
Q. Will there be any side-effects of this vaccination among older adults? If yes, what are they?
Dr Arvind: The common side effects of both the vaccines are as with any other – injection site pain, headache, fatigue, muscle pain, discomfort, mild fever, chills and nausea. These are reported to happen in about 1 out of 10 people who get the vaccine. In general, any side effect that is disturbing must be reported to the site where the vaccine was received, or to a family doctor who will advise appropriate medication, usually mild anti-inflammatory drugs like Paracetamol.
A lot of us took the vaccine in the last few days, including myself. We’re doing fine, so far so good.
Q How do senior citizens register to get vaccinated?
Dr Arvind: Frankly speaking we still do not have the registration plan for the senior citizens as it will take some time to finish vaccinating the first two target priorities- the health workers and the frontline workers and then move on to the senior citizens.
At present, for the institutional health workers, the institution submits a list of their employees to the municipal health authority (E.g., BBMP for Bengaluru) and registers them. The health authority informs each health worker about the date, time and site of the vaccination via a text message. The non-institutional health workers have been asked to get registered by themselves with the local health authority. By the time we move on to the general public and begin with senior citizens, I am sure we will have some means of online registration as we cannot expect seniors to register themselves on their own.
Q. Are there any precautions that need to be taken before or after getting the vaccine?
Dr Arvind: There are no specific precautions to be taken before or after getting the vaccine. The conditions which are important considerations to decide if vaccination should not be taken/should be taken with precaution include the following:
– Known allergy to the vaccine or any of the components of the vaccine
– Pregnant women and those who are nursing their infants
– People who are severely ill at the time of vaccination should wait till they are well
– Immuno-compromised individuals, that is individuals who are taking any drug or suffering from any condition which makes their immune system weak may not get the same immune response as others. The family doctor should be able to advise on this.
– People with bleeding disorders or those taking aspirin. The vaccine is given into the muscle and this may cause bruising or bleeding in such individuals.
– People who have had COVID 19 infection can take the vaccine 4-8 weeks after testing negative.
India has begun its second phase of Covid-19 vaccination rollout from March 1 for regular citizens targeting the senior citizens and those in the middle age bracket with comorbidities.
Want to know about the registration process for the vaccine? Below is the guideline.
User Guide – Citizen registration Ver 1.1 (1)
Here’s a state-wise list of both government and private hospitals offering Covid-19 vaccination. The cost of the vaccination at private hospitals will be up to Rs 250 per person per dose, while this is free of cost at government health facilities.
BENGALURU
Government centres
KC General Hospital, Jayanagar
General Hospital, Bangalore
Medical College and Hospital
Bowring Medical College Hospital
CV Raman General Hospital
Private centres
Vikram Hospital
Manipal Hospital, Old Airport Road
Raghavendra People Tree Hospital
Sapthagiri Institute of Medical Sciences
Columbia Asia Hospital, Yeshwanthpur
Apollo Hospital, Sheshadripuram
Columbia Asia Hospital, Sarjapur
Columbia Asia Hospital, Whitefield
Fortis Hospital, Bannerghatta Road
Apollo Hospital, Bannerghatta Road
Sparsh Hospital
Rajarajeswari Medical College & Hospital
BGS Global Institute of Medical Sciences
Columbia Asia Hospital, Hebbal
Aster CMI Hospital, Hebbal
Apollo Speciality Hospital, Jayanagar
Dayanand Sagar Hospital, Kumaraswamy Layout;
Mallige Hospital
Sushrusha Hospital
MS Ramaiah Medical College and Hospital.
All rural centres in Karnataka will have both online and walk-in registration and vaccination, according to the health department.
DELHI
Government hospitals
Aruna Asaf Ali Govt. Hospital
Balak Ram Hospital
GB Pant Hospital
Hindu Rao Hospital
Kasturba Hospital
Lok Nayak Hospital
Maulana Azad Medical College
Lal Bahadur Shastri Hospital
ESI Hospital Rohini DH
Deep Chand Bandhu Hospital DH
Dr Baba Saheb Ambedkar Hospital Rohini DH
CRPF Composite Hospital, Jharoda Kalan
RHTC Najafgarh
Private hospitals
Delhi Heart and lung hospital
Jeevan Mala Hospital
Sir Ganga Ram City Hospital, Pusa Road
St. Stephens Hospital
Indian Spinal Injuries Centre
Metro Hospital and Cancer Institute
Saroj Medical Institute, Jail Road, Rohini
Sunrise Hospital, Rohini
Mool Chand Kharaiti Ram Hospital
National Heart Institute
VIMHANS Hospital
Maharaja Agrasen Hospital, Punjabi Bagh
Sanjeevan Hospital, Daryaganj
CHANDIGARH
Government Hospitals
GMCH-32 CHD B Block 5th Floor Site 1
GMCH-32 CHD B Block 5th Floor Site 2
GMSH-16 CHD OPD Block 5th Floor Site 1
GMSH-16 CHD OPD Block 3rd Floor Site 2
Police Hospital, Sector 26, Chandigarh
Police Hospital, Sector 26 Chandigarh Site 2
Civil Hospital, Sector 45, Chandigarh
Civil Hospital, Manimajra, Chandigarh
HWC (Dispensary), Sector 49, Chandigarh
PGIMER Lecture Theatre Complex, Chandigarh
Advance Pediatric Centre PGI, Chandigarh
Community Centre, Sector 23, Chandigarh
ESI Hospital, Ramdarbar, Chandigarh
Sites for online registration
GMSH 16 CHD OPD Block
GMCH 32 CHD B Block
Civil Hospital Sector 45 CHD
Civil Hospital Manimajra CHD
HWC, Sector 49
Private centres
Santokh Hospital, House Number 846, Sector 38-A
Chaitanya Hospital, Site No. 1 and 2, Sector, 44-C
Healing Hospital and Institute of Paramedical Sciences, SCO 18-19, Sector 34-A
Landmark Hospital, House Number 846, Sector 38-A
Dharam Hospital, House Number 2040, Sector 15-C
The Government COVID Vaccination Centres (CVC) will provide free vaccinations to age-appropriate groups, However, private hospitals will charge Rs 250 per person per dose.
PUNE
Currently, Pune has 14 Covid vaccination centres.
Kamla Nehru Hospital in Mangalwar Peth
Jayabhai Sutar Hospital in Kothrud
Rajiv Gandhi Hospital in Yerawada
Sassoon General Hospital
Ganagaram Karne hospital on Nagar road
Kalas Hospital in Yerawada
Malti Kachi Hospital in Bhavani Peth
Babasaheb Ambedkar Hospital in Dias Plot
Bindu Madhav Thackeray Hospital in Warje
Bartakke Hospital in Warje
Bhangire Hospital in Mohammadwadi
Pote Hospital in Sahakarnagar
Aundh Institute of Medical Science in Aundh
Inlaks and Budhrani Hospital in Koregaon Park
HYDERABAD
Gandhi Hospital
Osmania General hospital
Fever Hospital
ENT Hospital
SD EYE Hospital
DH King Koti
AH Malakpet
AH Golconda
AH Nampally
Paldar UPHC
Nizamia TIBI Hospital
ESIC Medical College Hospital
KERALA
Government centres
TSC Hospital Private Limited, N.H By pass road, S N Nagar, Kulathoor, Thiruvananthapuram
Attukal Devi Institute of Medical Sciences Ltd., Attukal, Manacaud Po., Thiruvananthapuram, Kerala 695009
India Hospitals, Gandhari Amman Kovil Rd, Santhi Nagar, Thampanoor, Thiruvananthapuram, Kerala 695001
Goutham Hospital, PB No. 868, Panayappilly, Kochi – 682 005
Silverline Hospital # 53/307 A, K P Vallon Road, Kadavanthara P O., Kochi: 682020
Lakshmi Hospital, Diwan’s Road, Ernakulam: 682016
ASSAM
Government centres
Guwahati Medical College & Hospital, Guwahati
Assam Medical College & Hospital, Dibrugarh
Silchar Medical College & Hospital, Silchar
Jorhat Medical College & Hospital, Jorhat
Fakhruddin Ali Ahmed Medical College & Hospital, Barpeta
Tezpur Medical College & Hospital, Tezpur
Diphu Medical College & Hospital, Diphu
Private centres (All in Guwahati)
Apollo Hospital
Downtown Hospital
GNRC Hospital
Healthcity Hospital
Nemcare Hospital
Marwari Nursing Home
CHENNAI
Public Health And Welfare Society, Ramakrishnapuram, West Mambalam
Appasamy Hospitals, Arumbakkam
Sampat Nursing Home, Mylapore
Faith Multispecialty Hospital, Konnur, Villivakkam
Soorya Hospital Saligramam, Saligramam
Xcellent Care Super Speciality, Velachery
Thalessemia Welfare Hospital, Taramani
Prashanth Hospital Velachery, Velachery
Adyar PM Hospital, Adyar
Bloom Health Care, Velachery
Abhijay Hospital Perambur, Venkatesan, Perambur, Chennai
Hycare Super Speciality Hospital, Arumbakkam
MUMBAI
CAMA Hospital
Jaslok Hospital
HN Reliance Hospital
Saiefee Hospital
Breach Candy Hospital
Bhatiya Hospital
Kasturba Hospital
TNMC & BYL Nair Ch. Hospital
JJ Hospital
Wockhardt Hospital
Prince Aly Khan
KEM Hospital
Global Hospital
LTMC & GH Sion Hospital
K J Somaya Hospital
Hinduja Hospital
SL Raheja Hospital
SRRC Children Hospital
BKC Jumbo Hospital
K B Bhabha Hospital, Bandra
Lilavati Hospital
Holy Family Hospital
Seven Hills Hospital
Cooper Hospital
Nanavati Hospital
Kokilaben Hospital
Nesco
SK Patil Hospital
MW Desai Hospital
BDBA Hospital
Dahisar Hospital
Bhagvati Hospital
Kurla Bhaba Hospital
Centennary Govandi Hospital
Barc Hospital
MAA Hospital
Rajawadi Hospital
Hindu Mahasabha Hospital
LH Hiranandani Hospital
Veer Savarkar Hospital
Mulund Jumbo
Sushrusha Hospital & Research Centre, Vikhroli
KJ Somaiya Hospital & Research Centre
PD Hinduja Hospital & MRC
Kaushalya Medical Foundation Trust
Masina Hospital
Holy Family Hospital
S L Raheja Hospital
Guru Nanak Hospital
Bombay Hospital
Fortis, Mulund
Conwest & Manjula S Badani Jain Hospital
Holy Spirit Hospital
Surana Sethia Hospital
Tata Hospital
Here’s all you need to know about eSanjeevani, the Union Health ministry’s national telemedicine initiative and how it offers older adults easy access to healthcare.
eSanjeevani, India’s first-of-its-kind nation-wide telemedicine service crossed 1 million teleconsultations on December 14, 2020. An initiative of the Union Health ministry, this national telemedicine initiative has emerged to be especially beneficial for older adults at the time of the pandemic and social distancing. Ten per cent users of eSanjeevani are over 60 years; the majority of these users have used eSanjeevani more than once.
The rollout of eSanjeevani ensuring adequate delivery of health services while battling the raging pandemic has not only brought about a remarkable digital transformation in healthcare services but is also estimated to be a spearheading initiative at a national scale by a developing country. Until now, patients from over 550 districts in India have used eSanjeevani, the health ministry said in a statement.
In a statement, the health ministry said: These stands as a testimony to the fact that the public has started preferring telemedicine over visiting hospital OPDs for consulting a doctor.
How does it work?
eSanjeevani initiative at present is serving in two streams in 28 states and union territories.
The first stream of this platform enables doctor-to-doctor teleconsultations. It is implemented around 6,000 health and wellness centres served by specialists and doctors in 240 hubs that the states have set up in district hospitals or medical colleges. As many as 20,000 paramedics, doctors and specialists have been trained to use these eSanjeevani Ayushman Bharat-Health and Wellness Centres (AB-HWCs).
The second stream, eSanjeevani OPD deals with offering remote healthcare services to patients at home, enabling contactless, risk-free and safe consultations between a patient and a doctor.
Already 8,000 doctors have been trained and onboarded on eSanjeevani OPD and about 1500 of them practice telemedicine on a regular basis in 225 online OPDs of which 190 are speciality OPDs and 30 are general ones. As of now, eSanjeevani has been serving around 14,000 patients across the country every day.
Tamil Nadu, Uttar Pradesh, Madhya Pradesh, Gujarat, Kerala, Himachal Pradesh, Andhra Pradesh, Karnataka, Uttarakhand and Maharashtra are the top ten states with maximum users of eSanjeevani.
Paves way for online super-specialty OPDs and accessible healthcare
The roll-out of eSanjeevani has made it possible to launch a wide range of speciality and super-speciality OPDs online, making healthcare more accessible. These OPDsinclude alternative medical systems as well like AYUSH and naturopathy.
Want to register yourself with eSanjeevani and consult with doctors from the comfort of your home? Visit their website for more information.
Primus Lifespaces announces a special offer for the Silver Talkies community.
FREE STANDARD INTERIOR WORTH Rs 3,50,000 & Rs 50,000 OFF ON OVERALL PRICING
The offer is valid until December 31, 2020. Hurry now to ask for a site visit.
Want to grab the special offer? Write to us at connect@silvertalkies.com
About Primus Lifespaces
Primus Lifespaces is not a fly-by-night senior living provider to build spaces. They are an organization that wants to redefine the concept of senior care through a range of services like in house restaurant, concierge service, medical centre, curated fun activities that have been carefully crafted for the most convenient and luxurious experiences for senior citizens.
Want to know more about them? Visit their website
Here are some of the video testimonials from the residents of Primus Lifespaces: Testimonial 1
Silver Talkies recently conducted an interactive talk with Adarsh Narahari, MD, PRIMUS SENIOR LIVING on how Senior Living Communities are making a difference during COVID-19. Here’s the video on our YouTube channel in case you would like to hear the talk again.
Here’s all you need to know about tackling Diabetes during a pandemic from the comfort of your home.
The lockdown period has resulted in a significant change in health trends among elders. It has resulted in weight gain and has enhanced the risk of type 2 diabetes mellitus, reveals the latest study conducted by the National Centre For Biotechnology Information (NCBI). The lockdown is said to have triggered prediabetes, a condition where blood sugar levels are higher than normal but not high enough to be called diabetes, among many seniors, point out doctors.
Doctors have highlighted that senior citizens must be aware of reasons leading to a rise in diabetes during the lockdown and how they can manage the condition from within the four walls of their homes.
Why does Diabetes spike?
According to Dr Subrata Das, senior consultant, Internal Medicine And Diabetology at Sakra World Hospital, Bangalore, a sedentary lifestyle could be the culprit.
“Lockdown has made us mostly inactive. Going out for a walk or jogging has become restricted, gyms and fitness centres have remained shut, the movement has become minimal. Working from home has made our schedule erratic, completely disrupting our metabolic system and pulling up the blood sugar count. Most of us have tried to do away with lockdown boredom by becoming chefs and home bakers, preparing and consuming yum dishes. A significant rise in the consumption of sweets, oily and greasy foods have been observed over the last few months of lockdown. Unhealthy eating habits have unfortunately become our lockdown companion and have blown up the blood sugar count.”
Stress and anxiety have also played a vital role in amping up blood sugar levels during the lockdown, believes Dr. Manjunath Malige, Chief Endocrinologist at Aster RV Hospital. “The older adults have been increasingly lonely, stressed out and anxious with the overall Covid-19 infection throughout the lockdown period. Also, they have been unable to see the doctor on a regular basis due to Covid-19 concerns. As a result, the blood sugar level has shot up among seniors,” he says.
Pointing out the symptoms that older adults must watch out for at this time, Dr Malige adds: “Increasing thirst, frequently passing urine, tiredness, delayed wound healing, weight loss are the symptoms that may indicate the onset of diabetes and an increase in blood sugar levels.”
Managing diabetes from within the four walls
Doctors have shared some valuable tips by which diabetes can be efficiently managed during the times of lockdown and social distancing.
Reversing diabetes with daily food
“Diabetes is a disease of insulin resistance, caused by consuming too much of w6 fats, refined and packaged foods, excessive carbohydrates in the form of grains and a very small quantity of vegetables, fruits and good fat. Such a diet is high in glucose metabolism and so we do not have the metabolic flexibility of burning both glucose and fat. When we shift to unrefined oils, salt, milk and grains and balance the meals to have metabolic flexibility, we reduce insulin resistance and thus burn the excess blood sugar thereby reversing diabetes,” says Rajan Mahendra, founder of Aarogyahaar.com, a nutrition platform that provides customised health plans for individuals.
He believes that having increasing herbs and spices such as cinnamon, turmeric, methi and eating more fruits and vegetables cooked in healthy saturated or monounsaturated fats, fewer grains, nuts and berries and fermented foods will help balance the diet that will help in the reversal of diabetes.
Following the above tips and eating the right food can help in managing diabetes during the pandemic among older adults.
Dr Naganath Narasimhan Prem, Chief Consultant, Geriatric Medicine at Jaslok Hospital, Mumbai throws light on the various ways by which you can improve your memory.
Dementia cannot really be prevented but it can be controlled by putting extensive effort in improving one’s memory as one ages, believes Dr Naganath Narasimhan Prem, Chief Consultant, Geriatric Medicine at Jaslok Hospital, Mumbai. Observing World Alzheimer’s Month, Dr Prem takes us through the various ways by which one can enhance their memory.
These include keeping the brain active and giving it adequate work-out, keeping the body active and engaging in daily physical exercise, having adequate sleep, eating the right foods, committing time for friends and nurturing relationships, trying out ways of reducing stress, laughing out loud, taking good care of one’s general health and resorting to practical ways of boosting memory. Read his guidance below.
Physical activities
Certain kinds of physical activities may work wonders in enhancing one’s memory. Here are some suggestions:
Brain game and social engagement: How do they work on memory?
Brain games play a vital role in practicing memory improvement among older adults. “Brain games are defined as any activity that stimulates your thinking. It may include word puzzles like Crossword and Scrabble, traditional games like Chess, Sudoku, and Bridge. It also includes creative outlets like painting, playing an instrument, or learning a new language,” explains Dr Prem.
Interestingly, it has been observed that brain games help sharpen thinking skills that tend to wane with age, such as processing speed, planning skills, reaction time, decision making, and short-term memory.
He adds: “Having meaningful friendships and a strong support system is vital not only to emotional health but also to brain health. Having groups with similar passions such as volunteering, crafts, and singing help.”
Memory boosting diet
An appropriate diet can help in enhancing memory among older adults and slow down cognitive decline. Here are some of the foods that may help:
“Several other conditions could result in decreasing memory and eventual cognitive impairment among older adults. These include heart disease and its risk factors, hypertension, Diabetes Mellitus, multiple medications, hormonal imbalances like hypothyroidism, history of depression, abnormal sleep and obstructive sleep apnoea (OSA),” says Dr Prem.
Symptoms of Mild Cognitive Impairment (MCI)
Frequently losing or misplacing things
Frequently forgetting conversations, appointments, or events
Difficulty remembering the names of new acquaintances
Difficulty following the flow of a conversation
When to see a doctor for memory loss?
“When memory lapses become frequent enough or sufficiently noticeable to concern you or a family member, you must make an appointment as soon as possible to talk with your doctor and have a thorough physical examination. Even if you are not displaying all the necessary symptoms to indicate dementia, it may be a good time to take steps to prevent a small problem from becoming a larger one,” says Dr Prem who believes living a socially and physically active and engaged life and eating the right food can help enhance memory.
Caregiving for a loved one with Alzheimer’s is not easy. Here are certain things that one must be mindful of before becoming a caregiver.
Caregiving for a loved one with Alzheimer’s or Dementia can be the start of a long and sometimes exhausting journey. Many first time caregivers looking after an elderly loved one with Alzheimer’s tend not to realise the extent of caregiving work involved before plunging into it. It was no different for Indrani Bose, who has been a caregiver since 1994, first for her ailing in-laws and then for her parents.
“As someone who has been looking after old and ailing loved ones for decades, I didn’t think looking after my mother, who has Alzheimer’s would be so challenging. But it was. The most difficult thing for me was to figure out when she was my mother and when she was not. A simple thing like trimming nails would end up being a situation fraught with emotions – my mom wanting to do it herself like she always did and in the next minute, an accident happens because she doesn’t recognise that a nail cutter can also cut bits of her finger. And the worst thing I could do was to put her in a box, treat her like a child, guiding her every step. She felt, and rightly so, that I wasn’t being respectful,” says Bose who believes that knowing when to retreat is the hardest thing to learn.
Tanvi Mallya, a Neuropsychologist, and the founder of Tanvi Mallya’s ElderCare Services, Mumbai seconds with Bose and says: “The suddenness of becoming a caregiver is hard enough, add to it being plunged into a confusing world of poorly coordinated care, confusing systems, and an expectation that the caregiver could take on full-time responsibilities.”
Bose’s experiences have made her understand that when it comes to caregiving for a loved one with Alzheimer’s, it is always essential to get prepared about certain things that one may not be aware of from before. Here are a few things to keep in mind when you become a caregiver for a person with Alzheimer’s.
Have a strong support system: Caregiving is an emotional rollercoaster and it is imperative that the primary caregiver has a support system – a supportive spouse, friends, anyone to whom a caregiver may be able to trust and talk to.
Maintain a contingency fund to tackle emergency: It is necessary to have a contingency fund to ride out sudden issues, believes Bose., Emergencies can always be round the corner for a senior citizen with Alzheimer’s. From a fall to a cold that turns serious — the possibilities of disasters are galore which is why a caregiver must be well-equipped with financial backups to face such situations.
Overcome stigma, taboo and myths associated with seeking help: Thanks to our conditioning and the stigma associated with seeking help, many first time caregivers mistakenly assume that they will be available to perform innumerable activities: coordination of care, making decisions about the appropriateness of providers, dealing with payments, and keeping the rest of life at bay. “Caregiving is a lonely experience, one which can be taxing on even the ablest and energetic person. Caregivers of patients with Alzheimer’s need to be extremely empathetic, consistent, patient, and creative – all these requirements become difficult in face of the challenges listed above. Thus, it is essential for caregivers to reach out for help and not take up everything on their own,” says Mallya.
Hire paid caregivers at the right time: Traditionally, most people only reach for paid caregiving help when Alzheimer’s reaches more advanced stages, or when the elderly need physical support. However, quality of life (for both the patient and the caregiver) can be better if paid caregiving help can be sought at the very beginning, says Mallya. Doing this helps prepare the patient for the idea of being supported by an ‘outsider’. This can help ease them gradually to be more comfortable when they eventually also need help with bathing and other activities of daily living – which can otherwise be situations where they feel robbed of their dignity.
“Paid caregiving also helps set forth a consistent schedule, which is extremely important for someone with Alzheimer’s. Moreover, it takes a load off the primary caregivers’ plate, allowing them more bandwidth for tasks that cannot (yet) be outsourced and to strike a balance between leading their own individual lives and caregiving,” says Mallya.
Be upfront and inform other people about the condition of your loved ones: Every family has an instinctive reaction to their loved one’s suffering. They want to appear normal to the world. “That is, in my opinion, the worst thing you can do to your loved one suffering from Alzheimer’s. She is anyway suffering from acute confusion and if she’s someone like my mom, a very intelligent, academically gifted lady, a complete intellectual, it is horrible to be in a situation where people, unknowingly hurt her by saying things like, ‘I can’t believe that you don’t remember/know/recognise/understand the conversation.’ It is much better to be upfront and let people know that your loved one is suffering from an incurable disease and whatever she may say or do, she must not be held responsible for it,” adds Bose.
Focus on caregiver burnout: Caregiver burnout is a state of physical, emotional, and mental exhaustion that may be accompanied by a change in attitude often from positive and caring to negative and unconcerned. Burnout can occur when caregivers don’t get the help they need, or if they try to do more than they are able to physically, financially or emotionally. It may manifest through stress, fatigue, depression and anxiety. Some caregivers place unreasonable burdens upon themselves because they see providing care as their exclusive responsibility. Many caregivers also feel guilty if they spend time on themselves rather than on their beloved elder.
“Visiting nurses and therapists, house managers, outsourced help, support groups go a long way in helping manage caregiver burnout. It is important for the caregiver to regularly take time out for themselves, for ensuring they get regular exercise, and indulge in activities they love (maybe gardening, reading a book or simply talking to a friend!),” adds Mallya.
Educating oneself about the progressive nature of Alzheimer’s Disease and making plans in advance may go a long way in helping organise things and make Alzheimer’s caregiving a little easier.
Over the last few months of the Covid-19 crisis, there has been a rising demand for retirement and senior living communities among retired Indian seniors, especially those living alone and away from their children. Here’s all you need to know about it.
Since the outbreak of Covid-19 pandemic, Sukhshanthi Retirement Homes in Bangalore has received a significant number of phone calls from seniors willing to opt for its services. It has been the same at Primus Reflection Senior Living in Bangalore. “The fact that self-sufficient retirement communities have been the safest option for seniors is our biggest takeaway from this pandemic. Retirement communities are going to see a very large demand as it acts as a safe bubble where normal life remains undisturbed,” says Adarsh Narhari, managing director of Primus Reflection Senior Living.
Indian seniors living by themselves in independent houses or those residing in apartment communities have been severely affected during the lockdown. A majority of them struggled to procure daily essentials including milk, groceries and medicines; mental health professionals say many elders have suffered anxiety attacks; several senior citizens across our cities had to depend on volunteer initiatives of several NGOs, social enterprises and RWAs. Silver Talkies’ Covid-19 volunteering initiative was one such that helped senior citizens living alone in Bengaluru with doorstep delivery of essentials including groceries and medicines during the lockdown.
Seniors who were under the care of well-managed retirement communities have a different story to tell. “We are very fortunate to live in a retirement community space during the Covid-19 crisis as we have never felt any difference compared to normal times. Be it the timely supply of food on our tables, the hygiene that has been maintained throughout despite inability of the staff to reach our community during the lockdown, hassle-free cleaning of the house and uninterrupted availability of doctors, nurses and doorstep delivery of medicines, our life has been as smooth as possible,” says Ramakrishna, one of the residents of Primus Reflection Senior Living.
Most senior living communities have prioritised safety along with taking care of their senior residents’ physical and emotional well-being during this time. “Our residents hardly realised we were going through a bad phase. While those living alone are facing loneliness, monotony, anxiety, depression and several other mental health issues due to self-isolation, our residents were kept socially engaged in the form of fun activities, virtual interactions and more, keeping in mind the importance of social distancing and following all safety measures,” says BS Nalini, Operational Director from Sukhshanthi Retirement Homes who believes living in a retirement home is convenient for senior citizens who are on their own no matter what the circumstances are.
Sukhshanthi Luxury Retirement Homes
“At Sukhshanthi, we keep a 15 – days stock of all essentials like groceries, milk, cooking oil, medicines from beforehand even during normal times. This is why the sudden announcement of lockdown could not interrupt any of the services that we provide to our residents,” she adds.
Why retirement communities are a viable living option in the post-pandemic world
Narahari believes that senior living communities have been able to safeguard seniors from all aspects during the pandemic. “Elders living in independent houses faced several difficulties during the lockdown. Starting from the inability to complete their errands to loneliness or lack of companionship to difficulty in managing household chores to getting exposed to risk factors like allowing cooks, maids, helpers, plumbers at home, seniors living alone had to tackle several inconveniences. In a senior living community, all staff and helping hands reside within the community, thereby lowering the risk of community-based contraction of the virus,” he says.
Residents of Primus Reflection Senior Living enjoying fun activities before outbreak of the pandemic
Here are the reasons why retirement communities may work better, especially in a crisis:
Daily needs sorted: Elders are in the high-risk category and compelled to spend more time in isolation. A senior living community addresses all their needs without having to step out.
Enhanced and safe socialising: The lockdown has made people feel lonely, especially seniors. In a senior living community, elders can know they are part of an accessible community and have access to people they can talk to.
24/7 assistance: During the lockdown with government advisory barring the entry of maids and cooks, ageing seniors needed to do all the work by themselves. In senior communities, the in-house staff takes care of household chores and preparing meals which are planned as per the dietary requirements of the residents.
Efficient handling of emergency: The staff at senior living communities are specifically trained to deal with any emergencies. Well-trained nurses and doctors on campus take care of any immediate health risk.
Senior safety on priority
Senior living communities are focused on the safety of their residents, as seniors are at a greater risk of contracting the virus due to underlying comorbidities. “At Sukhshanthi, we ensure maximum safety for our residents. Starting from restricting the entry of visitors from outside to making arrangements for the staff to live within the campus for avoiding the risk of contraction to strictly maintaining hygiene and sanitisation as per the government guidelines and keeping cautious eyes on our residents’ health, we have not left any area untouched when it comes to prioritising safety for the seniors. We are making sure that our staff wear masks, gloves, face shields whenever they step out to get essentials or run errands. We have shut down our community dining facility and are serving meals at the doorstep to reduce the risk of community transmission at any cost. We are focusing more on keeping them engaged despite social distancing,” says Nalini.
Several long term care senior facilities have come forward to help take care of the infected patients at the time of crisis. Such units have converted into nursing units to take in stabilised Covid-19 patients to relieve acute care hospitals. These units have been set up to isolate patients with trained staff equipped with appropriate PPE.
Would Senior Living Communities Have More Takers Now?
“During a pandemic, we certainly recognize the value of senior housing and more seniors will tend to gravitate toward this lifestyle. They offer a greater level of protection and care to the residents by limiting their exposure; separating the “Vulnerable” from the “Carriers”. However, operators will need to revisit and possibly expand their models of care to absorb a wider group of seniors with varied medical conditions,” says Tania Phillips AIA, senior associate at Perkins Eastman, who expects to see considerable design changes in both existing and upcoming retirement communities.
Speaking about some of the recommended designs that could help retirement communities in India adapt to the new normal post-COVID-19 outbreak, she adds, “Architectural designs should consider more emphasis on ‘Well Design’ principles. Mechanical systems should be designed to minimize the possible spread of infection. Air filtration, humidification, UV sanitizing, zoning and decentralizing HVAC systems, increased air changes, and many other factors are all part of this planning.”
Phillips suggests that intergenerational living may not be a very wise option in light of the current pandemic and believes that expanding the senior living community model into Continued Care Retirement Communities (CCRCs) will enable operators to provide care to a larger group of seniors as well as be a place where younger active adults can age in peace and know that they will be cared for in the long run.
It is evident that as we adapt to the new normal post-pandemic, retirement communities will witness a steady increase in demand among Indian seniors and undergo significant transformation in terms of concept, design and services.
These locally available and least expensive superfoods can provide you the best of nutrition, amp up your immunity and help in healthy ageing.
Malnutrition is an increasing burden and one of the most pressing public health concerns in our country. Experts observe that a majority of Indians do not get an adequate amount of nutrients – vitamins and minerals that can offer appropriate nutrition despite consuming three to four meals a day. This could be because most of us are not aware of the nutritional value of the food that we take in and this is where superfoods can be our saviour. Superfoods are foods with very high nutritional density providing a substantial amount of nutrients and very few calories. They are a storehouse of minerals, vitamins and antioxidants, the three most essential ingredients for older adults that ensure healthy ageing.
Superfoods need to be sourced internationally or be expensive. At a time when we are striving towards native foods and going #vocalforlocal, nutritionist and author Kavita Devgan shares a list of superfoods with Silver Talkies that are highly beneficial for older adults, can enhance immunity and can be easily obtained locally.
Methi seeds (fenugreek seeds) – They pack a lot of fibre (1 tbsp gives 3 grams), and most of it is soluble fibre which is great to keep our digestion humming along fine, making it work like a laxative that can help you bid farewell to constipation. This kind of fibre and the non-starch polysaccharides (NSP) helps mop up bad cholesterol from our body and aid in turning the lipid profile pink, making it a heart-friendly food. You can add fenugreek seeds to every tadka and consume it.
Eggplant – Magnesium in it helps keep the heartbeat regular, and the functioning of nerves normal. Also, it buffs up the immune system. It is loaded with antioxidants, particularly chlorogenic acid, which works on four fronts: fighting free radicals and many viruses, lowering LDL (bad) cholesterol, and providing protection against cancer. It is extremely versatile and can be roasted, grilled, fried, steamed, or sautéed. Expand your palate and try some international variants: ratatouille (Mediterranean), moussaka (Italian), and babaganoush (Greek).
Ginger – Ginger provides protection against cancers, promotes healthy sweating even during the cold months, and works as a good detox agent. It is anti-diabetic, anti-inflammatory and a wonderful immune system booster too. Have ginger tea every day. You may also add ginger to your daily dishes.
Garlic – It is our heart’s best friend, helps lower bad cholesterol, is a cancer slayer, and (this will probably interest you the most) it is a great weight-loss food too. Plus it is a brilliant diuretic that increases the amount of water and salt expelled from the body as urine. All you need to do is just peel and crush two cloves of garlic and gulp them with water first thing in the morning.
Fennel Seeds – It facilitates digestion and reduces flatulence, the accumulation of gas in the alimentary canal. It is an active carminative (a drug that relieves flatulence) agent, helps release gas from intestines and provides relief from stomach problems like pain, restlessness, heartburn and indigestion. Also, it is a natural diuretic. You can eat a few seeds after every meal.
Cauliflower – It is our heart’s best friend, helps lower bad cholesterol, is a cancer slayer, and it is a great weight-loss food too. It is an excellent source of vitamins (C, K, B vitamins), and minerals (potassium, manganese, magnesium, phosphorus), containing some of almost every vitamin and mineral that you need. It also delivers choline which is needed for a healthy nervous system. You can eat cauliflower, raw or cooked, twice a week for sure.
Moringa – This naturally dried leaf of the drumstick tree is one of the most nutrient-dense plants we know of. It is packed with 13 essential vitamins and minerals. Apparently it has four times the potassium of a banana, four times the calcium of milk and seven times vitamin C – the immunity-boosting antioxidant – as compared to oranges. It is a super-concentrated plant protein source. Just mix it up with water and lemon and drink every day.
Turmeric – Thanks to curcumin in it, turmeric works as a tonic to relieve congestion and soothe headaches and cough. It supports better memory, focus and cognition too by increasing the growth of new neurons and fighting various degenerative processes in the brain. Also, is your heart’s friend and a known cancer slayer. Have haldi doodh every day.
These easily available superfoods in your kitchen can certainly help you keep your immunity strong and beat all kinds of viruses and flu at a time when the world is facing a raging pandemic. Get started on them now.
Heard of an ear stroke? Did you know it could have a sudden onset of hearing loss? Read on to know more about it.
It was a shocker for 54-year-old Gayathri (name changed to protect privacy) from Bangalore when she started experiencing sudden hearing loss in her left ear within a span of just seven days. While earlier, there was no difficulty at all in hearing, Gayathriwas Diabetic and hardly worked on controlling it. The hearing tests showed an 80 per cent decrease in hearing. Hearing tests conducted consequently did not show any significant improvement in hearing. Gayathri is undergoing treatment at present.
The case is s similar to Hariprasad’s (name changed to protect privacy ). The 58-year-old from rural Karnataka was referred to a hospital in Bangalore following an acute stroke. He was found to have a history of hypertension and Diabetes. A brain MRI confirmed the stroke involving the auditory region of the brain. While he recovered over a period of 4 to 6 months after being treated with antiplatelet medications, he was left with residual hearing loss.
Both Gayathri and Hariprasad suffered from ear stroke which is medically termed as Acute Sensorineural Hearing Loss (SNHL). It refers to the onset of sudden severe loss of hearing in one ear, which, according to the doctors, is predominantly caused by acute ischemia or loss of blood supply and consequent tissue death. While not much may be known about them, Dr Pramod Krishnan, HOD & Consultant – Neurology, Epileptology, Sleep Medicine, Manipal Hospitals Old Airport Road, Bangalore highlights a recent study that has shown about 92 per cent of individuals affected by ear stroke had a clot in the anterior inferior cerebellar artery (AICA) which is a blood vessel in the brain. Any age group may be affected by ear stroke, the incidence increases with age, putting those above 50 at a greater risk.
What causes an ear stroke?
“The most common cause of acute SNHL is blood vessel occlusion leading to an ischemic stroke. Intracerebral haemorrhage, viral infections of the brain such as herpes zoster or influenza can also result in an ear stroke. The predominant risk factors are increasing age, systemic hypertension, diabetes mellitus, heart disease, smoking and alcohol use,” says Dr Krishnan.
Signs to watch out
Those experiencing a sudden drop in hearing, commonly affecting one ear, or a block sensation in the ear which wasn’t pre-existing or sudden onset vertigo with ringing/buzzing/whistling sound in the ear must not delay and seek clinical help immediately.
Dr Rohit Udaya Prasad, Consultant, ENT and hearing implantology, Aster RV Hospital, Bangalore, says: “Most patients suffering from an ear stroke tend to ignore or self medicate linking the problem to common cold or wax in the ear and do not reach the doctor on time. Patients present within 24-48 hours respond better to treatment. Early audiological evaluation helps to identify the degree of hearing loss.”
Treating ear stroke: Why and How?
Initiating treatment at the right time is extremely crucial, as otherwise, ear stroke may lead to permanent hearing disability. What would your treatment include? Dr Honey Ashok, Senior Consultant – ENT, Head Neck Onco Surgery, Sakra World Hospital, Bangalore, says: “The primary part of the treatment for ear stroke is to start high dose intravenous steroids at the earliest for a period of 3 days followed by oral steroids. Usually, we prefer the patient to get admitted to the hospital for the IV steroids so that the fluctuations in blood pressure and sugar can be monitored. We also start on antivirals, some drugs to improve the blood flow to the nerve. An MRI of the brain is performed to look for any tumours or lesions in the brain or course of the nerve. The patient is also advised to take blood tests like blood sugars, complete blood count, lipid profile, thyroid profile, vitamin levels, etc.”
Clinical help for an ear stroke can help with mental stress and disturbance in sleep. “?It is quite distressing to lose the sense of hearing all of a sudden which exactly happens in the case of an ear stroke. It creates a deep impact on the mind and also hurts an individual’s sense of confidence. Also, associated tinnitus or noise in the ear can cause a lot of irritation resulting in sleep loss,” says Dr Sreenivasa Murthy, Consultant ENT, Columbia Asia Referral Hospital Yeshwanthpur, Bangalore.
Preventing ear stroke: Dos and Don’ts
Stepping out for a Covid swab test and home quarantine in case needed may be difficult for many seniors. Here are two packages that may help ease that problem.
COVID-19 swab test from Portea
Portea is offering Covid Swab testing at Home. The company has already conducted 40+ test in Bangalore successfully. Here’s what you need to know:
Test name: SARS-CoV-2 (COVID-19) Qualitative PCR.
Sample Type: Throat Swab ( Oropharyngeal Specimen ) & Nasal Swab (Nasopharyngeal Specimen )
Report Availability: 3 days
Price: Rs 4500 ( Includes home sample collection + processing the sample + Logistics)
Available in: Bangalore, Hyderabad, Chennai, Kolkata, Delhi NCR & Mumbai
Good to know: A doctor’s prescription is needed as its a mandatory requirement to undergo the test. If you feel the need to undergo the test but don’t have a prescription, Portea can arrange a teleconsultation with a doctor.
Home Isolation & Remote Monitoring Packages from Portea
Package 1 for INR 5,000
What’s on offer:
Package 2 for INR 12,000
What’s on offer:
Available in: Mumbai, Chennai, Bangalore, NCR, Kolkata, Hyderabad, Chandigarh, Indore, Vijaywada and Pune.
For details, contact: https://www.portea.com/
Home Quarantine Care Program from Nightingales
This is a package-based home quarantine support program that provides an end to end clinical care solution for “Pre-symptomatic/mildly symptomatic or Asymptomatic COVID patients. Any customer/patient who has been advised home quarantine for 14 days can avail this program.
What it includes:
Home Quarantine Team with the following:
– General Physician
– Nurse
– Physiotherapist
– Psychological Counselor
– Nutritionist
Components of the program:
1. Multi-disciplinary Home Quarantine Team
2. Patient monitoring trackers
3. Quarantine Kits- COVID care kit, medicine kit, safety kit
4. Family support and advice
5. Nutritional advice and support
6. Mental Health and well-being support
7. End Quarantine support
Home Quarantine Care Packages:
Home Quarantine Care – Advantage – Rs.3999
Home Quarantine Care – Advantage Plus – Rs.7999
Home Quarantine Care – Advantage Plus + – Rs.11999
Good to know: The Advantage package is available PAN India, Advantage plus and Advantage plus+ are available in Bangalore, Mumbai, Hyderabad, Pune, and Chennai. This is a stand-alone program, not in partnership with the Government.
They do not offer COVID-19 testing.
To know more, contact: https://www.nightingales.in/
The Coronavirus pandemic and the lockdown have resulted in senior citizens opening up about their mental health issues. Here?s all you need to know about it.
Every day the mental health helpline for senior citizens run by Agewell Foundation gets 80 to 100 calls. The calls are related to psychological issues that seniors are facing during the lockdown due to the COVID-19 outbreak.
Why is this significant? Because earlier, in a pre-pandemic, pre-lockdown time, the helpline would get hardly 10 to 15 calls related to mental health issues.
It's a considerable rise, according to Himanshu Rath, the founder of the Agewell Foundation. And it's surprising yet revealing.
Seeking help for mental health has always been taboo in India, especially among senior citizens. Yet the lockdown has made many realise the significance of it. It has significantly affected the Indian elders psychologically and made them reach out for help, Rath told Silver Talkies. Interestingly, not just senior citizens but also their children and family members are seeking help from Agewell's helpline. If it receives around 100 calls in a day, 40 of these are from the seniors and the remaining 60 are from children reporting about their parents? inconveniences, Rath adds. Otherwise busy in their own world and out of home, many children are now able to observe their parents? anxiety and lack of interest in day to day activities, getting worried and reaching out for help for their parents.
The Fear Factor
The pessimism created around the Coronavirus outbreak has been tough on the mental health of senior citizens, says Rath.
From day one, senior citizens are being projected as the most vulnerable age group. The news channels are constantly flashing negative figures of leaping death counts and the spread of the virus. Rumours on social media have added to the plight. There is, however, no noise around the recovery from the pandemic. In India, while over 1 lakh has been affected, the death figures stand at around 3,000 which is only 0.3 per cent. While the media is loud about the virus claiming the lives of those who are 50+, there is not adequate reportage on how octogenarians and nonagenarians are getting cured of the virus. Senior citizens who are reaching out to us have given up the hope of life. They feel they will not see a new day anymore and this feeling of absolute uncertainty is adversely impacting their psychology, he cautions.
Mental health professionals Silver Talkies spoke to say that the lockdown, social distancing and self-isolation have made several seniors suffer from anxiety and panic attacks in the recent past. Fifty-eight-year-old Mansi (name changed) is stuck in her daughter's home due to lockdown. She had started feeling anxious, restless and had episodes of a panic attack. Mansi was visiting with her daughter in Bangalore when the lockdown was announced. She started having sleep disturbances, decreased interest in daily activities and worry increasingly about her husband who was alone back home. Her daughter consulted a psychiatrist from Sakra World Hospital on phone to help her mother out.
Anxiety, boredom, depression, fear of acquiring infection, fear of death are some of the common problems that senior citizens are seeking help for. The lockdown has been enforced strictly on elders and the restrictions have led to fear, uncertainty, insecure feelings, conflicts in relationships, lack of social contact, loneliness. They also fear death and the worsening of the medical conditions they suffer from and worry about children or relatives staying abroad or in other parts of the country. All these have taken a heavy toll on their mental health. Also, youngsters who are now homebound with senior members can better observe them and help them seek out consultation, says Dr Naveen Jayaram, Consultant Psychiatrist, Sakra World Hospital, Bangalore, who believes there has been a remarkable increase in senior citizens reporting about their mental health during the lockdown.
Opening Up About The Mind
The increasing availability of several online consultation platforms and helplines making it easily accessible for seniors to seek help could be a reason for the surge in calls, thinks Dr Satish Kumar, Consultant Clinical Psychologist, Manipal Hospitals, Bangalore.
"Several mental health professionals and Rehabilitation Council of India have opened helpline numbers for a free consultation via telephonic sessions which are very efficient for seniors to seek immediate help. Also, the lockdown has helped create awareness about mental health. Among Indian seniors, health is always about physical health. They fail to realise that health includes both physical and mental health and tend to ignore their mental health. Awareness helped senior citizens learn self-care techniques to fight this pandemic including mental care techniques, says Dr Kumar."
It may have also led to some mental health self-care. Sandhya Rajayer, a mental health counsellor based in Bangalore believes that the lockdown has made several seniors open up about a lifetime of mental health issues that are now weighing them down. The lockdown is a trigger for a large number of senior citizens who were not mindful of their mental health issues. Those who had been on therapy and took care of their mental health from earlier have been able to cope with the lockdown better, says Rajayer
Sixty plus Pratima (name changed) approached Rajayer with anxiety and depression and sought help after the lockdown was announced. Interestingly, her problem did not show up during the lockdown; she had been facing these from earlier. However, she only reached out for help when the situation got worse. Pratima has been a caregiver to her husband who suffers from a chronic ailment and is still trying to cope with the burnout. A yoga class used to be her only relief but with its closure, during the lockdown, she could no longer manage her state of mind and sought help.
The Way Forward
The best way to help seniors in this situation is by establishing a smooth communication with them, believes Himanshu Rath. According to him, youngsters barely communicate with the seniors these days. They are unable to share their fear, anxieties and feelings with anyone. Despair, stress, loneliness and panic keep bottling up among them and burst out in the form of mental trauma during crisis times like this.
"It is important to initiate heart to heart communication with seniors; be a good listener; help them de-stress while interacting and suggest ways to tackle the rough times in a friendly manner. The moment one imposes on them, it can backfire. Also, in the present situation, it is equally important to keep seniors away from negative news and fill them up with optimism, hope and the desire to live, says Rath."
If you are staying with the senior loved ones in your life, or far apart from them, checking in on them on a regular basis and engaging them more in day to day activities and discussion during the lockdown can help them take care of their mental health.
Fasting is an essential part of Indian culture. We fast for religious and cultural reasons — whether it is Christians fasting for Lent, Hindus for Navratri and Muslims for Ramzan. In fact, with the month of Ramzan coming to an end soon, here’s a guide from our expert on fasting dos and don’ts, especially with the ongoing pandemic.
The fasting season is on at present and many are fasting for Ramzan. The Ramzan fast lasts for about 14 to 18 hours a day. Fasting is a spiritual practice in several faiths. The entire process behind fasting is that you are allowing the insulin levels to drop far enough and activate your body to use stored fat to burn off. Someone with uncontrolled sugar levels and with other ailments needs to consider before deciding on fasting.
Fasting during the time of Covid-19 and summer heat means one needs to keep a close watch on their health and avoid it at the slightest signs of illness. Studies showed that Ramadan fasting has health protective effects. Ramadan fasting has been shown to mildly influence the immune system which gives short term benefits. The alterations are transient and return to basal pre-Ramadan status. In cardiac patients, Ramadan fasting can have beneficial effects including lipid profile improvement by increasing levels of good cholesterol and alleviation of oxidative stress.
Feasting after fasting, lack of sleep, less activity, poor intake of fluids, skipping your medicines or supplements and bringing an imbalance in nutrient intake can not only ruin the benefits of fasting but also devastate your health and predispose to major illnesses. No studies of fasting and risk of COVID-19 infection have been performed yet. Do not follow any advice without consulting your healthcare provider. Here are safe and healthy practices to benefit the best out of fasting, whenever you may choose to do it.
Fresh fruit juices can keep you hydrated
Hydrate before and after fasting: Although water is important for the moisture of the human body, it does not protect against the virus. However, it is necessary to prevent dehydration during summer hence include fluids before your fast and after you break it. Exclude sugar-based or fizzy drinks.
Get a customized plan from your nutritionist: Your healthcare professional should provide culturally-sensitive patient-centered care to fulfil your spiritual goals. Get your doctor to review your prescribed medicines during your fasting season.
Follow a healthy meal plan or Mediterranean way of eating: Follow the Mediterranean diet during fasting days to prevent the risk of following unhealthy meal practices which are commonly observed.
Consult the doctor if you suffer from Diabetes or kidney disorder: Health-care professionals might not appreciate that their patients are unable to take most of their medications while they fast during the day, therefore consult your doctor if you are suffering from Diabetes, kidney disorder or any other ailment.
For those who are on their Ramadan fasting, these tips may be helpful. These are also helpful for anyone planning to fast during any season.
Follow these guidelines and you should be able to have a safe fasting season, whenever you may choose to do it.
The views expressed here are the author’s own. We would suggest checking with your physician before starting any new fasting routine.
Here is all you need to know about the assisted therapies for treating Parkinson’s Disorder that make the treating approach more comprehensive and holistic.
Treating Parkison’s Disease, a progressive nervous system disorder affecting movement involves a holistic approach and assisted therapies that are not just focused on medicines and surgery. Tanvi Mallya, a Neuropsychologist, and the founder of Tanvi Mallya’s ElderCare Services, Mumbai says that when medication is accompanied by different therapies like cognitive stimulation therapy, physiotherapy, counselling for the family and the patient and occupational and speech therapy, it ensures a better quality of life for those with Parkinson’s Disease.
Assisted Therapies For Parkinson’s Disorder
Dr Nicole D’Souza, MPT (Neurophysiotherapist), Head of Therapy & Research at Parkinson’s Disease and Movement Disorder Society, Mumbai, says: “The treatment for Parkinson’s Disease requires a multidiscipline approach and is conducted by a team of doctors from different specialities including neurologist, physiotherapist, psychologist, dietician, social worker, speech therapist, occupational therapist, creative therapist, yoga therapist and more. The team and the assisted therapies are decided based on the symptoms displayed by the person diagnosed with Parkinson’s Disease and their needs and that of their caregivers.”
Here’s a list of assisted therapies that can help those with Parkinson’s Disorder.
Cognitive Stimulation Therapy (CST): It is a psychosocial intervention with engaging and cognitively stimulating activities. CST considerably improves the quality of life of those with Parkinson’s Disorder and also improves outcomes like quality of life of the caregivers. Some of the cognition stimulating activities include task sequencing (text-only), knitting, word association, word search, matching pairs by category, moving cubes, one-way journey, repeated words, etc. These activities enhance language, reasoning, semantic memory, visuospatial skills and processing speed among those with Parkinson’s Disorder.
Physiotherapy: One of the vital components of Parkinson’s Disease treatment, physiotherapy not only helps to offset the consequences of Parkinson’s but also addresses the issues of mobility, flexibility, posture and balance among those with the condition. It maintains one’s mobility and balance, making them functionally independent, helps to mobilise stiff joints and makes tight muscles flexible. It also makes it possible for those with Parkinson’s to perform daily activities safely.
Occupational Therapy: Occupational therapy, also known as physical therapy can help one to compensate for the changes brought about by Parkinson’s Disorder. These exercises can be performed at home and can help in strengthening and loosening muscles, improve movement and relieve pain. It can help with balance problems, lack of coordination, fatigue, pain, gait, immobility and weakness.
Speech Therapy: Dysarthria or difficulty in speaking and dysphagia or difficulty in swallowing are two common signs of Parkinson’s Disorder which can be managed efficiently through speech therapy. It can help one maintain as many communication skills as possible and conserve energy and non-verbal communication skills. A speech therapist can recommend appropriate communication technologies to help with daily activities, treat speech, language and communication issues and evaluate swallowing function.
Creative Therapy: According to Dr Pankaj Agarwal, Head, Movement Disorders Clinic and DBS Program, Global Hospitals & Teaching Faculty in Neurology at KEM Hospital, Mumbai, creative therapy that uses music, dance, art and theatre engage different parts of the brain of those with Parkinson’s Disease that not only improves the motor functions but also deal with emotional and mental issues like mood swings, anxiety, depression and other non-motor aspects of the disease to provide an enhanced and comprehensive treatment.
Music Therapy: This includes singing, playing an instrument, listening to music, creating music and rhythm. It helps to improve the speech – loudness, clarity, pitch, intonation, tone, improve swallowing, breathing, aids in walking and overcome freezing, improves communication, builds confidence and boosts self-esteem, enhances cognitive process – memory, attention and more and improves mood, reduces stress, depression and anxiety.
Art and Craft: This includes drawing, painting, sculpturing, clay modelling, sand art, origami, paper quilling, knitting, sewing, art appreciation and more. They help in improving eye-hand coordination, motor control and fine motor skills, mind-body coordination, cognition like memory, attention, visuospatial abilities, thinking, enhancing mood, reducing anxiety and disorder, confidence and creativity.
Dance Therapy: Dance and movement therapy offer physical, psychological, cognitive and social well-being in Parkinson’s Disease. It helps in balance and gait, coordination, motor control, flexibility, endurance, fine motor skills, facial masking and overcoming freezing. It also improves mood, helps in emotional regulation, relieves stress, tension, reduces anxiety, depression, enhances cognition, positivity and hope, confidence and self-esteem, reduces feelings of shame and embarrassment, isolation and withdrawal.
These days doctors are working on implementing technology to strengthen the assisted therapies for attaining a stronger and wholesome treatment approach for Parkinson’s Disorder. It is essential for those with the condition to make use of these therapies and improve their quality of life.
Silver Talkies had organised a webinar on April 10 to make senior citizens aware of how to protect their mental health during COVID-19.
The outbreak of Coronavirus (COVID-19) and the lockdown has been stressful for most of us. Fear and anxiety about a disease can be overwhelming and cause strong emotions especially in older adults and people with underlying health conditions. The instructions to stay at home and the current lockdown may also add to these factors. Making wise use of technology, Silver Talkies organised a webinar on HOW TO PROTECT YOUR MENTAL HEALTH DURING COVID-19 on April 10.
Dr Soumya Hegde, Consultant Geriatric Psychiatrist with over 18 years of experience managing mental illness and related issues among seniors addressed concerns of over 50 senior citizens who were a part of the webinar over Zoom, the video calling app. Here are some key points of the discussion for those who were unable to join us Here’s how to take care of your mental health during these unprecedented times.
What could be some of the mental and emotional wellbeing issues that seniors, especially those staying alone, face?
Anxiety, depression and exaggerated Obsessive-Compulsive Disorder (OCD) could be the three major issues that the seniors may face. The anxiety and depression could be due to the fear of contracting the infection, long-term uncertainty about social isolation and depletion of essential resources. The constant advisory of handwashing could make symptoms worse among those already suffering from OCDs.
Media channels and social media are always emphasising the fact that senior citizens are at a greater risk. With the fake news related to Coronavirus getting viral on WhatsApp and other social media platforms, the situation is getting even worst. Those with Obsessive-Compulsive Disorder (OCD) are getting disoriented about how often to wash their hands. With the groceries and medicines running out and nobody to reach out for help around, those with underlying anxiety disorders are often having panic attacks. To know more about the mental issues affecting older adults during the lockdown, click here.
In case one is facing such issues, they can reach out to psychiatrists from the Indian Psychiatric Society (Karnataka Chapter) offering free counseling over the phone to address issues during the crisis time. NIMHANS has also come up with its telemedicine service to offer help to those facing a wide variety of mental disturbances due to the coronavirus outbreak and the lockdown. To know more about these services, click here.
How would you identify the mental issues among seniors?
Level of anxiety may disrupt one’s daily routine and one may start showing a lack of interest in activities that they enjoyed earlier. Increased stress may result in a disturbance in one’s sleeping pattern and appetite. In extreme conditions, one may experience weight loss as well.
Do some gardening to keep yourself engaged at home
What would be your advice to keep an active lifestyle even while being homebound?
It is ideal to not disrupt the diurnal clock during the lockdown and stick to the usual routine of going to bed and waking up. Have healthy meals and cook fresh food in small quantities every day. That way you get to eat healthy fresh meals and also you have something to do every day to keep yourselves engaged. Try on new recipes and experiment. Even if it may not be as good as a walk in fresh air, try and do activities at home that you were doing outdoors earlier. Learn to use technology and find out online sessions and classes. You may not get the exact results but it is better than doing nothing. Join online yoga classes, look out for online sessions on simple exercise and stretches.
Cooking healthy meals every day can keep you engaged
Divide the day and allot time for different activities. Keep separate time slots for cleaning cupboards, watering the plants, watching television or video calling friends and family. Remember to set a structure to your daily life. In case one is struggling to keep oneself engaged, it is always good to get in touch with social engagement platforms like Silver Talkies and have access to several online activities that will keep you engaged and not feel lonely or isolated. Click here to know about the various volunteering communities helping out senior citizens during the lockdown.
Many are struggling to manage their daily chores in the absence of their house helps. This has led to increased stress and anxiety amongst them, even impacting their physical health. What would your suggestion be in this situation?
In a way, it is good to do household chores as it helps one to remain engaged throughout the day. However, it is essential to not overburden oneself. You do not need to mop the entire house at the same time. You can divide the work and take up one room every day. Also, try out ways to curtail your work. If you have three bathrooms in the house, stick to using only one and do not use the other two. That way, you will have to clean only one bathroom that you use.
We often come across a wide spectrum of behaviour. One where people are still taking the situation lightly and want their newspaper and regular walks and another where people are having rising anxiety or OCD due to the advisories about constant sanitizing. What would be your advice to these opposite ends of the spectrum?
There has to be a middle line to it. A lot of people are becoming complacent about the situation as nothing has happened to them or to the people around them. But that way you may be wrong. Nothing has happened because we are under lockdown. However, the number of positive cases is only increasing and gradually people will come inside and start following the basic safety measures. The other end of the spectrum who are going overboard with the washing will not be able to continue that for too long. At some point, they will get fed up and will relax a little. However, if it does not get better and reaches a point of development of OCD, they need to reach out and seek clinical help.
Some seniors may worry about being the most vulnerable group as is commonly believed. As a medical professional what would be your advice to them? How should they deal with all this without adding to stress?
There is nothing to be stressed about it. Following simple safety measures are enough. Avoid going outdoors unless it is needed. When you go out, come back and wash your hands. Make sure there are separate bags to get groceries from outside, wash the packets and the veggies before storing them, wear a mask when you go out. If you abide by these measures, there will be no such risk.
What should one be prepared for if one does need to visit the hospital during this phase for any physical emergency?
For seeking help related to hospitalisation and medical emergency, you can call 108. 1091, the elder specific helpline is also available. You may also call 100, the police central line and if you tell them you want to get connected to the elders’ helpline, they will connect you.
The webinar was of great help for the senior participants who got enough ideas on how to tackle the crisis situation and keep their mental health intact while following social distancing.
Here is a list of telemedicine services being offered by several hospitals and healthcare providers to help senior citizens with health assistance during the Coronavirus lockdown.
With the country declaring a nation-wide 21-days-long lockdown since March 25, 2020, to contain the spread of coronavirus that has already claimed 137 lives and infected 4,858 people in India (at the time of writing this), movement has become restricted for all, especially senior citizens. It is not safe for senior citizens to visit hospitals currently as they fall in the high-risk category of contracting the infection. With self-quarantine and social distancing measures in place, several hospitals and healthcare providers have introduced telemedicine services and online consultancies to enable senior citizens to consult doctors from their homes. Here is a handy and verified list:
MANIPAL HOSPITALS, BANGALORE
Manipal Hospitals has initiated telemedicine services since the inception of the lockdown and is using it to provide health education, counselling related to specific clinical conditions, advice regarding new investigations that need to be carried out, specific treatment by prescribing medicines, identifying an emergency situation and offering guidance on referral to hospitals. Their telemedicine facility will continue even after the removal of lockdown.
How does telemedicine service work?
. Covers various health specialities including Geriatric Medicine, Internal Medicine, Neurology, Cardiology, Psychology, Endocrinology, Pulmonology, Rheumatology, Oncology, Hematology and Neurosurgery.
. Ideal for follow-up cases where the history and clinical condition of the patient are already known to the doctor. It can be used for new cases also, provided the patient/caregiver can provide correct information regarding a patient’s condition including medications.
. The service includes video consultations designed exclusively for senior citizens so that they can reach out to doctors for any medical concern without having to travel to the hospital.
Functional round the clock in case of emergencies. Out Patient Department (OPD) consultation is functional from 8 AM to 8 PM every day.
To avail of their telemedicine service, you can call 18001025555/9606457127.
ASTER CMI HOSPITAL & ASTER RV HOSPITAL, BANGALORE
Aster CMI Hospital in Hebbal, Bangalore and Aster RV Hospital in JP Nagar Bangalore have launched their telemedicine services from April 2020 to help patients, particularly senior citizens, get hassle-free connectivity with the doctors amidst lockdown.
How does telemedicine service work?
. It covers Cardiology, Orthopaedic, Neurology, Neurosurgery, Urology, Nephrology, Gastro Sciences, Dermatology, Paediatrics, OBG and Nutrition.
. Patients can do consultations from home via laptop or desktop.
. This facility requires patients to make prior appointments by contacting the hospital number or via online booking.
. Timings of consultations are blocked based on the availability of the consultants.
In order to seek help, you can get in touch with Aster RV Hospital on 080 22040400 and Aster CMI Hospital on 080 43420100. For further information on the telemedicine services, you can visit their website: https://www.asterbangalore.com/.
APOLLO HOSPITALS, BANGALORE, HYDERABAD, CHENNAI, DELHI & KOLKATA
While Apollo had introduced its telemedicine app, Apollo 24/7 in Chennai and Hyderabad just six months back, the hospital has implemented the app in Bangalore after the announcement of the lockdown. The application has been modified and strengthened to tackle a rising number of requests for online consultation with doctors, especially from the senior citizens. Silver Talkies has been informed that very soon this app could be used by users in Delhi and Kolkata.
How does telemedicine service work?
. All health specialities are covered under the app including General Medicine, Internal Medicine, Gastroenterology, Endocrinology, ENT, Orthopaedics, Dermatology, Paediatrics, Obstetrics, Gynaecology and more.
. The app allows one to consult a doctor anytime, anywhere. It is a mobile-based app but also available on the desktop.
. To use this Android-based app the user needs to download it from the Google Play store, sign in and book a doctor prior to consultancy. The app will then block a specific time for the consultancy.
In order to log in from desktop, you can click here: https://www.apollo247.com/
In order to download the app on your mobile, please click here: https://play.google.com/store/apps/details?id=com.apollo.patientapp
INDIAN PSYCHIATRY SOCIETY KARNATAKA CHAPTER
This is a free of cost initiative to address psychiatric issues arising due to Covid- 19 pandemic and the resulting lockdown status among all, especially senior citizens. This also includes alcohol and drug use related problems and particularly withdrawal symptoms resulting due to non-availability of alcohol and other drugs.
How does telemedicine service work?
. Via call, the psychiatrists will be addressing symptoms like anxiety, fearfulness, restless, acute suspiciousness regarding Covid, acute stress reaction, sadness, hopelessness, helplessness, sleep disturbances, substance abuse, disease anxiety, obsessions & compulsions, irrelevant thoughts and more.
. Alcohol and other substance use-related problems, especially withdrawal symptoms resulting due to non-availability of the same will be addressed on priority and appropriate guidance and counselling will be given to overcome the above problems. Information and referral to the nearest mental health setting will be provided if found necessary.
Someone seeking help should follow this list that has the psychiatrists’ name, contact numbers and the timings of their availability.
NATIONAL INSTITUTE OF MENTAL HEALTH AND NEUROSCIENCES (NIMHANS), BANGALORE
The premier mental health institute has also come up with its telemedicine service to offer help to those facing a wide variety of mental disturbances due to the coronavirus outbreak and the lockdown.
How does telemedicine service work?
. Psychiatrists and counsellors from NIMHANS will address calls and help those suffering from anxiety, fearfulness, restlessness, acute suspiciousness regarding Covid; acute stress reaction, sadness, hopelessness, helplessness, sleep disturbances, substance abuse, disease anxiety, obsessions & compulsions, irrelevant thoughts and more.
. This is a pan-India facility and anyone from any place in the country can reach out to the doctors for help.
In order to get help for these concerns, you may call NIMHANS toll free number 080 4611 0007.
Here is all you need to know about how the Coronavirus outbreak and the present lockdown are affecting the mental health of senior citizens and the ways to overcome it.
With the Coronavirus outbreak turning into a global pandemic, the government has declared a complete lockdown in the country to control the quick spread of the deadly virus. Also, every citizen has been advised to practise social distancing and self-quarantine which may come with psychological fallout for some, including senior citizens. We spoke to experts to know the mental health implication for seniors locked down within four walls of their homes and how to overcome it.
Deviation from the normal routine can be tough: The nation-wide lockdown and the advice of maintaining social distancing and self-quarantine have resulted in considerable disruption of the daily routine for most senior citizens. According to Dr Naveen Jayaram, consultant psychiatrist at Sakra World Hospital, Bangalore when a senior citizen is unable to follow his regular schedule like taking a walk in the park or going for a walk with a group of like-minded friends or reading the morning newspaper, it can lead to significant encroachment of mental space and increased level of stress.
“With the lockdown, the house is filled with the presence of other family members which may interfere with their privacy. They may not get their convenient slot to watch a television show and more. While being among family members may boost up a senior citizen’s spirit, it may also cause stress and irritation if the senior citizen does not share a comfortable space with them,” says Dr Jayaram.
The danger of depression: For senior citizens living alone and far away from their families, social distancing and self-isolation has aggravated the loneliness that they have been already suffering from. “At present, they are unable to step out, take part in the activities of social engagement clubs, go out for lunch dates with friends and more. A lot of them are not even being allowed to step out to get milk from the nearby dairy shop or veggies from the local stall by their family members and are being constantly reminded that they are more vulnerable to the virus. All these are making them all the more depressed,” says Dr Jayram.
Panic attacks and anxiety: Media channels and social media are always emphasising the fact that senior citizens are at a greater risk. There is no point to continuously remind them that they are more vulnerable as there is nothing more that they can do to take precautionary measures compared to what the youngsters are doing. According to Dr Soumya Hegde, a geriatric psychiatrist, being aware of the fact that Coronavirus in India has claimed the lives of only senior citizens till now is exceedingly enhancing the risk of panic and anxiety attacks among senior citizens.
“With the fake news related to Coronavirus getting viral on WhatsApp and other social media platforms, the situation is getting even worst. Those with Obsessive-Compulsive Disorder (OCD) are getting disoriented about how often to wash their hands. With the groceries and medicines running out and nobody to reach out for help around, those with underlying anxiety disorders are often having panic attacks,” says Dr Hegde.
Utilise technology to virtually connect with the world: Dr Hegde believes that technology can come to immense aid of seniors during this period of social distancing. “They may get on video calls and chat with their loved ones. It is always a relief for them to see their friends and families safe in front of their eyes and it considerably cuts down stress and depression.” Click here to understand how to get on the Zoom app and get social virtually.
Take part in virtual games, quizzes, riddles and puzzles, yoga and meditation classes: Online games, puzzles, e-books, quizzes, e-theatres, e-yoga and meditation classes can keep senior citizens mentally engaged at home, thereby reducing their loneliness and monotony, amping up mental health and keeping them calm.
Find some relevant links here: https://dhyaanawellbeing.com/online-classes/
https://stories.audible.com/start-listen
Keep off news channels, avoid fake news related to Coronavirus: It is essential for senior citizens to stay away from news related to Coronavirus and give up following on the death counts to avoid being worried. d. There have been several recoveries too. Try to read more on that if you can’t avoid the news.
Help yourself by pursuing hobbies and trying new recipes: Trying out hobbies like gardening, knitting, painting, pottery and more and sharing with friends on social media or trying out new recipes, experimenting and preparing yum dishes and then sharing the recipes with friends and family may help one keep themselves engaged.
Do not skip your indoor exercises: In order to keep one’s body and mind active, it is important for the seniors to practice freehand exercises that could be done at home. E-yoga and e-meditation sessions are wonderful ways of keeping oneself physically fit and mentally sound. Natasha Sekhon, a counselling psychologist at Central Social Welfare Board and visiting counsellor at Grey Shades, who is tackling at least 15 to 20 panic calls from senior citizens at present, engages seniors in mindful exercises over the phone as part of calming them down. She uses two techniques, 5-3-5 and the activation of five senses.
“In the former, a senior citizen is asked to inhale for five seconds, hold the breath for three seconds and again release it for five seconds. The latter involves activation of five senses including what they see, eat, smell, touch and hear, thereby calming them down,” says Sekhon.
Seek help when needed: Various mental health professionals are offering free counselling services over the phone. If you are worried, anxious and unable to cope, please contact one of these helplines to seek expert guidance.
These are some ways that can help senior citizens tackle the impact of lockdown and social distancing on their mental health.
The Union Government permitted some private labs to conduct the Covid-19 detection test and Indian Council Medical Research has put up a list of the same.
Here are the 16 private labs across various states that can now conduct Covid-19 screenings. (Info Courtesy: Indian Council of Medical Research)
Delhi
1) Lal Path Labs, Block-E, Sector 18, Rohini, Delhi
2) Dr Dangs Lab, C-2/1, Safdarjung Development Area, New Delhi
3) Laboratory Services, Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi
Gujarat
4) Unipath Specialty Laboratory Limited, 102, Sanoma Plaza, Opposite Parimal Garden, Beside JMC House, Ellisbridge, Ahmedabad
5) Supratech Micropath Laboratory and Research Institute Private Limited, Kedar, Ahmedabad
Haryana
6) Strand Life Sciences, A-17, Sector 34, Gurugram
7) SRL Limited, GP26, Sector 18, Gurugram
Karnataka
8) Neuberg Anand Reference Laboratory, Anand Tower, #54, Bowring Hospital Road, Bengaluru
Maharashtra
9) Thyrocare Technologies Limited, D37/1, TTC MIDC, Turbhe, Navi Mumbai
10) Suburban Diagnostics (India) Pvt. Ltd., 306, 307/T, 3rd Floor, Sunshine Building, Andheri (W), Mumbai
11) Metropolis Healthcare Ltd, Unit No. 409-416, 4th Floor, Commercial Building – 1, Kohinoor Mall, Mumbai
12) Sir HN Reliance Foundation Hospital and Research Centre, Molecular Medicine, Reliance Life Sciences Pvt. Ltd., R-282, TTC Industrial Area, Rabale, Navi Mumbai
13) SRL Limited, Prime Square Building, Plot Number 1, Gaiwadi Industrial Estate, SV Road, Goregaon, Mumbai
Tamil Nadu
14) Department of Clinical Virology, CMC, Vellore
15) Department of Laboratory Services, Apollo Hospitals Enterprise Limited, Chennai
Telangana
16) Laboratory Services, Apollo Hospitals, 6th Floor, Health Street Building, Jubilee Hills, Hyderabad.
The National Task Force recommends that the maximum cost for testing should not exceed Rs 4500. This may include Rs 1500 as a screening test for suspect cases and an additional Rs 3,000 for confirmation test, the guidelines stated.
Find out about the symptoms, precautions, screening centres and government helplines for Coronavirus and stay safe. Find a complete list of testing centres India wide here.
Coronavirus (COVID-19) outbreak has been declared a pandemic by the World Health Organization. With 110 positive cases and three casualties at the time of writing, India is trying hard to fight the virus. Older adults have been found to be more susceptible to the coronavirus and keeping that in mind, HelpAge India has come up with a list of necessary precautions that can enable senior citizens to remain safe and healthy.
Also, Indian Council of Medical Research (ICMR) and the government health departments have put out a list of hospitals where you can go and get yourself tested in case you experience any of these symptoms: Fever, tiredness, dry cough, nasal congestion, runny nose, sore throat, aches and pains and diarrhoea.
Silver Talkies has put useful information together along with the government helplines available where you can report issues related to Coronavirus and seek help. Find out more below.
Stay sanitised
Precautions for senior citizens against Coronavirus
1) Wash your hands frequently with soap and water or alcohol-based sanitiser
2) Maintain at least one metre (three feet) distance between yourself and anyone who is coughing or sneezing.
3) Cover your mouth and nose with a tissue or your bent elbow when you cough or sneeze.
4)Throw the used tissue into a closed dustbin immediately.
5) Avoid close contact with anyone if you have a cough or fever.
6) Avoid touching eyes, nose and mouth.
7) Avoid gatherings with a large number of people.
8) Do not spit in public
( Information courtesy: HelpAge India)
Where can you get tested?
The health government has pointed out 64 centres across the country for Coronavirus testing. As of now, no private hospitals have the authority to conduct Coronavirus screening. Only the following government hospitals across the various states can conduct Coronavirus screening for you.
Andhra Pradesh
1) Sri Venkateswara Institute of Medical Sciences, Tirupati
2) Rangaraya Medical College, Kakinada
3) Siddhartha Medical College, Vijayawada
4) GMC, Anantapur, AP
Andaman and Nicobar Islands
5) Regional Medical Research Centre, Port Blair, Andaman and Nicobar
Assam
6) Gauhati Medical College, Guwahati
7) Regional Medical Research Center, Dibrugarh
8) Silchar Medical College, Silchar
9) Jorhat Medical College, Jorhat
Bihar
10) Rajendra Memorial Research Institute of Medical Sciences, Patna
Chandigarh
11) Post Graduate Institute of Medical Education and Research, Chandigarh
Chattisgarh
12) All India Institute Medical Sciences, Raipur
Delhi-NCT
13) All India Institute Medical Sciences, Delhi
Gujarat
14) BJ Medical College, Ahmedabad
15) MP Shah Government Medical College, Jamnagar
Haryana
16) Pt. BD Sharma, Post Graduate Institute of Medical Sciences, Rohtak, Haryana
17) BPS Government Medical College, Sonipat
Himachal Pradesh
18) Indira Gandhi Medical College, Shimla, Himachal Pradesh
19) Dr Rajendra Prasad Government Medical College, Kangra, Tanda, HP
Jammu and Kashmir
20) Sher-e-Kashmir Institute of Medical Sciences, Srinagar
21) Government Medical College, Jammu
22) Government Medical College, Srinagar
Jharkhand
23) MGM Medical College, Jamshedpur
Karnataka
24) Bangalore Medical College and Research Institute, Bangalore
25) National Institute of Virology, Field Unit, Bangalore
26) Mysore Medical College and Research Institute, Mysore
27) Hassan Institute of Medical Sciences, Hassan
28) Shimoga Institute of Medical Sciences, Shivamogga
29) Wenlock District Hospital, Mangalore
Kerala
30) National Institute of Virology, Field Unit, Kerala
31) Government Medical College, Thiruvananthapuram, Kerala
32) Government Medical College, Kozhikode, Kerala
33) Government Medical College, Thrissur
Madhya Pradesh
34) All India Institute Medical Sciences, Bhopal
35) National Institute of Research in Tribal Health, Jabalpur
Meghalaya
36) NEIGRI of Health and Medical Sciences, Shillong, Meghalaya
Maharashtra
37) Indira Gandhi Government Medical College, Nagpur
38) Kasturba Hospital for Infectious Diseases, Mumbai
39) National Institute of Virology, Mumbai Unit
Manipur
40) JN Institute of Medical Sciences Hospital, Imphal-East, Manipur
41) Regional Institute of Medical Sciences, Imphal
Odisha
42) Regional Medical Research Centre, Bhubaneshwar
Puducherry
43) Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry
Punjab
44) Government Medical College, Patiala, Punjab
45) Government Medical College, Amritsar
Rajasthan
46) Sawai Man Singh, Jaipur
47) Jhalawar Medical College, Jhalawar, Rajasthan
48) Dr SN Medical College, Jodhpur
49) RNT Medical College, Udaipur
50) SP Medical College, Bikaner, Rajasthan
Tamil Nadu
51) King’s Institute of Preventive Medicine and Research, Chennai
52) Government Medical College, Theni
53) Tirunelveli Medical College, Tirunelveli
54) Government Medical College, Thiruvarur
Tripura
55) Government Medical College, Agartala
Telangana
56) Gandhi Medical College, Secunderabad
57) Osmania Medical College, Hyderabad
Uttar Pradesh
58) King’s George Medical University, Lucknow
59) Institute of Medical Sciences, Banaras Hindu University, Varanasi
60) Jawaharlal Nehru Medical College, Aligarh
Uttarakhand
61) Government Medical College, Haldwani
West Bengal
62) National Institute of Cholera and Enteric Diseases, Kolkata
63) IPGMER, Kolkata
Updated centre in Delhi
64) National Centre of Disease Control, New Delhi
(Information courtesy: https://icmr.nic.in/node/39071)
Wash your hands
When to get tested for COVID-19?
The Health Department, Government of India has specified when you need to get a Coronavirus screening done.
Please remember that you are NOT required to get tested for COVID-19 if you do not have symptoms like cough, fever or difficulty in breathing.
If you have any of the above symptoms and have travelled to any of the COVID-19 affected countries including Italy, Iran, Republic of Korea, France, Spain, Germany, UAE, etc or you are in contact of a laboratory-confirmed positive case, immediately call the State Helpline Number or Ministry of Health & Family Welfare, Government of India’s 24×7 helpline 011-2397 8046.
For Karnataka, the State Helpline Number is 104.
Arogya Sahayavani, phone number: 080- 22208541/ 22374658, Email address:ssuidspbangalore@gmail.com.
For Maharashtra, the State Helpline Number is 020- 26127394, 104, 1123978046 or send Email to ncov2019@gmail.com.
The helpline service will note down your contact details and contact you with the testing protocols of COVID-19.
If you qualify as a case for testing as per the protocol, you will be tested at a Government approved lab only.
Find out why you should be more cautious about Coronavirus and what you must do to keep it at bay.
The coronavirus outbreak that began from the Chinese province Wuhan is gradually becoming an epidemic with the death toll rising. According to a report in CNN, at least 1,300 people have died and more than 60,000 people have been infected. The World Health Organization (WHO) has declared the outbreak a public health emergency of international concern. Interestingly, at least half of the 12 reported cases of Coronavirus in the US are people who are 50 and older. While only three coronavirus positive cases been reported in Kerala so far, the doctors across the country have issued an alert for all to take preventive measures and stay safe. Silver Talkies got in touch with doctors to understand how vulnerable senior citizens are to coronavirus and what preventive steps should the older adults take. Remember, these are simple, healthy measures to avoid illness and there is no cause for panic or alarm.
Why older adults may be at a greater risk of getting infected
Going by the preliminary estimates, Dr Sachin Kumar, senior consultant and head, Department of Pulmonology, Sakra World Hospital believes that older adults may be particularly susceptible to the respiratory illness triggered by the novel coronavirus, also known as 2019-nCoV. He highlights two main reasons for the increased vulnerability of older adults and senior citizens to coronavirus. First, the increased tendency of older adults to suffer from underlying conditions that may hinder the body’s ability to cope with the virus and recover from the illness and second, the age-related weakening of the body’s immune system.
“The older adults and senior citizens most often suffer from respiratory conditions like chronic obstructive pulmonary disease (COPD) and other conditions like heart disease or kidney problems. And these conditions prevent the body from fighting the virus. Early findings from China, which pertained to the first 17 people to die in the outbreak, revealed that their median age was 75, and a recent study in the New England Journal of Medicine found that the median age of the first 425 people infected with the virus was 59,” says Dr Kumar.
Signs to watch out for
Highlighting the symptoms of coronavirus, Dr Naganath Narasimhan Prem, chief consultant geriatric medicine /elderly care specialist, Department of Geriatric Medicine, Jaslok Hospital, Mumbai, says: “The older adults should be specifically cautious and reach out to a doctor in case they suffer from fever, cough and shortness of breath. The symptoms may show up within two to 14 days after exposure. Severe cases can have pneumonia.”
Coronavirus is a communicable disease and can spread from an infected person’s coughs, sneezes, droplets of saliva or discharge from the nose.
Prevention is better than cure: Here’s what one must do
Wash hands frequently with soap and water or use alcohol-based hand rub.
Always cover the mouth and nose while sneezing.
Maintain social distancing
Avoid touching eyes, nose and mouth.
If you have fever, cough and difficulty in breathing, seek medical care
Avoid contact with stray animals
Avoid consumption of raw or undercooked animal products
Wear protective masks.
Take care of the co-morbid medical conditions like diabetes, hypertension and update on the flu and pneumonia vaccines in general.
Go for a healthy and balanced diet with lots of vitamins and minerals and plenty of water that may help recover with any viral illness including coronavirus.
Avoid any non-essential travel to China or other parts that are already infected with the coronavirus. Follow health advisories issued by the embassies.
Malini Mundle, 67, a Qigong practitioner and a member of Silver Talkies Social, who got attached to it in 2007 shares her experience with Qigong and highlights how it can be beneficial specifically for seniors.
Are you aware of Chi Kung, also known as Qigong, that helps one to master the art of developing energy for health, vitality, longevity, mind expansion and spiritual cultivation which are a few of the key ingredients to active ageing? If not, here we are to make you aware of how this ancient Chinese healthcare modality involves the three treasures of an individual – form, energy and mind and increases the fitness in mind and body, develops vitality and enables curing stress along with various degenerative and chronic ailments. Although its origination is rooted back to 1122 BC, Qigong which means the work one does to cultivate energy over time has made a strong comeback at the beginning of the 21st century and has gained popularity over the recent past. Malini Mundle, 67, a Qigong practitioner who got attached to it in 2007 shares her experience with Qigong and highlights how it can be beneficial specifically for seniors.
How does Qigong work?
Chinese Medicine states that we fall sick for three reasons: deficiency of Chi or energy, blockages of the meridians or energy channels and Yin/Yang (outside-inside) imbalance or disharmony. When one practices Qigong, there is a substantial increase in the level of one’s Chi or energy that makes the immune system stronger. This naturally can heal many physical issues. Meditation associated with Qigong relaxes and recharges the energy and can act as a natural healer. Practicing Qigong frees the energy that accumulates inside the body enabling its natural flow thereby alleviating blockages. This balances the emotions, reduces stress, increases vitality, agility and flexibility and rejuvenates body, mind and spirit. Slowness, lightness, clarity, balance and calmness are the key qualities of Qigong.
How and when is it done?
The five essential principles of Qigong include relaxation, concentration, meditation, harmony and breathing.
RELAXATION – Be soft and yielding. Exert no strength.
CONCENTRATION- Let the mind direct the movement.
MEDITATION – Balance the movements of the mind, the body and Chi
HARMONY – When thoughts and movements are in accord, you gain the power to feel.
BREATHING – Breathe naturally through the nose into the abdomen. With the abdomen relaxed, tranquility will prevail.
According to Mundle, significant improvements to health and well-being can be achieved after practicing Qigong for just a short time. During the meditative exercises, the energy flowing inside the body is felt. When all the channels are clear the energy will be very strong. Outside the body will feel soft, all the muscles and joints are relaxed, and this means that the inside is strong.
Mundle says: “Qigong is best practiced early in the morning or at sunset, preferably in the open, in a park where air and earth chi (energy) is abundant. There are no dietary restrictions though Qigong trains in balance and harmony in all aspects of life. Eating in moderation and mindfully and practicing on an empty stomach is good.”
Why Qigong is beneficial for seniors?
Here is why every individual above 60 must practice Qigong.
Qigong can heal and prevent a large number of age-related conditions: Be it Alzheimer’s, Parkinson’s, cataracts, stroke, diabetes, osteoporosis, asthma and even cancer, Qigong is known to act as a healer and reduce suffering along with saving your pocket and cutting down on medical expenses. Being a holistic theory, Qigong can improve breathing, blood sugar levels, cholesterol levels and aiding in stroke recovery simultaneously. Not just treating them, Qigong can prevent ailments as well. Studies have found that those doing Qigong have been able to maintain their body weight, bone density, blood pressure, eyesight, hearing, flexibility, cholesterol levels thereby keeping several diseases at bay, having perfect eyesight and hearing, maintaining their natural hair colour without having to apply dyes, firm and lustrous skin and looking much younger.
Qigong can improve the quality of life: Not being sick or disabled due to practicing Qigong is itself bliss. Additionally, the lives of older adults improve with Qigong as they are able to feel hungry and enjoy yummy foods, stop feeling lethargic, have better concentration, better memory, become stress-free, happy and more alive. These ways, Qigong can provide the perfect dose of active and happy ageing.
Qigong can prevent accidents: The older population is more vulnerable to falls and accidents. Qigong can help prevent accidents in several ways. Starting from making an individual stronger, healthier and more alert, it can improve his or her balance, eyesight, coordination, hearing and make him or her more flexible. Thus, one will be at a lesser risk of falls and he or she will have better visibility, will be more alert, will have a stronger grip and much better control of the body.
Mundle in her Qigong learning sessions in Lodhi Gardens, Delhi
Experiencing Qigong and observing the difference
Mundle’s engagement with Qigong began 13 years back when her Master, an American living much of his time in China got in touch with her. At that time she was working in a hospice as a psychologist for cancer patients in terminal stages. He wanted to do Qigong healing with these patients and teach the movements to those who could.
“This started a journey into a form which was akin to slow dance. At the time I was in the 5th year learning and performing with a dance group and was looking for a new form of activity that would not be as fast-paced as I had a degenerative lower back problem. Yoga did not appeal nor did the gym. Additionally, I found myself unable to meditate in the traditional way because of a chattering mind and discomfort in the sitting position. Meditative Qigong ticked all the boxes. It gave me dance-like movements, greatly improved my breathing and focus as I learnt to balance the breath and the movement to achieve a rhythm conducive to being meditative,” says Mundle.
For the next three years she continued to learn with the master at Delhi, Dharamshala and Bangalore and due course, she utilised this form with psychiatric patients that she found to be immensely beneficial. “I consider myself a Qigong practitioner of a life-enhancing practice which I have shared with groups in workshops over the years. I found my ideal form of meditation and movement. This is an individual choice for both seniors and others. Yoga and dance suit some, the gym or walking and stretching suit others. For older people like me, this form is easy as it does not put a strain on joints and muscles and once grasped is gentle and soothing and rejuvenating,” she says.
Did you know that sound therapy could be an amazing non-invasive way of tackling many age-related health and mind conditions, that too without any side-effects? Find out more about sound healing here.
Being a caregiver to someone with a progressive degenerative disorder like Dementia is challenging. Here are ways to take care of yourself to avoid burnout.
Mahuya Paul, 49, has been a caregiver since 2006 when her sister was diagnosed with paranoid schizophrenia. Then in 2013, her husband suffered three cerebral strokes that led to brain damage and vascular dementia with serious movement disorder. She was his primary caregiver until he passed away in 2017. The sole earning member of her family, Paul is currently a caregiver to her sister, 52, and mother, 88, who has early signs of Dementia apart from Parkinson's and movement disorder.
Nita Mishra, 63, is the primary caregiver to her 71-year-old husband who has Alzheimer’s Disease. Mishra used to run a Montessori school but closed it down a few months ago due to her caregiving challenges. We spoke to Paul, Mishra, and few other caregivers to figure out some of the challenges caregivers face and the ways in which they take care of themselves.
Why You Need To Be Aware Of Caregiver Stress
Caregiving for someone with dementia or any other progressive degenerative ailment is challenging and even isolating. “Except for my evening walk with some of the building ladies, I don’t meet anyone much,” says Mishra.
Dementia care can last for many years, draining the caregiver emotionally, physically, and even financially. Symptoms of dementia or related behavior are regarded as normal parts of aging in India, making it difficult for the caregiver to explain its gravity to others. Trying to manage not just caregiving but also careers and other family and financial responsibilities adds to the stress.
Depression is higher in Dementia caregivers compared to other caregivers and a study has shown that one fifth to one-third of carers had a significant psychological illness, says Dementia Care Notes, a definitive dementia care resource.
If you are a caregiver, please remember that feeling overwhelmed and stressed is a very normal feeling. It is important to be aware of this and take steps to avoid caregiver burnout, which is defined as the physical and emotional strain that results from taking care of someone. Though caregiving is a fulfilling experience for many, it can take a toll on the quality of life of the caregiver.
Common challenges faced by caregivers
Daily Living Challenges: Taking care of the hygiene and daily living activities of the person you are caregiving can become challenging and tiring on a daily basis. Mishra has hired part-time help to assist her husband with these but still finds it difficult as he’s often agitated and she has to do these activities herself to calm him down. “I have a lower back problem and it’s a physical strain on me,” she says.
Professional Challenges: Paul was in a senior management role in a reputed IT MNC. “It was extremely challenging because often I had to take official calls from home that coincided with my husband’s feeding or shower times,” she says. It also becomes challenging to juggle doctor visits and diagnostic tests, keep track of medications and treatment approach, and manage professional commitments. Mishra couldn’t manage to run her Montessori as even with paid help, balancing both ends became tiring.
Emotional Challenges: Lack of understanding or empathy from others can cause emotional stress. Gita, a caregiver who doesn’t wish to share her full name, learned it the hard way when her mother, who has Dementia went missing for a few hours. “Although we were lucky to find her soon, a lot of fingers were pointed at me and my sister as are her primary caregivers. People thought we neglected her and that’s why she left when the truth is she wasn’t aware of her surroundings due to her condition.”
Lack of trained attendants: This is the biggest challenge most caregivers face. “Attendants with empathy and a good attitude to learning are rare,” says Paul, who changed at least 12 attendants before she found the right person. Mishra finds it challenging to deal with the lack of punctuality and reliability and the constant supervision required.
Read this to know why it’s important to get a paid attendant for your elderly loved one.
How to Take Care of Yourself. Caregivers Weigh In:
Mahuya Paul: When I was juggling with three people — husband, mom, and sister — the only me time was the 40-minute drive to work. I had a driver so that I could listen to music and calm my nerves before plunging into work. I had a lot of work to catch up on even at night and my regular day was 20 hours with only four hours of sleep. Despite the stress, I had a peaceful state of mind and deep restful sleep no matter when I went to bed. And mornings would be a new day. Being able to regenerate myself on a daily basis was something I could manage to do with a lot of help from a professional mentor and coach, who helped me understand and accept my situation, which helped me deal with it better. Now, I have changed jobs and also work with an NGO to support backward villagers in starting meaningful alternate livelihoods. I intended to take up Yoga or meditation but my general involvement in social work has a calming effect.
Gita: I’m lucky to share caregiving responsibilities with my sister but even then, self-care takes a backseat. Last year, I went on a meditation course for 15 days, during which my sister cared for our mother, with the help of a close relative. The course helped me calm my feeling of distress at the situation and I meditate daily. I also try not to miss my regular daily walk and recently started learning to play an instrument as it relaxes me.
Self-care routines vary from person to person but the important thing is to plan for it. Don’t let this stress you out and plan what works for you in a relaxed, gradual manner.
Asking For Help
Not everyone around may empathize with a caregiver or be willing to lend a helping hand. However, you may have a circle of support, no matter how small, among your family and friends. Many times, they may not be sure of what kind of help you need so let them know the specifics. “I have an excellent neighbor who buys my weekly vegetable and other grocery necessities when she buys her own. This is one of the best forms of support I have received and I’m grateful for it,” says Mishra.
If your support crew is comfortable around the person with dementia and vice versa, you can enlist their help for doctor visits or any other necessary outing. They can even spend time with them for a few hours to give you a much-needed break. One caregiver’s friend encouraged her to seek counseling after she shared her challenges and now ensures she goes for her sessions with the therapist.
If you find yourself feeling overwhelmed, ask someone close to help you with some of the tasks or simply to hear you out. Reach out.
For more suggestions, please read: Support for Dementia Caregivers: Face to Face Meetings
September 21 is World Alzheimer’s Day and observing the month of September as the Dementia month, Silver Talkies is covering various aspects of Dementia to make the readers aware of the condition. Click here for other related stories.
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Our experts here have shared some tips to help you set up your home in a way that will make life easier and comfortable for your loved one with dementia.
If you are a dementia caregiver, it is important for you to adjust your home in a way that makes life comfortable for your loved one. People with dementia often have difficulty in understanding their surroundings and find it tough to walk around or even do regular tasks. Having a home set-up that is safe and convenient for those with dementia can make your life somewhat easier. Here are suggestions from experts.
WHY IS IT IMPORTANT TO MAKE HOME ADJUSTMENTS?
Neha Sinha, Chief Executive Officer of Epoch Elder Care, an assisted living home for seniors with dementia in Gurgaon and Pune, says: “Our environment decides a great deal about how we feel in our everyday life. Similarly, the environment can have a huge impact on a person with dementia symptoms like orientation, confusion, comprehension and decision making.”
Sinha believes that a well-adjusted home can reduce confusion, help people with dementia process information clearly, aid in comprehension and helps the person stay more oriented and less anxious. “A home is one’s safety net and comfort zone and it is super important that the place where we spend our maximum time takes care of these feelings,” adds Sinha.
A dementia-friendly home can also be a relief for a caregiver and reduces stress. Sinha explains how: “By reducing confusion and anxiety, the loved one with dementia is more receptive to receiving care and assistance in their daily activities. A dementia-friendly home is more of a necessity and safety measure, than a choice. Symptoms of dementia can be very unpredictable and even a single second can change things. It is not always possible to be present with the person 24X7, hence it is even more critical to ensure that the environment is safe for them and the caregiver is stress-free.”
Here are a few simple but effective tweaks that can make life much simpler for a dementia caregiver.
De-clutter the house and surroundings
Get rid of the unnecessary things that add to disorientation. Remove extra bottles, toiletries, decorations from the washrooms, living rooms and bedrooms which may not be used on a day to day basis. To make it easier for the person to shower, just keep a soap and shampoo bottle in the bathing area and nothing else. Clean up their bedside table and keep important things like glasses, water bottle and the accessories regularly used well within their reach.
Label if they can read
People with dementia may face difficulty in identifying where to keep what and where to get their necessary belongings from. If your loved one with dementia can read easily, process the information and comprehend it properly, labelling their rooms and personal spaces can help them a great deal. Like, if you label their closet and let them know where they can get their things from, it becomes easier for them. However, do this only if they do not face any difficulty in reading. Otherwise, it may lead to another source of confusion.
Remove any harmful objects lying around
Removing harmful objects or those that pose a safety risk can actually prevent undesirable mishaps and accidents. Any electric appliances, sharp objects, non-edible liquids, naked wires or loose wiring should be gotten rid of to reduce safety risk as much as possible at home.
Put grills on the windows and balconies
This is another must-do, especially if the apartment is in a high rise. Ensure there are grills on the windows and balconies. A person with dementia may experience an increase in anxiety or paranoid feelings quite commonly. If at any point they perceive a threat to their safety, they may risk escaping the room or house. Uncovered windows and unguarded balconies can become a threat in that case.
Take measures to reduce fall risk
Reduce fall risk by removing loose wires, rugs, carpets, furniture or just children’s toys lying around. Dementia also changes depth perception in a person, so a person may not be able to fully make sense of a glass table or a foot mat which might seem like an added layer on the floor. Chairs with armrests must also be considered, as loss of balance is also commonly experienced as dementia progresses.
Avoid fancy packaged stuff
Soaps shaped like fruits or bottles shaped like a book and fancy decorative objects should be avoided at homes with a loved one having dementia. The key is to simplify. It is not uncommon to see someone with dementia get confused between a remote and a phone or calculator. Thus, it is always helpful to only keep things that look like what they are supposed to be.
Keep your doors locked to prevent wandering
Wandering (click here to know about Wandering in Dementia and some safeguards) is a very common symptom of dementia. Keep the main doors locked to prevent wandering. However, it is also important to ensure that if they are trying to get out and encounter a locked door, a reasonable explanation is given on why the door is locked instead of making them feel ‘locked up’ in the house.
Adequate lighting is a must
Avoid lighting which creates multiple shadows and can add to paranoia or hallucinations. Put up bright lights so that they are able to see things clear and move about without any obstructions due to low visibility.
Dr Naganath Narasimhan Prem, Consultant Geriatrician and Elderly Care Specialist at Jaslok Hospital and Research Center, Mumbai, shares some additional home-safety tips.
• Be prepared for emergencies. Make sure safety devices are in working order.
• Add extra lights to entries, doorways, stairways, areas between rooms and bathrooms. Use night lights in hallways, bedrooms and bathrooms to prevent accidents and reduce disorientation.
• Place medications in a locked drawer or cabinet. To help ensure that medications are taken safely, use a pillbox organizer or keep a daily list and check off each medication as it is taken.
• Remove tripping hazards. Keep floors and other surfaces clutter-free. Remove objects such as magazine racks, coffee tables and floor lamps.
• Watch the temperature of water and food. It may be difficult for a person with dementia to tell the difference between hot and cold.
• Avoid injury in the bathroom. Install walk-in showers. Add grab bars to the shower or tub and at the edge of the vanity to allow for independent, safe movement. Add textured stickers to slippery surfaces. Apply adhesives to keep throw rugs and carpeting in place or remove rugs completely.
• Improve laundry room safety. Secure and lock all cleaning products such as detergent, liquid laundry. Prevent access to the washer and dryer
• Support the person’s needs. Try not to create a home that feels too restrictive. The home should encourage independence and social interaction, hence, clear areas for his or her activities.
Adoption of technology (click here to know how gadgets can help dementia caregivers) can help in preparing your home to be safe and convenient for one with dementia, improve quality of life and provide assistance in several ways. Sensors can be used to prevent falls, motion detectors can provide alerts on movements, especially during the night. Assistive technologies for pill reminders or automatic pill dispensers, smart technology with a timer that helps in automatic switching off for appliances, stoves, lights, wireless devices to measure heart rates and respiration, talking clocks and calenders, padlocks for locking the main entrances, in-home cameras for monitoring and locator devices and GPS can ensure the safety and comfort of those with dementia to a great extent.
September 21 is World Alzheimer’s Day and observing the month of September as the Dementia month, Silver Talkies is covering various aspects of Dementia to make the readers aware of the condition.
Finding a dementia support group can help you deal with the challenge of caregiving for a loved one with dementia.
Seeing a loved one’s decline into dementia or Alzheimer’s disease can be heart-wrenching. It can also mean that someone from the family has to take on the role of a caregiver. The task is challenging, rewarding and exhausting at the same time and several caregivers feel the need to connect with others in the same situation. Becoming part of a Dementia Support Group can help you learn to navigate the situation better and give you a peer group dealing with similar issues.
What is a dementia support group?
The aim of a Dementia support group is to provide caregivers with an environment of support and a platform to share their feelings. It is essentially a group for people who are taking care of Dementia patients or those with other neurocognitive impairments. The group helps the caregiver understand and cope with the complexities of the disease, focuses on empowering the dementia community towards a better knowledge of the disease and provides tips and guidance on caregiving and most importantly emphasises on improving the well-being of caregivers.
Why is it needed?
Dementia is characterised by a progressive decline in cognitive, physical and functional abilities. As a Dementia patient loses one ability after another, a caregiver has to face tests of stamina, problem-solving, and resiliency. With increasing responsibilities, it is easy to become overwhelmed and neglect their own health and well-being. The burden of caregiving can put caregivers at increased risk for significant health and psychological problems. A Dementia support group is a safe place for caregivers to meet and develop a mutual support system. The caregivers can gain information on methods of coping with the disease. Not just that, a Dementia support group can also help those suffering from the condition cope with it. Here’s how a support group can be beneficial for both the caregivers and their loved ones with Dementia.
How does it help caregivers?
Support group for caregivers includes experts who offer guidance to solve difficulties faced by the caregivers. They also allow a safe space for each caregiver to tell their story and release any emotional distress which they might be facing. The focus is mainly to provide the family members or caregivers a dependable platform where they could unload their emotions and struggles and do not get judged or stigmatised. This is a sharing space where the caregivers meet individuals like themselves and share the problems or tips to deal with the problems that might arise while taking care of a loved one with Dementia.
How does it help people with Dementia?
Support group for people with Dementia or neurocognitive impairment is focused on providing a sense of belongingness within the society and feeling of inclusion in a community. These support sessions include fun-based cognitive activities, movement and art, music therapy sessions and more. The participants are encouraged to share their life experiences, feelings and thoughts in a judgment-free area.
We bring you some Dementia Support Groups across India.
Samvedna Senior Care
Gurgaon, Haryana, New Delhi, Bengaluru
For Gurgaon and Delhi location, call 9818421446, 0124-4229659 or mail to contact@samvednacare.com
For Bengaluru location, call 0124 422 9659
This support group (www.samvednacare.com) is for families of patients of Dementia and the objective is to share knowledge and information on Dementia and help families deal with the challenges associated with this illness. A typical meeting involves sharing and participating in activities and singing and dancing together. Once in a while, an expert is invited to talk about relevant issues at the meeting. Members are asked to share their stories and instances like what were the first symptoms they noticed in their loved one and how did they accept when their loved one was first diagnosed with Dementia. They are also asked to share instances of success or failures in caregiving that other members can learn from. Information on the latest research on Dementia is also shared with the members.
Nightingales Medical Trust
Bangalore, Karnataka
Email: dementiabangalore@gmail.com
The support group meetings are held with minimum 15-20 caregivers at various locations around Bangalore for two to two and a half hours, usually on a Saturday. It is open to all, family & caregivers, students working with elders or anyone interested in knowing more about dementia. The sessions begin with a group discussion and open forum where everyone is asked to share their experience, the daily schedule at home and other issues. All this is followed by a small talk by an expert who has been invited and deals with various issues over the different sessions. Members try to find a solution towards caregiving in the midst of busy working lives and share tips with each other on behavioural patterns, healthcare tips, etc. Members have even formed a group on the messaging service Whatsapp and stay in touch with each other. You can email them to find out the date for the next meeting.
ARDSI, Hyderabad, Deccan Chapter Office & Dementia Activity Centre
Hyderabad, Andhra Pradesh
Email: ardsihyd@gmail.com
Website: www.ardsihyd.org
Contact Number: 9618527072, 9004528557, 9246519063
Alzheimer’s and Related Disorders Society of India Hyderabad (ARDSI) has a centre equipped for persons with dementia. It has an associated memory clinic. Please do check their very useful website listed above. For monthly caregiver support group meetings in Hyderabad, contact them on email or call.
ARDSI Kolkata Chapter
Kolkata, West Bengal
To reach them out, call +91 08232014540, 03332017044, 08232014540
E-mail- ardsikolkata@yahoo.co.in
Website: www. Ardsikolkata.org
ARDSI Kolkata offers a comprehensive range of services aimed at holistic dementia management. Starting from home visits for counselling the caregivers and making them aware of who to turn to for support, helping caregivers with a memory clinic that provides medical services for people with Dementia, training the caregivers at home and offering daycare for 6 days a week under daycare and home companionship program, ARDSI Kolkata is an efficient dementia support care group.
ARDSI Chennai Chapter – Madras Memory Clinic
Chennai, Tamil Nadu
Contact Number: (044) 42629209 and (0)98 4101 9910
The objective of this group is to provide various mental healthcare resources to deal with psychological, emotional and behavioural issues and provide comprehensive evaluation, development and application of alternative healing treatments along with maintaining clinical prudence and research.
Silver Age Foundation in collaboration with ARDSI Bhubaneswar
Puri, Bhubaneswar
Website: http://www.silveragefoundation.org/
ARDSI launched its chapter in Puri, Bhubaneswar this month in order to reach out to the people with Dementia and their caregivers with its support framework. It will be led by Silver Age Foundation, a non-profit organisation that is working towards the health and well being of the seniors.
In order to get in touch with Bhubaneswar Dementia Support Group, call 9090222666, 9090666222
Deenanath Mangeshkar Hospital
Pune
Tel: 020-40151000/66023000 (extension 1059)
The hospital conducts various Dementia Support Services. Memory clinics, guidance and counselling, memory improvement and memory exercise programs, and Alzheimer’s support group meetings, dementia research, and dementia awareness. Call them to know dates and timings.
Echoing Healthy Ageing
Mumbai
E-mail: info@echoinghealthyageing.com, Ph: (+91) 9167 61 3665
Website: www.echoinghealthyageing.com
Contact person: Amrita Patil Pimpale (9167613665 )
Echoing Healthy Ageing (EHA) is a social enterprise working in Dementia care sector, focusing on home-based therapies, counselling & Dementia care training for family carers and professionals. This includes counseling after the diagnosis, training for family carers and healthcare professionals, care planning assistance, and activity planning. EHA offers support for two populations i.e. the caregivers and family members of people with dementia and for individuals who are diagnosed with dementia or neurocognitive impairment. The focus and objective of each support group are customized differently according to the need of the population. The monthly support group meet for Family caregivers of Dementia is conducted every first Friday of the month in Holy Family hospital, Bandra. The cognitive stimulation sessions for People with Dementia are organized in Lower Parel, Andheri, Bandra and Thane.
Varishta
Ahmedabad, Gujarat
Website: https://www.varishta.org/contact.html
Varishta is an initiative of the Silversmile Elder Care Foundation, a not for profit company with the objective to promote awareness about Dementia and provide support to people with Dementia and their families. Its services include care solutions to those with Dementia and their caregivers in order to improve their quality of life.
Much of the information on this page is courtesy the website Dementia Care Notes, one of the best dementia resources in India. For a complete and constantly updated list of city-wise dementia care resources, which also include support groups, please check https://dementiacarenotes.in/resources/city-wise/
September 21 is World Alzheimer’s Day and observing the month of September as the Dementia month, Silver Talkies is covering various aspects of Dementia to make the readers aware of the condition.
In case you are a dementia caregiver and planning to put your loved ones in a dementia care home, check out the things to be kept in mind before choosing the appropriate home.
Anupama G, 57 years, has been a caregiver to her husband, Suresh Babu with Dementia for over a decade. It became almost next to impossible for helpless Anupama to take care of her husband single-handedly and manage her job simultaneously. While Babu grew more violent, started displaying several behavioural changes along with his waning reasoning skills and could no longer control his bodily functions like urination, Anupama suffered sleepless nights taking care of her husband and attended office in the mornings as she became the only breadwinner for the family.
“I cannot express in words how unimaginably difficult the situation was for me. I could not quit my job as there was no one to support my family financially. Since my husband got diagnosed with dementia, I was the sole earning member. Neither was I able to leave him alone at home as eventually his symptoms worsened and he became unmanageable. I could not peacefully take a sip of water or even sit for a while and rest. It was then when I started looking out for a Bangalore-based dementia care home that looked after my husband during the work hours. It was such a relief when I found one,” says Anupama who has lost her husband just a few months back.
Caregivers often go through extremely tough situations to take care of their loved ones with dementia all alone. This could be due to the lack of additional caregiving support care, managing professional lives at the same time and even due to inadequate mental aid. This is when a dementia care home comes to their rescue. While experts say, both the caregiver and the loved one with Dementia can be immensely benefited from an ideal care home, it is not an easy decision to take. It’s essential for the caregiver to actually understand the concept of a care home and the criteria that they must look for before selecting one for their loved one.
According to Dr Soumya Hegde, geriatric psychiatrist, a care home is essentially a place where someone moves into (or when someone moves their loved one into) when they need help and support for their day to day care. “The concept of moving out of one’s home and being cared for by strangers is very new in India and often associated with stigma. Families are deemed uncaring when the senior is moved into a care home. However, the truth is, families who have to make this very difficult decision are far from being uncaring and possibly live with that guilt for the rest of their lives. On the contrary, care home is a familiar concept in the West and placement in these places is generally covered by insurance policies or the government. This is not the case in India where families have to fund their own care. As such, the criteria for admission to a care home are also different,” Dr Hegde says.
“When a loved one is affected with Dementia, the decision to move them to a care facility is made only when the behaviour challenges make it difficult to continue providing care at home or when there is no family member available to supervise care,” she adds.
As dementia is a progressive disease, a person’s condition worsens with time and he/she needs more care and support. Neha Sinha, Chief Executive Officer (CEO) of Epoch Elder Care, an assisted living home for seniors with dementia in Gurgaon and Pune believes that choosing between home care and residential care is always a difficult choice but there can be some guidelines that help in the decision making. In case you are a caregiver and looking for a dementia care home for your loved ones, here is a list of vital things you must keep in mind while selecting a care home.
Tips to choose the appropriate care home
Check whether the overall ambience of the care home can offer a homely feeling and comfort to your loved one.
1) See if the staff is trained in dementia care or not.
2) Look out whether the staff seem warm and caring.
3) Always try to take a round and observe staff interactions with other residents.
4) Observe the presence of nursing staff and see if the staff is available round the clock on duty.
5) Check out the aspect of safety of the facility as it houses a lot of residents who may have wandering issues.
6) Find out if the facility is equipped enough to personalise meal and meal timings, in house, since every resident may not stick to specific meal timings.
7) See if the facility conducts structured and planned activities personalised for each resident
8) Check whether the team is equipped to handle disease progression, especially skilled nursing needs
9) Find out if there are there any restrictions on visitor timings
Sinha believes that an appropriate dementia care home will have assisted living facilities such as assistance with ADLs (activities of daily living), meals, housekeeping, emergency response, engagement; staff who are trained and specialise in dementia care, who understand the disease progression well, can handle challenging behaviour and are able to help residents engage in various activities as per their current stages.
Benefits obtained from a dementia care home
“Although it can be a very emotionally overwhelming decision to move your loved one to a care home, there are a lot of long term benefits to this decision which may not be so apparent. More often than not, lack of basic care requirements like following a routine, proper meals and sleep, maintaining personal hygiene and meaningful engagement can result in the elderly becoming agitated resulting in refusal to accept care or becoming completely withdrawn,” says Sinha.
“Caregiver burden is a real issue in any chronic condition and more so in dementia since it is very difficult to accept changes in the personality and behaviour of the loved ones as part of the disease condition. Many caregivers suffer from stress, undiagnosed mental health conditions, give up jobs and even face isolation themselves in these situations. Once these basic needs are taken care of in a care home, family members are not only relieved of caregiver burden but are also able to spend quality time with their loved and can then focus on creating more positive associations,” explains Sinha. Here are a few ways by which a dementia care home can offer support to those with dementia and caregivers.
1) Providing support with daily activities (eating, bathing, activities etc) as most of the times families struggle to fulfil these basic needs at home.
2) Offering holistic care catering to health, cognition, social needs, engagement, nutrition, mobility needs and more.
3) Providing Emergency support.
4) Extending specialised medical care as and when the need arrives
5) Enabling meaningful engagement and activities to prevent isolation
Dementia care homes in India are not enough
The existing number of dementia care homes in India does not match with the number of facilities that are needed. India has an estimated 5.12 million people affected by Dementia, as per Dementia India Report estimates, according to Alzheimer’s and Related Disorders Society of India (ARDSI).
“Specialised dementia homes in India are difficult to find and nowhere in proportion to the current needs. One of the main reasons for this is the availability of trained resources and lack of skilling. There are more than enough players in the industry who would be open to launching dementia care homes but can only do so if trained people are available. Another aspect is also the fact that the dementia homes are currently not regularised, hence the absence of a framework to set up protocols, process and overall operations become a barrier to set up these specialised homes,” Sinha told Silver Talkies.
There is an urgent need for the government and other stakeholders to join hands and focus on establishing a greater number of well-equipped dementia care homes to tackle the increasing burden of dementia.
To get a list of dementia care resources in India, city-wise, click here. Click here to know more about respite care and long term stay facilities.
September 21 is World Alzheimer’s Day and observing the month of September as the Dementia month, Silver Talkies is covering various aspects of Dementia to make the readers aware of the condition.
September 21 is World Alzheimer’s Day and we have Echoing Health Ageing, a social enterprise providing consultation, education, and home care support for people with dementia and their families providing us with its expert tips on keeping brain active.
As time passes by, we enter another stage of life, more enriching than the previous one. Each stage brings its own milestones and as we grow old, we forget to take care of ourselves. However, there is nothing to worry as we have got a few tips to keep the brain active during these changes. Here are 5 ways that can help you keep your brain active.
Work out
This is one of the most basic things which one can do for their brain and the body. 30-minutes-long evening or morning walk inclusive of some stretching and meditative exercise. Walking daily can result in improved blood circulation to the brain and a healthy heart.
Socialize
Being a member of different clubs or organization can uplift the mental well-being during old age, being involved in a social groups and community projects gives a sense of inclusion with the society. Meeting old friends or acquaintances can improve the happiness hormone in the body according to research. “The more social connections someone has, the better they are at preserving mental function and memory. Social interaction also helps memory as it helps your mood,” highlights the research.
Do art
Researches have shown that doing art relaxes the mind, body and brain, which in turn promotes creativity and exploration. Doing art once a day can help in channelising emotions and feeling. Also, it can be a great exercise to focus on preserving your gross and fine motor skills.
Cognitive activities
Cognitive activities are those which challenges the brain to work and solve different problems using different skills. Activities such as puzzle, building block, maze, Sudoku, find the difference, vocabulary etc., come under cognitive activity. They help in restoring and preventing the loss of the skills you have already acquired throughout the course of life.
Find a hobby
Having a hobby during old age can really upgrade the experience of that stage of live. These hobbies could be anything such as singing, dancing, painting, traveling, reading, any sports, or something you couldn’t pursue when you were young. You can have multiple hobbies and focus on maintaining each one of them. Having a
hobby can also provide with sense of purpose or accomplishment during old age.
Echoing Healthy Ageing offers Cognitive stimulation activities for Group of Seniors in Mumbai through its Mumbai Memory Café event. Mumbai Memory Café is a group therapy session for seniors. It provides cognitive stimulation therapy through art and music therapy. The session is facilitated by elder care specialist therapist. For more information on Echoing Healthy Ageing, visit our website: http://www.echoinghealthyageing.com/
September 21 is World Alzheimer’s Day and observing the month of September as the Dementia month, Silver Talkies is covering various aspects of Dementia to make the readers aware of the condition.
High blood pressure can adversely affect older adults if not diagnosed on time. We speak to doctors to understand the effects of high blood pressure and the brain damage it could cause.
When 80-year-old Chandrika* was brought to a Bangalore-based hospital, she had a recurring stroke and memory loss. Hardly did anyone realise that her increasing blood pressure was responsible for the stroke and memory loss till she was diagnosed to have elevated home blood pressure with persistent morning spikes in blood pressure. Not just that, her nighttime blood pressure was found to be very high. Interestingly, her office blood pressure recordings taken at the doctor’s were just normal which is why her hypertension did not get detected earlier, resulting in stroke and memory loss.
DOCSPEAK: Vascular risk factors are associated with the risk of not only vascular dementia but also Alzheimer’s disease.
According to Dr Sanjay Bhat, Consultant – Interventional Cardiology at Aster CMI Hospital, Chandrika’s treating doctor, optimising blood pressure measurements and early diagnosis could have prevented the stroke and memory loss in her. “Uncontrolled high blood pressure can lead to stroke by damaging and weakening your brain’s blood vessels, causing them to narrow and rupture. High blood pressure can also cause blood clots to form in the arteries leading to your brain, blocking blood flow and potentially causing a stroke. High BP in middle age is a risk factor for dementia. To fully evaluate its impact, hypertension should be assessed several decades before the onset of dementia. Vascular risk factors are associated with the risk of not only vascular dementia but also Alzheimer’s disease,” says Dr Bhat.
Did you know that high blood pressure had a connection to the brain? An observational study recently published in The Lancet Neurology Journal reveals that high blood pressure may have an adverse impact on the brain among older adults. The study highlights that high blood pressure along with a considerable increase in blood pressure in midlife may be linked with brain pathologies in later life and may result in several disorders associated with the brain.
High blood pressure has already become a serious health concern among older adults in India and can result in a significant burden on the country’s healthcare, specifically the elderly care services in the days to come. Data recorded by the Indian Council of Medical Research (ICMR) shows that around 10.8 per cent of deaths in the country is due to high blood pressure or hypertension. Not just that, this data also indicates that hypertension happens to be one of the primary drivers behind the increasing rates of dementia in India.
Another study has revealed that the urban Indian population suffers more from hypertension compared to the rural Indian population. The percentage of the population suffering from high pressure has seen a rise from 23.0 per cent to 42.2 per cent in urban areas between 1991 to 1994 and 2010 to 2012. In rural areas, the percentage of increase was from 11.2 per cent to 28.9 per cent over the same time period.
DOCSPEAK: A person who has normal blood pressure at the age of 50 years has an 80 per cent lifetime risk of developing high blood pressure.
According to doctors, there is a noteworthy association between increased blood pressure and brain pathology. Dr Sreekanth B Shetty, Senior Consultant and Head, Interventional Cardiology, Sakra World Hospital, Bangalore, told Silver Talkies: “A person who has normal blood pressure at the age of 50 years has an 80 per cent lifetime risk of developing high blood pressure. High blood pressure is silent and often undiagnosed. Even when identified, it often remains inadequately treated, often due to misconceptions amongst doctors and patients alike. Untreated and inadequately treated blood pressure affects blood vessels everywhere in the body leading to heart diseases, stroke and other brain pathology, kidney failure, blindness and more.”
DOCSPEAK: High blood pressure is associated with a high incidence of ischemic and hemorrhagic strokes as has been proven by various studies. In fact, every 10mmHG rise increases the risk several-fold.
Speaking about how high blood pressure particularly affects the brain and results in cognitive decline among older adults, Dr Charu Goel Sachdeva, Consultant, Internal Medicines, Manipal Hospital, Dwarka, said: “High blood pressure is associated with several detrimental effects on the body particularly on the brain. Its association with the atherosclerotic process causes the vessels to narrow leading to poor blood supply to various parts of the brain. An essential vessel may get obliterated and lead to a complete blockage of blood supply. High blood pressure is associated with a high incidence of ischemic and hemorrhagic strokes as has been proven by various studies. In fact, every 10mmHG rise increases the risk several-fold.”
Several brain-related diseases can occur due to the adverse effect of high blood pressure. Here are some of them that you must be aware of.
Ischemic Stroke
This happens because of blockages in brain arteries. It manifests as the weakness of limb (paralysis), facial asymmetry, loss of sensations and more. The disability varies in severity depending on the amount of brain involved. If large arteries to the brain are affected, stroke can be life-threatening and severely disabling. Early detection of stroke and treatment is very important to limit the damage.
Cerebral Haemorrhage
This happens due to the rupture of blood vessels in the brain, usually in those with high blood pressure. This manifests as severe headache, limb paralysis, vomiting, altered consciousness, fits, etc., depending upon the extent and location of the bleed. Prompt recognition and treatment are obviously lifesaving.
Dementia and Vascular Parkinson’s Disease
Blood pressure also manifests less dramatically, but in an equally or more disabling manner by causing dementia. This is because of the slow degeneration of blood vessels in various forms with progressive damage to the brain tissue. This leads to memory loss and even Parkinson’s.
You can diagnose Brain disorders related to high blood pressure by Imaging modalities such as MRI, MR angiography, CT scan, Ct angiography, carotid ultrasound doppler. Immense advances have been made in the area of radiology which allows rapid recognition and treatment of stroke. Additionally, heart-related tests such as ECG, Echocardiography, Holter are needed to be done to complete the assessment.
It is essential to keep a check on rising blood pressure in order to keep both your brain and body healthy. Doctors suggest older adults go for a daily check-up to keep hypertension-related brain and body disorders in control.
*Name of patient changed on request
A supportive parent could go a long way in not just creating a circle of acceptance in the LGBTQ community, they could also work towards changing the stigma and social mindset. A mother and son speak to us on the one year anniversary of the decriminalization of Section 377.
On September 6, 2018, in a historic verdict, the Supreme Court of India decriminalized Section 377, saying sexual orientation is natural. Many LGBTQ people in India do not get support within their homes and find it hard to come out to their parents. But for every parent who chooses to live behind the veil of stigma and rigid conditioning, there are many who have been a strong source of support and acceptance for their children. On the anniversary of the historic judgment on decriminalization of Section 377, we spoke to textile expert, Silver Talkies Social member, and entrepreneur Chandrika R Desai, 72, and her son Rajiv Desai, 38, Vice President – Global Diversity & Inclusion at Gartner, to find out how they have built a circle of love and acceptance together.
Chandrika, how has your family background been? Was it open-minded and discussion encouraged between parents and children?
We wouldn’t consider our family conservative. Throughout childhood, we have made an effort to expose the children to different views and perspectives. We also have discussions with an open mind and do learn from each other (even if we might not agree). We’ve always lived in big cities like Calcutta and Bangalore so I guess that sometimes helps too.
When did your son tell you that he is gay?
My son, Rajiv came out to me and told me he was gay in the summer of 2010 when we visited him in Belgium. Prior to telling us, he had only come out to a couple of close friends in 2008 and to our daughter in 2009.
What was your initial reaction? Did you accept immediately? If not, what were the reasons and how did you gradually accept?
I think my initial reaction was something along the lines of “Beta, if you are happy, I am happy.” But deep inside, I was crying – but didn’t know why. I couldn’t pinpoint what exactly was making me upset. Rajiv was there to answer a lot of questions and my daughter Dipali helped me understand it all a bit more, resulting in the realization that I didn’t know anything about this topic. Subconsciously, I had built layers and layers of misconceptions and ignorance – which Dipali and Rajiv helped clarify and remove.
I was also worried about how my husband would react and he accepted it without much worry. As I got more clarity over the situation, I realized that not accepting his choice was hypocrisy. And since I have always criticized hypocrisy in others, I choose to accept.
My daughter Dipali also helped me understand that coming out is a process that is difficult for my son too and that my crying all the time would make him feel worse – and that he didn’t deserve to see his mom like that.
I logically accepted but it took me a few months to undo years and years of assumption making on how my son will marry. But it got easier every day, as I realized nothing has impacted our love for each other.
Rajiv and his sister Dipali
How did understanding scientifically about homosexuality help you in the acceptance journey as a parent?
Additional conversations with my children were definitely helpful. Also, a very close friend of ours was a leading psychiatrist in Chicago and he had explained to me that being gay is a natural phenomenon, not a choice someone makes and is common in many species, including human beings. This definitely helped me towards my path of acceptance with a feeling of pride.
Were you worried about what would people say? What was and has been the reaction of your friends and family?
I was not worried about relatives, people, and society, but I did want to know how best to communicate and share, at least with near and dear ones. With Rajiv’s permission, my daughter helped us draft an email/ letter which not only included Rajiv’s coming out and our acceptance but also some educational facts and information about the LGBTQ community and a clear conclusion that we stand with him, no matter what. The responses to these letters/emails were, for the most part, that of acceptance, love, and support. Some openly admitted they didn’t know much about this ‘topic’ but were still supportive and commended our courage to be open about this:
“We still love you. Bravo for accepting who you are, it takes a lot of courage in this paranoid world.”
“I personally am so happy for you that you are at peace and can lead a normal happy life, which you have all the right to enjoy like the rest of us. I wish there was more awareness about this when you were younger, so all of us could have understood this and you did not have to go through unhappiness and discomfort alone for so long.”
What these responses taught me is, if we love and respect our children, society will, as well (and it doesn’t matter if it doesn’t).
Did your support make things smoother for your child in terms of facing society?
I think it definitely helped – he no longer had to worry about his family’s acceptance. Even the older generation, including my father at the age of 86 and my uncle at the age of 86, accepted this announcement graciously.
As Rajiv says, this also helped with the “when are you getting married” question, but not for long. Our relatives now ask him, “When will we meet your husband!”
How did it benefit him emotionally?
He was able to be freer and more open with us. There wasn’t that “big secret” in the room that put pressure on every other conversation.
What would be your message to parents, especially from an older generation, about accepting their gay children?
If you suspect or think someone in your family is gay, do not out them, confront them, spy on them or try to find out the truth. Instead, focus on creating a welcoming, respectful environment, so they feel comfortable telling you first.
Be open, accepting and listen to what your gay children and grandchildren have to say. Remember – if you think it’s hard for you to listen to them, imagine how hard it is for them to say it.
Ask questions (without presumptions or prejudice) and be curious to learn more about the topic. Ignorance drives fear which leads to disastrous consequences.
Respect their truth and give them your confidence – it is not food for gossip or broadcasting to others, without their permission.
Your love for them shouldn’t change. If anything, your acceptance should make it stronger.
If you think you need help dealing with it or just talking about it, seek it; preferably from a professional.
Chandrika Desai with her son Rajiv
Rajiv Desai’s take:
I struggled with a lack of clarity around my sexuality for most of my childhood and early adult years. I was always attracted to males, but never quite knew what that meant for me from a lifestyle perspective.
When I was living in Dubai (2007-2008), I met a few expat individuals who had been in the closet for over 45 years and felt they had lost out on so much, by not being true to themselves. The weeks leading up to my coming out (to myself), I was extremely stressed. It was affecting my skin and health through acne and weight gain.
The moment I came out to myself in June 2007, I felt as if the world’s weight had been lifted off of me. I was happy inside. I told a few friends and had their immediate acceptance. A few years later I told my family and I consider myself very lucky to have their love and acceptance. I encourage all to consider their truths and be transparent about it. Those who matter will accept gradually. Those who don’t, they probably don’t matter.
Thank you for sharing your thoughts here Ma – for this and many more reasons, I love you.
Chandrika & Rajiv Desai were interviewed by Reshmi Chakraborty
All photographs courtesy Chandrika & Rajiv Desai
Support groups that also help parents understand more about sexual orientation could go a long way towards helping change societal attitudes towards LGBTQ. Here are some:
https://www.facebook.com/goodasyoublr/
https://www.facebook.com/SweekarTheRainbowParents/
https://humsafar.org/ (They recently completed a six-month-long course called Prabal for parents of queer children.)
These simple ways can gift you an independent life beating your age. Try them out and live your silver years on your own terms.
We all crave for an independent life and the last thing we want is age to interfere in our individual space of freedom. Although aging may not be an easy process, several older adults have shown us that age truly is just a number by being active and independent.
The World Health Organization describes Active Ageing as “the process of optimizing opportunities for health, participation and security in order to enhance quality of life as people age.” At Silver Talkies, we are constantly trying to showcase older adults who are living examples of that definition. However, age can bring with it certain limitations. Here are ways in which older adults have navigated these. In the month of Independence, Silver Talkies shares how older adults can stay independent and active.
Living an active life
Incorporating exercise and physical activity to the daily routine can help older adults enjoy a healthy life. According to doctors, having a physically active and engaged life enables older adults to prevent their muscles from getting weak, improve coordination and enhance bone density. Not just that, it keeps the brain health strong and prevents any form of stress and anxiety among the seniors.
Making use of technology for senior safety and independence
Technology has come up with several ways to ensure safety, comfort and independence of older adults. Starting from apps providing medical and life alerts to home care technology including telephones with enlarged numbers, smart applications providing customised control over operating electrical appliances at home, real-time video monitoring devices to make the caregivers aware of any kind of emergency can extensively increase the freedom and comfort of the seniors. With the help of advanced technology, seniors may not have to depend on manual help and can easily get their jobs done online. From getting groceries, medicines and other necessities delivered to the doorstep to booking an appointment with the doctor and paying of bills from home, technology has made seniors independent than ever before.
Staying social always increases the feeling of independence
Several studies and surveys have revealed how a socially engaging life can reduce physical and cognitive decline among the seniors. In India, a country of over a billion people, one in every two elderly individuals suffers from loneliness, says a study by the Agewell Foundation. Social activities enhance an older adult’s ability to continue managing and controlling his or her own life and sustain self-esteem along with having a purpose in life. At Silver Talkies, we recognise the importance of social engagement for our active seniors and try to bring them together through peer group interactions and activities. If you live in Bangalore, find out how you can build your social network with Silver Talkies.
Having a smart budgetary plan
Financial independence plays a vital role in maintaining an individual’s freedom and having a nest egg in place is of great importance as we grow older. Money always remains an area of concern in one’s older years and a smart budgetary plan post-retirement can make the silver years absolutely stress-free and enable seniors to live independently. Opting for an independent health insurance cover helps a great deal in meeting the healthcare expenses in later stages of life. Some additional sources of income like mutual funds, real estate and stocks can serve as a steady source of income for older adults and help them meet required expenses without having to be dependent on anyone. Appointing a financial planner for smart planning of post-retirement budget and making use of budgetary tools and applications available to track monthly and non-monthly expenses may help gain financial independence.
Being independent is the best way of living life and age should ideally not come in the way. Follow these simple hacks and live your life on your own terms — independent and free!
These seniors have been an inspiration for us to donate organs and save more lives, which at present is the need of the hour in India.
August 13 is Organ Donation Day. It’s a day that reminds us about the importance of organ donation and the sad fact that although our country is in dire need of organs, the deceased donor donation rate stands at 0.34 per million which is far less than the required rate as reported by a study conducted by Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow in 2018. Despite the low rates, some senior citizens around the country are setting an example donating their organs. Mohan Foundation a not-for-profit, registered non-government charity organisation in India that works in the field of deceased organ donation and transplantation, shared some examples with Silver Talkies.
S Srinivasan along with his father
This 60-year-old’s father encouraged him to pledge his organs
Breaking all taboos, this father and son duo has shown it is never too late to realise the significance of organ donation. S Srinivasan, 60, a practising Chartered Accountant from Kuwait had pledged to donate his organs in 2010 and pledged his body for research in 2012 and he thanks his father, Mr Santhanakrishnan for inspiring him to be a part of this noble cause.
“My father who is 89 years old was and is my inspiration. Many, many years ago, even before body donation gained prominence, he had pledged to donate his body. To do this, he had to go to the GH (General Hospital-Chennai) many times. Not willing to give up, he persevered and finally managed to complete the donation. His famous joke was that, when he volunteered and was signing up, the staff on duty asked him, “Sir, where is the body?” For which, his reply was, “This is the body (pointing to himself), but you will get it only later.” He told me that he noticed in the register when his name was entered that the donor before him was none other than actor Kamal Hassan,” says Srinivasan.
He explained how his father was able to convince a few of their family friends too to donate their body including his younger sister, who currently works in the UAE. “My Dad was inspired by watching it on TV and through newspapers,” he adds. Srinivasan has pledged to donate his eyes and inspired and convinced at least 25 people among his family and friend circle to donate their eyes too. He hopes to inspire many more in days-to-come and help India to overcome its organ donation crisis.
Dr Padmasri Ayyagari with her mother Lakshmi Ayyagari
Her mother’s wish to donate organs makes this doctor daughter proud
For Dr Padmasri Ayaggari, 54, her mother’s wish to donate organs is the best thing that happened to her medical career. Even today when her mom is no more around her, she drives immense strength just thinking about her contribution in giving a fresh lease of life.
My mom, Smt. Lakshmi Ayyagari (73 years) had always been a homemaker. She was an excellent cook, very creative and good in painting, embroidery, tailoring, knitting, doll-making, crochet and more. Her dream always had been to be a teacher but due to various circumstances, she could not be one. She wanted to be an organ donor and wanted to donate her body to the Gandhi Medical College Anatomy Department in Hyderabad. This she said will help the teachers to show and explain the anatomy to students very well. This act of hers has fulfilled her teacher instinct and her dormant dream,” she recalls.
Dr Ayaggari’s father who took care of her mom during her long-standing illness supported her decision. “I am a doctor myself and thought only medical fraternity can do the greatest service to humanity. But what can be best than the service done by my mom. I have no words for this noble action that my mother did and get tears in my eyes always with pride and love when I remember her,” says Dr Ayyagari.
V Ganeswara Rao who has given sight and learning by donating his eyes and body
Breaking taboos and gifting a new life was this octagenarian’s last wish
Veeravalli Ganeswara Rao, 80 years, had set an example before his children by donating his eyes and body this year. He was a chemist and ran a medical shop for many years in Aravalli, a small village in Andhra Pradesh. Closely observing various illnesses and suffering of people inspired him to donate his eyes and body.
Dr V Vijayalakshmi, his daughter-in-law says: “He was not a religious person and didn’t believe in the afterlife and such things. Long-time ago he expressed his desire to donate his body to a medical college. When he became sick about 15 days before his death we again spoke to him about his wish. As medical professionals, we know the importance of organ and eye donation so we decided to fulfil his wish.”
How to donate organs?
Once an individual is declared brain dead, the organs should be removed from the body within a stipulated time and then transplanted on a recipient’s body. The stipulated time stands as 6 hours for eyes and up to 12 hours for skin. In order to be an organ donor, an individual must register by signing up for organ donation. The following websites can help you know more about the process.
https://www.mohanfoundation.org/
There are several state-based deceased organ donations and transplant programs that can help you with the organ donation procedure. Here are the links to the government-based committees.
Jeevasarthakathe in Karnataka (http://www.jeevasarthakathe.karnataka.gov.in/Website/English/Home.html),
Mrithasanjeevani in Kerala (http://knos.org.in),
Jeevandan Cadaver Transplantation program in Telangana (http://jeevandan.gov.in/),
Zonal Transplant Coordination Centre in Mumbai (http://www.ztccmumbai.org/ztcc/).
Caregiving across the world is largely a woman’s job, show most studies. We spoke to caregivers to find out the real picture.
In the summer of 2016, IT professional Nalini Kumar’s* mother had a fall and broke her femur bone. Kumar, who lived in Delhi then, packed her bags and moved in to care for her mother in Agra. It’s 2019 and Kumar hasn’t gone back to live in Delhi. The broken bone led to other ailments, and Kumar’s 84-year-old mother is unable to live on her own, even with round-the-clock paid help. Kumar’s older sibling lives in another metro and occasionally visits. He bears the costs for his mother’s medical expense but believes his sister is “better-suited” to take care of their parent.
“I had to move from a full-time job to contractual remote work when I realised she needed me around. I haven’t been able to give it my hundred per cent as I can’t leave my mother and step out much.” Kumar wishes there was an acknowledgement or understanding of the responsibility she bears daily. “I’m glad my brother shoulders the financial burden but few in our family realise how taxing everyday caregiving and taking care of small things like ayahs paying truant, organising medical equipment and unscheduled hospital runs can be.”
Kumar isn’t alone. The burden of caregiving mostly falls on women in the family, say studies.
Women often shoulder caregiving duties
Caring At Home
A survey on ‘Role of Family in Caregiving’ by Helpage India in June 2019 across 20 cities, showed that female caregivers outnumbered men when it came to providing physical care for activities of daily living (ADL) for elders. And in many cases, it is either the daughter or the daughter-in-law who does it. The survey showed that across the national level, 28 to 68 per cent of daughters-in-law are providing care for Instrumental Activities of Daily Living (IADL) such as preparing meals, helping with phone and housekeeping, taking medicine or managing money. The help from sons for such care ranged between 10 per cent to 51 per cent.
Female caregivers (56% to 59%) are also primarily the ones who extend emotional support to the elderly with problems like loneliness, anxiety and fear of dependence.
According to the Helpage Survey, female Caregivers largely assist the elderly dependent except for assistance required in managing money where males assist the elderly dependent persons more. Most often, daughters-in-law followed by daughters support the elderly dependent in cooking or housekeeping. It is mainly the female caregivers, especially daughter or daughter-in-law who assist the elderly parent or parent-inlaw in visiting the hospital to seek treatment.
“Bulk of caregiving in our country falls within the family and community. There are very few cases of institutional care, even for people who can afford it. The government also believes that family is a mainstay and it reflects in our policies,” says Anupama Dutta, head, policy research and advocacy, Helpage India.
Keeping that in mind, Helpage India decided to analyse the changing realities of the family that the burden of caregiving is on.
Dutta feels it’s time to take note of some new realities. “Traditionally women were looking after the home. Now women are entering the workforce, especially among the middle class. If that is the case, we have to look at changing ethos within the family and the challenges the caregivers are facing.”
Mumbai based gerontologist Amruta Lovekar agrees. “Conventionally, in our families, caregiving burden is largely on women. It is accepted that women are good at this and supposed to fulfil their responsibility.” Lovekar feels it can have a significant impact on women, without the elderly themselves or the rest of the family realising it. Take the example of B*, a caregiver. One of her parents had orthopaedic surgery and another suffers from memory loss.
B continued to work for a year and finally had to give up her job as her parents were uncomfortable with a paid caregiver. Gradually it became impossible for B to step out, as her parents were uncomfortable and not always willing to let anyone else share the caregiving duties.
Neelika Jain is a 40. Her ageing in-laws live with her, and her mother lives an hour’s drive away. Jain has a supportive spouse but admits that the bulk of emotional and instrumental support falls on her. “I also have two schoolgoing children, and a small enterprise I am actively involved in and managing everything does become tough.” She says her spouse chips in but the primary caregiving is part of her routine. “The assumption is that I’m good at managing elders, I have a flexible work schedule and that it (caregiving) comes naturally to me.” Is she uncomfortable about the expectation she bears? “I’ve never thought about this honestly,” she admits.
The numbers tilting towards women caregivers are not just for India alone. In the US, The National Alliance For Caregiving estimates that women provide 60-70 per cent of informal care for Alzheimer’s patients. Dutta feels that the care burden on women is also increasing because people are living longer. “Earlier life expectancy was much less, but now people live longer and therefore the duration of care is more.”
Caregiving without support can have mental and physical impact
The Fallout
Caregiving regularly can be tiring, stressful, sometimes even thankless. The Helpage study tries to point out that the caregivers are taking on this burden without much assistance. “It is important to look into the space of the Caregiver to understand the burden of eldercare and the challenges faced by them,” Mathew Cherian, Chief Executive Officer (CEO) HelpAge India was quoted saying in a report in Mint.
Could it lead to elder abuse? “The most common abuse we come across is disrespect, verbal abuse and neglect. This may sometimes be related to care because if the caregiver is caring for a long time, she does expect acknowledgement that mostly never comes. The caregiver may also be growing older herself, and it may be tough on her,” adds Dutta, though she cautions that abuse cannot be condoned, no matter what the circumstances are. But the root of the cause behind it could be caregiver stress and ignoring the gender angle to care.
“The government should encourage people to share the burden and create respite care so that the caregiver gets to take a break,” she adds. The caregivers in the Helpage Survey are from the ‘sandwich generation’ who are looking after both the younger and the older generation.
Also Read: Why India’s Middle-Aged Are The New Sandwich Generation
Here too, it is mostly the women who shoulder the caregiving duties, and not everyone has the support of helping hands at home, whether for financial or socio-cultural reasons. Stress and lack of time for oneself are common. “During our survey, most women told us they were speaking to friends to share their worries and burden. This is indicative that there is a possibility of mental health nuances.” Dutta adds.
The caregiver’s mental health is not a big part of mental health discussions in our country when it should ideally be. Studies have shown that anxiety and depression can be common in caregivers of person’s with dementia. Physical health may also take a beating, leading to caregiver burnout.
The other implication is financial. Caregivers like Kumar have seen their income take a beating because of lack of time to find new work. Jain sometimes rues that her fledgeling enterprise has taken a backseat because often she has had no time to devote towards it, losing money in the process.
The New York Times’ article “The Weight of Elder Care on Women,” points out that fourteen million older Americans cannot live on their own and the burden of care falls predominantly on female relatives. Caregivers spend about 20 hours per week, providing care—half of a full-time job. Four out of five have missed work because of caregiving duties, and one out of ten have lost a job because of it.
In India, it’s hard to find such precise data. In the absence of more surveys on gender in caregiving and it’s implications, it’s also hard to figure out sometimes whether a change is afoot.
The Other View
Amrita Patil Pimpale of Echoing Healthy Ageing, Mumbai, which works with persons with Dementia and their caregivers, believes it’s hard to say if women always bear the primary burden of caregiving. She thinks that caregiving may come naturally to many women.
“As professionals, we see clients ask for female caregivers and therapists. Caregiving services are dominantly female. It could be because by nature they have more empathy. However, we have also seen sons being involved, pay for things, take decisions. In some cases, the spouse of the person comes forward to take the decision. In other words, the leadership in the house matters in deciding who plays the caregiving role.”
At the same time, Patil-Pimpale feels there is no general rule.
“It also depends on the family structure and social strata sometimes. Our therapies are usually affordable for upper and upper-middle-class families where most women go out to work and have strong views. In most of these places, if women take on caregiving, it’s not because they are expected to do it but because they want to.”
Mumbai resident and former teacher Indrani Bose, 64, is one of those people who are caregivers by choice and not because they were expected to be. Bose took care of her late in-laws, followed by her parents. While her father passed away some months ago, her mother, who is 85, was diagnosed with Alzheimer’s in 2016. In Bose’s case, her family recognised the effort that went into her role as a primary caregiver and ensured she had the support she needed.
“When my mother-in-law fell ill, my father-in-law insisted I keep a paid caregiver so that I could continue with my job.”
Both Bose’s in-laws and parents emphasised on the need for a full-time paid attendant so that she did not have to put her life on hold and could work and travel. Her story is an example worth holding up because very often the caregiver’s own needs are overshadowed by the enormity of the ailment she is taking care of.
Patil-Pimpale thinks that gender roles around caregiving are gradually changing. Indeed in certain sections of society, it probably is. But research globally shows us that caregiving predominantly remains an area where the bulk of the responsibility falls on women and it’s time gender entered the caregiving conversation to make it an equal caring field.
Age-related eye disorders are many, most of which we do not know about and tend to delay in identification and diagnosis. Here we are with a list of top age related eye diseases and the ways you can prevent them.
With growing age, it is not just your hair that turns grey or your skin that gets wrinkled but also your eyes that get weaker and need special care. Several age-related issues have direct adverse impacts on eyes thereby resulting in the occurrence of eye-related disorders that are age-specific, say doctors. Most seniors are not aware of the age related eye conditions they can develop.
Here are some of the age related eye conditions seniors can develop
Cataract: This is the most common.. It occurs when there is movement of proteins in your eye lens that leads to clouding of the lens. A cataract causes glare and clouded or blurred vision.
Glaucoma: It is a disease that can actually cause blindness, hence, one needs to be careful about detecting its symptoms. Glaucoma is the umbrella term for a group of diseases that damages the optic nerve thereby resulting in vision loss and blindness. It occurs due to high intraocular pressure which is the pressure of fluid inside your eyes.
Age-Related Macular Degeneration (AMD): This also is considered to be one of the most common vision problems in older adults. This usually occurs among people above 60 years and the condition progressively degenerates or destroys the macula, the central portion of your retina that impairs the central vision. AMD hinders a person’s ability to see objects and that prevents him or her from daily activities like reading.
Dry Eye: It develops due to poor quality or inadequate secretion of tears in the eyes. It results in itchiness, irritation in eyes and redness and pain in the eyes as well.
Diabetic Retinopathy: This is a condition that is associated with Diabetes and leads to blurred vision.
According to Dr Jalpa Vashi, consultant ophthalmologist at Manipal Hospital, Whitefield, here are certain symptoms that senior citizens and older adults should watch out for and not delay in visiting an eye doctor when they have one.
Signs to worry about
Sudden onset of spots and floaters in the field of vision: Eye floaters occur due to a benign, age-related condition known as Vitreous Detachment. This happens when the gel-like interior of the eyes liquefies and gets separated from the retina. However, sudden spots and floaters may also occur due to a severe, sight-threatening tear of retina or retina detachment. This is when you need to see an eye doctor without any delay.
Feeling of a dark curtain settled across the field of view: This can happen due to a retinal detachment when the retina separates from the underlying layer of nourishing blood vessels (choroid). This can result in permanent loss of vision in case the retina is not attached within a couple of hours.
Sudden eye pain, nausea and vomiting: In case you are experiencing these, you must be suffering from acute narrow-angle Glaucoma that can permanently damage your optic nerve. Visit an ophthalmologist immediately to prevent permanent vision loss.
Double vision, double images or ghost images: This can be caused by several eye conditions. It can indicate a stroke or paralysis of external eye muscles.
Sudden blind spot in the eye: If you are above 50, you may have a chance of developing a macular hole in the most sensitive part of the retina. Macular holes may cause extensive damage to your eyes, even permanent loss of vision.
How To Prevent These Conditions
Speaking about the ways of preventing these age-related conditions, Dr Asha MS, Ophthalmologist at BR Life SSNMC Hospital, says: “Regular eye check-up can help in tracking and early diagnosis of any eye disorder. Avoiding smoking can help a great deal in keeping your eye health steady. Staying away from alcohol also works wonder as alcohol consumption leads to a gradual reduction of vision and vision loss.”
Dr Sirish Nelivigi, senior consultant, Ophthalmology at Sakra World Hospital, adds: Maintaining a healthy diet also helps in amping up your eye health. You must have a diet rich in Vitamin C and E, Zinc, Copper, Vitamin B complex, Omega – 3 fatty acids and beta-carotene. Eat whole grains, lean meats, fish, nuts, legumes, eggs, orange and yellow veggies, sweet potatoes and spinach for healthy eyes.
According to Dr Karthiyayini Mahadevan, Head, Wellness and Wellbeing at Columbia Pacific Communities, a balanced diet, healthy lifestyle, adequate rest, mental relaxation and the right kind of physical activity like walking and yoga can give you healthy eyes.
Tips for healthy eyes from doctors
Quit smoking: Smoking is bad for eyes and can cause a vision problem.
Wear sunglasses: Wearing sunglasses while you are out in the sun can protect your eyes fromUV rays that can cause serious harm to vision.
Wearing Contact lens: Contact lenses are often handled carelessly by many people. You should wash your hands before wearing and removing it. Unclean contact lenses can result in inflammation of the cornea.
Avoid looking directly at the bright light: Looking directly at the bright light can permanently affect your vision. It is better to avoid staring at bright light objects for longer hours.
Eye Exercise: Eye exercise can improve the blood circulation to the eyes and increase the oxygen level and prevent toxins.
Rest and Sleep: A good sleep can boost your eyes healthy and make it feel fresh. Take frequent breaks between work and give rest to your eyes.
Planning to live out your dreams in your silver years? Here’s the best way to have an active life after retirement.
The years after retirement can be the most active years of your life, doing things that you had always planned to do but never had the time for because of work, bringing up children and other family responsibilities. By the time you retire and decide the next course of action, many of these responsibilities have been taken care of, leaving you with the freedom to do things that you had always wanted to.
Across India, retirees have taken up a variety of new things to do like athletics, art, writing, learning a new language or picking up a new instrument to play on. If you have the will and energy to invest in expanding your horizon – the sky is the limit.
How To Get Active Post-Retirement
One of the best ways to do that is to spend your post-retirement years in a beautiful community of likeminded people, with thoughtfully designed conveniences on hand and daily chores taken care of. It takes your mind off routine work like cleaning or cooking and makes sure that you have enough free time on hand to put to good and productive use. If you are part of a community of active seniors who have worked hard all their lives and are now looking forward to spending their silver years living their long-cherished dreams, you are already on the road to being enthusiastic and socially engaged.
Well-planned senior living communities offer activities that ensure days spent in being creative, social and energetic. At the upcoming senior living setup, Parkside by Brigade, a wide array of activities has been planned under ‘Silver Smiles’ to make sure that residents have an assortment of things to engage with. Fun activities around the year include group outings, discourses and talks on subjects that expand the mind and widen the horizon.
Making The Most Of Your Special Time
Spending your time fruitfully: Hobbies are a great way to stay occupied, improve your cognitive abilities by learning a new skill and sharing them with others. You can learn a new hobby or simply pick up the threads of an old one. Hobby clubs, where you can find similar enthusiasts are a great addition in most retirement communities. There’s no better bond than the ones shared over similar loves and hobby clubs can help you find those connections with ease. In fact, there have been retirees who have had successful second innings by learning a new hobby or engaging themselves with an old one and even starting a new business based on it. It’s a win-win situation for sure. Not only do you keep your mind creative and working, you now have the pleasure of having “work” that is done in your own time and for your own passion!
Social activities: Loneliness has often been one of the biggest fallouts of urban living. It can lead to mental health issues, leading to a multitude of problems – both physical and emotional. Engaging in fun outings and interests with a bunch of peers ensures you stay not just occupied but happily so. Having a group of friends isn’t enough, what also keeps the connections going are shared activities, like games and music sessions that break the ice and invite laughter. What could be better than spending your evenings playing indoor games like Housie, Tambola or simply having a fun session singing old songs?
Skill building: Learning something new keeps your mind sharp. And there’s a world of things out there to acquaint yourself with if you have the inclination. For example, you have the technology but would love to know how to use it right. While there are enough places where senior citizens can brush up their tech chops, travelling a distance to learn something doesn’t always work for all. A senior living set up like Parkside by Brigade offers you the convenience of learning right at your doorstep. Knowledge workshops under the Silver Smiles program include familiarization of WhatsApp, Browsing the Internet the right way and making Online payments, among other things, with coordinators assigned for each activity, you can be sure that you are in good hands.
How Could These Activities Help You?
Research has consistently shown that social activities not only help people stay independent, it also works the brain cells. An active life may help to keep progressive disorders like Dementia at bay. Under Silver Smiles, activities would be planned to keep in mind knowledge improvement, skill development and would be done through travel, bonding and building up great friendships. The idea behind such activities is to celebrate the second innings of life for all seniors. With their duties and obligations discharged, this is the time for them to expand their mind, skills and life goals.
Physical activities also go a great way in keeping seniors in top shape and keeping ailments at bay. Keeping this in mind offerings like Silver Craft would coach senior citizens in physical activities like Yoga, Swimming or Dancing, among other things. Again, you could join these classes anywhere but doing it within your own senior living community would be having the added advantage of the classes being specially modulated for older age groups. The level of attention and focus given to each participant would also be different from doing a regular class.
Would learning something new work out expensive? At Parksides, it comes as part of the package though there would be incidental costs based on actuals for some of the activities. But that’s a small price to pay for a life of engaged, active, joyful living.
For more on how to lead a super-active retired life, visit: https://www.parksidebybrigade.com/
Yoga is a discipline of goodness and positivity. It’s also an exercise open to all ages. Here are five health benefits of Yoga for older adults. And don’t forget to check two awesome Yoga events in Bangalore & Pune that day.
Yoga, a spiritual and ascetic discipline, works through breath control, simple meditation and practice of bodily postures, providing the best of health benefits and relaxation to all, irrespective of age. For seniors, Yoga has a wide range of advantages that keep their body and mind young, fit and good going, beating the leaping age numbers. To mark the International Day of Yoga on June 21, here are five health benefits that Yoga offers for older adults.
Improves sleeping habit: For most older adults, disturbance in sleeping habits is pretty common. They are either insomniac or suffer from oversleeping, both of which are not healthy. According to research, Yoga has a positive impact on the time taken by seniors to fall asleep and the duration of time slept. Studies have found that those practising Yoga are able to reduce their fall-asleep time by an average of 10 minutes and amped up their sleeping duration by one hour.
Enhances muscle strength and protects joints: For silvers, Yoga acts wonders in increasing the strength of muscles and guarding the joints, especially for those who are suffering from arthritis. Studies have revealed that Yoga increases handgrip strength for children, adults and older adults. This is not an exception for patients of rheumatoid arthritis as well. In fact, Yoga can lessen the risk of arthritis and carpal tunnel syndrome.
Keeps Diabetes in control, curbs hypertension, aids in weight loss: Yoga plays a crucial role in keeping Diabetes under check and is beneficial for patients suffering from Type 2 Diabetes. Research has shown that practising Yoga for 40 days can result in a considerable reduction in the blood sugar levels. It also plays magic in keeping hypertension levels low. Within 3 months of regular Yoga practice, a senior can experience a drop in blood pressure, cholesterol and triglycerides. While too much of weight gain and obesity can cause damage to seniors, Yoga also helps in weight loss and keeps the body fit.
Maintains a healthy mind: Age-related crankiness and mood swings are not rare for older adults. This is where Yoga comes to the rescue, lifts up the mood and lessens anxiety. According to studies, Yoga is the best form of exercise that among other benefits, has a soothing impact on the mind and helps in mood enhancement and anxiety reduction. Researchers have found that practising Yoga increases the production of gamma-aminobutyric acid (GABA), that helps in calming down the body.
Cures breathing and lung issues: Yoga actively plays a role and helps in getting rid of breathing and lung issues. A study has shown that yoga practice can make the lung capacity better, by as much as 10% in only 40 days. Just 30 minutes of yoga breathing techniques can make the condition better for those suffering from bronchial asthmatics.
HOW TO MAKE YOGA A PART OF YOUR LIFE THIS WORLD YOGA DAY
If you are in Bangalore, join us for Chair Yoga for Seniors by Silver Talkies, in association with Manasum & Portea Medical.
On the occasion of World Yoga Day, Silver Talkies has organised Chair Yoga for Seniors by Yoga Acharya Dina Khimasia, 60, an advocate of yoga for everyone, especially elders. She has written extensively on yoga, about breathing techniques, asanas and calming the mind with meditation. Read about Dina here.
The session will include Pranayama, Mudras for hypertension, diabetes, aches, pain and insomnia, Chair Surya Namaskar, Asanas that strengthen the spine and deep relaxation and meditation using Tibetan singing bowl. It is a free entry event that will take place in the Rotary Club Bangalore, Promenade Road, Opposite Coles Park from 11 am to 12:15 pm on June 21, Friday. Do bring your 55+ family or friends along.
Register now: 9980508000/ 9886283816
If you are in Pune, join Rejuvenate by Seniority on June 21
Seniority.in, the online shopping portal for seniors is organizing a mega event to celebrate Yoga with 300+ people. On offer is a Masterclass on Yoga with Art of Living experts on Yoga asanas and techniques.
The event will take place on June 21, Friday at 07:00 am to 09:00 am in Jogger’s Park, Kalyani Nagar, Pune and will have Shri Jagdish Tukaram Mulik, MLA, Vadgonsheri Assembly as the chief guest.
To register, call 8390786053 or WhatsApp 8291051868
There is no fixed age to exercise and being an older adult shouldn’t keep you from it. Our experts on why the best time to exercise for seniors is now!
One of the ridiculous notions society places on senior citizens is that the elderly need to take rest continuously and there is no need for any form of exercise for seniors. Moreover, this is the reason why most of the silver generation population is sceptical about exercising or seeking fitness related advice.
An elderly lady who had a Yoga class in her society every Saturday and Sunday loved to attend it and was a regular for years. Unfortunately two years ago, she developed knee osteoarthritis and was unable to sit on the floor to do Yoga. So she requested the teacher if she could sit on a chair and do the same exercises in a modified way. The yoga teacher agreed. However, the relief was short-lived when the senior lady realised that all the other group members were commenting behind her back- ‘What does she think of herself? Is she some queen that she gets to sit on a chair while we all sit on the floor?’
Frustrated with this hostile behaviour, she left the class.
Depriving someone of a fit and healthy lifestyle is as big a crime as not providing them with proper medical care. It is never too old to exercise. It is a shame that terms like ‘workout’ ‘gym’ ‘fitness’ brings to our mind an image of a young man or woman in their prime looking toned and happy. Take a moment and google these terms right now and you’ll agree.
However, this is just an unwritten rule created in our minds.
Let’s break this rule. As Swami Vivekanand had said- Weakness is Sin. Why stay weak when you can stay fit? Let’s move towards fitness. It is our duty towards our body to keep it healthy and fit ALWAYS. Also, this duty doesn’t end at retirement.
Doing exercises has many benefits. Some of these are:
? Maintains flexibility
? Strengthens muscles
? Improves blood circulation
? Improves balance and coordination
? Improves endurance
? Improves confidence
? Enhances Mood
? Delays & shortens the period of illness
? Prevents falls
? Helps in healing
? Controls diabetes, hypertension
? Prevents or delays Alzheimer’s
? Aids quality sleep
? Reverses or prevents urinary incontinence
What kind of exercises need to be done, once you are convinced about the benefits? There are various types of activities that will help:
Strengthening exercises, aerobic exercises, flexibility exercise, postural training exercises, balance and coordination training, resistance training, balance training are some of these. Even playing various sports is a fantastic form of exercise. Example: lawn tennis, badminton, volleyball, basketball, squash, swimming.
Cycling is an excellent exercise
Various games too are an excellent form of exercises like hopscotch, musical chairs, dog and the bone and cycling. Alternative forms of exercises can avoid making your fitness routine monotonous.
Some of these are:
Dance therapy, Zumba, Aqua-aerobics, Taichi.
Taichi is an ancient Chinese form of martial art that involves slow rhythmic movements of the body which helps to develop reasonable control over your body hence improving balance and coordination. It also improves memory, calms the mind, and improves concentration. Yoga is one of the best exercises for the mind and body.
It is always advised to seek the help of an expert if you are starting for the first time and once you learn the exercises right, you can continue at home. You can get a Comprehensive Geriatric Assessment done, where the team also includes a physiotherapist who does an in-depth assessment before creating a tailor-made exercise protocol based on your fitness. The physiotherapist then coordinates with the geriatrician/Elderly Care Specialist to maintain a long term follow up for holistic care.
There is an exercise principle widely followed known as ‘FITT principle’
F stands for Frequency. Frequency of 4-5 times/week is advisable.
I stands for Intensity. The intensity of the exercise session is calculated using a formula depending on your age and other contextual factors.
T stands for time. Duration of each session should be 30-40 min initially, progressing up to 50-60 min over a few weeks or months.
T stands for type. The type of exercise could be aerobics, strength training or balance training among others.
The aim is to exercise up to 150 min per week of moderate intensity exercise. Always start with a proper warm-up of 5-10 min and a good 5-10 min of cooling down to prevent muscle injury. In case you are suffering from body aches like knee pain, neck pain or back pain, please visit a physiotherapist and get the concerned problem treated first.
The Chinese have a famous saying that the best time to plant a tree was 20 years ago, the next best time is now. The same goes for exercising. The best time to start a fitness routine was 20 years ago, and the next best time is NOW. So break all barriers in your way and do yourself a great favour by investing in your health. Because “I like to stay unfit” said no one ever.
— Co-written with Dr Pratha Mehta
Parkinson’s most often goes undetected for years in a large number of people. In the elderly, Parkinson’s Disease symptoms are usually attributed to the ageing process. While in the younger age group, people think they’re too young to have Parkinson’s. Here’s an expert guide on 10 Parkinson’s Disease symptoms to watch out for.
Although there hasn’t been a single symptom which if detected, can be used to diagnose Parkinson’s Disease, there are a few obvious and not so obvious signs and symptoms which could indicate Parkinson’s disease.
First, the obvious signs – these signs are visible to the naked eye and are usually the reason people would first go to consult a doctor.
1. Tremor – It is a repetitive shaking that may occur in the hand, leg, head or jaw. The Parkinson’s tremor usually occurs when you’re not using that body part, i.e., when the part is at rest. For example, if you’re sitting to watch TV and your hand placed on your lap starts to shake but the minute you lift it up it stops shaking. Then it could be a Parkinson’s tremor.
2. Slowness and heaviness in one limb
3. Dizziness – Dizziness occurring when standing up from a chair or after lying down for a while is known as orthostatic hypotension. This can be linked to Parkinson’s disease.
4. Change in walking style – Most people are able to feel or notice a change in the way they walk. Most often though they aren’t able to pinpoint what has changed. Some of the changes that occur with Parkinson’s are walking much slower, shuffling of the feet while walking, dragging of one leg, loss of arm swing on one or both sides. You may even notice the person bending forwards or leaning to one side while walking.
5. Change in handwriting – In Parkinson’s this symptom is called Micrographia. As one writes, the size of the letters become progressively smaller until it’s almost illegible. Some people may have difficulty signing and thus have cheques rejected.
6. Change in speech – sometimes people with PD notice a change in the volume of their voice while some people feel that they can no longer pronounce all their words clearly.
Next, come the not so obvious signs – these are considered to be pre-clinical or present even years before the actual diagnosis.
7. Loss of smell – this is considered to be one of the earliest symptoms of Parkinson’s. This loss of smell can also affect the taste of food.
8. Sleep disorder – REM (Rapid Eye Movement) Sleep disorder is seen in PD. When asleep a person may “act out” dreams, talk or thrash out, sometimes even becoming violent. This is different from tossing and turning in bed.
9. Depression & Anxiety – Bouts of sadness or of “feeling low” and anxious which you’ve not experienced before could be a sign of PD.
10. Constipation – Researchers say that difficulty with bowel movements could be an early sign of Parkinson’s.
What to do if you or a loved one has one or more of these symptoms: Do not panic. These symptoms occur in a variety of conditions and may not necessarily be Parkinson’s. You should consult a Neurologist or a Movement Disorder Specialist for an evaluation.
Read our extensive guide to Parkinson’s Support Groups & Living With Parkinson’s Disease:
How Support Groups Help – Parkinson’s Disease
Living Alone With Parkinson’s? Here’s An Expert Guide
Did You Know of This Pune Based Dance Program For People with Parkinson’s Disease?
ElderEase, India’s first omni-channel retail destination for seniors, provides products that can make tasks of daily living and mobility extremely safe and easy for senior citizens. We take a look at what’s on offer.
They say old age is like a second childhood. We couldn’t agree more given how often many of us tend to worry about our parents.
Would the stairs in the ancestral home prove hazardous? Is the bathroom in danger of being a fall zone? Is the walking stick giving dad a firm footing as he goes on his daily round? Can we find a solution that can make getting up from a chair easier for mom?
The seed for ElderEase, a company that specialises in quality products for senior citizens, was sown when one of the founders saw the difficulty faced by their ageing parent when getting up from a chair. The lack of availability of quality products which would provide a solution to the problem motivated the founders to start ElderEase.
ElderEase provides assistive aids for elders, right from mobility, bathroom safety, bedroom safety, daily living aids and products for various conditions, from Parkinson’s to Dementia.
What are the products seniors need the most?
The common problems the elderly face can be categorised as under:
Most seniors are looking for aids that prevent falls in the bathroom. Grab bars, bath chairs, anti-slip solutions for the bathroom floor and alarms in case of an emergency are of high priority as a fall could have very far-reaching and damaging effects at an older age.
You can find a solution for all bathroom types at ElderEase, even when you do not want to make a permanent change therein.
As one ages, balancing one’s own body becomes a challenge for an elderly person. This increase in physical instability also increases the risk of falling. External support, like a walker or a walking stick, for seniors, can often increase sensory input and in turn one’s confidence, encouraging a person to move out rather than be confined to home.
ElderEase offers a range of mobility products, including exclusive walking sticks, walkers, rollators as well as specialized walkers for neuro conditions.
Aids like bed pads and chair pads are convenient solutions for incontinence related issues, especially when diapers can cause extreme discomfort.
The elderly tend to fall off the bed at night while sleeping. As a solution, ElderEase provides bed rails that can be installed in minutes without screwing onto your bed and also blends with the furniture of your house.
Bed Rail
Where there’s a problem, there’s a product that can help
How do I help my father, who has trouble every time he tries to get in and out of the car? How do I help my grandmother get up from the sofa without hurting her? Does my mother, ailing from arthritis, have to ask somebody to cut her nails? Every time my grandfather drops a piece of paper or his keys, does he have to wait for somebody to pick it up for him?
Car Assist
These are a few challenges the elderly face in their day to day lives. For the first time in India, ElderEase has introduced global brands with quality products and unique functionality to enable the elderly to overcome the above challenges.
A Change In How We Do Things
www.ElderEaseIndia.com is the only online retail destination for the elderly which provides a 24-hour chat service along with a toll-free number (1800 3000 5594) for its customers. They service almost 20,000 pin codes in India, providing delivery free of charge. For ease of payments, they offer multiple payment options including cash on delivery, debit card/credit card, net banking, Paytm, EMI as well as PayPal for international customers.
ElderEase prioritises customer satisfaction, and thus, offers an easy return policy. Their entire range of products is also available on Amazon India. For the touch and feel of the products, you can also visit their flagship store in Kolkata.
As Smita Dalmia, co-founder of ElderEase says, “Personal engagement is a key to customer satisfaction. We take pride in bringing about a qualitative change in the lives of the seniors.”
This is exemplified by the feedback ElderEase receives from its customers.
As Ms Ferzeen Chhapgar remarked, “It was a pleasure to do business with this company due to the exceptional service I received. I was looking for, and provided a tremendously marvellous user buying experience/customer care.”
Going forward, this is the experience which motivates the entire team at ElderEase.
Pune based Hrishikesh Centre for Contemporary Dance has been successfully running a Dance Program for people with Parkinson’s Disease since 2009. Here is a photo feature on how it can help.
Mrs Lele finds it hard to walk and put her foot forward in a normal, coordinated way — something many of us take for granted. Yet, you’ll find her taking an auto from her home to Hrishikesh Pawar’s dance studio every week to attend a specially designed dance program for people with Parkinson’s. The brainchild of dancer Hrishikesh Pawar, The Dance for Parkisnon’s program in Pune started because of a film Why Dance for PD by the Brooklyn based Mark Morris Dance Company. “We screened the film at Prayatna, a festival I started in Pune. The screening was attended by the Parkinson’s Mitra Mandal group and that’s how the program started here. It’s affiliated to the Dance for PD group and run in collaboration with the Sancheti Orthopedic Hospital, Pune,” Pawar says.
He wanted the space to be different from a rehab centre. “I did not want to use dance as therapy but wanted to help the community. for our people. I was always aware that it’s not going to be only PD patients. I’ll also have younger dancers. There has to be a philosophical teaching that runs parallel to performing arts. E.g., a young dancer takes his/her body for granted till something happens to it. Here they are sensitised to age and what happens to the body as we age. The format was largely remains the same. My class has dancers like Tarini, who is 8 and Chandu Kaku, a lady in her 50s. The young in my class know that they have to help. It’s an inclusive space where people just come and dance. The oldest here is 86, says Pawar.
The project has seen some long time enthusiasts. Mr Joshi, a gentleman in his 70s with Parkinson’s, has been part of it since beginning, notwithstanding a hip replacement surgery.
We ask Pawar about improvement. “Just the fact that they come here every day is an improvement. Even if we have a cold and cough we want to stay at home. They have Parkinson’s which still has a stigma in today’s society. Most of the people in the morning batch take local transport!” says Pawar, adding that their medication has remained stable despite PD being a degenerative disorder. The medicine intake was monitored through Sancheti Hospital. “Psychologically they are participating more, they are going out publicly, which is liberating. All this can be intimidating for somebody with PD. They have started performing on stage (see video below). The idea of the performance was to look at their cognitive responses.”
Video - https://silvertalkies.com/wp-content/uploads/2018/12/WhatsApp-Video-2018-07-04-at-1.54.01-PM.mp4?_=1
The inclusive classes have worked out well. Pawar believes it leads to the older people emulating the energy of the young and the young developing empathy for the old. The elders have even performed at the Prayatna festival. Kudos to these elders who have shown an amazing will to be active as much as they can, through a medium that appeals to us all — Dance!
To know more, contact: http://www.hrishikeshpawar.com or https://www.facebook.com/Hrishikeshs-Centre-Of-Contemporary-Dance-154432524599258/
Read excerpts from an older interview with David Leventhal, Program Director, Dance for PD from our archives on how Dance can help people with PD here:
1. For people living with PD, exercise is a vital component to maintaining a sense of balance & mobility. How does dance help in that regard?
Dance and exercise both address balance and mobility, but dance addresses those issues by teaching people how to think about them strategically and consciously. Dancers spent their whole lives practicing ways to stay balanced and mobile, and in a good dance class, the teacher uses imagery, rhythm and technique cues to pass that information on. Dance also has a high adherence rate–because it’s often more enjoyable than a straight exercise program, people come back week after week to work on their skills.
2. Does dance help in creating a more positive mindset in them?
Absolutely. It’s important to remember that Parkinson’s is classified as a movement disorder, but it’s really a quality of life disorder. Mood is affected, and depression is common. People feel isolated from their former communities, and their relationships begin to change as their lives become defined by chronic disease. In a dance class, the emphasis is on positive possibilities rather than on limits, and always on the joyful aspect of moving rather than trying to solve a problem. The music is inspiring, and there are constant opportunities for playful interactions with other participants. In quality of life surveys, we’ve done, joy, confidence, self-esteem and social interaction are often mentioned as some of the most valuable benefits of the dance class.
3. What has been your first hand experience in conducting dance therapy for Parkinson’s Disease? Have you seen any visible benefits and improvements or positive reactions? Has there been any neurological assessment of dance therapy?
Over time, people with PD become better dancers as a result of the class. That’s quite an impressive achievement given the fact that Parkinson’s is a degenerative disorder–over time, it usually gets worse. One of the satisfying things about teaching the class is that you see results instantaneously. People might enter the studio with a fair amount of rigidity, immobility and facial masking, but an hour later, they have a swing back in their step, fluidity in their arms, and a smile on their face. One of our participants told us that it’s not perfect, but it’s often like taking an extra dose of medication–symptoms can slip away. Over time, although physical elements might become more difficult, the emotional, expressive and social components of the class remain important and beneficial. The class can be a lifeline that separates a lonely, completely medicalized existence from a humanistic, community-centered, artistic one.
Diabetes currently affects 425 million adults worldwide, with 73 million cases in India alone. Talks of a diabetic diet often lead to confusion about what to eat. Here are 10 easy ways to a diabetes-friendly diet and lifestyle.
India currently has 49 per cent of the world’s diabetes burden, with an estimated 73 million cases in 2017. The number is expected to almost double to 134 million by 2025, according to the International Diabetes Federation. A report in IndiaSpend says diabetes prevalence has increased by 64 per cent across India over the quarter-century, according to a November 2017 report by the Indian Council for Medical Research, Institute for Health Metrics and Evaluation, both research institutes, and the Public Health Foundation of India, an advocacy.
Often called a lifestyle disease, inactivity and excessive consumption of high-calorie foods is considered one of the culprits. Nutritionist and author Kavita Devgan says diabetes can cause much more damage in the body than earlier thought. It is a harbinger of multiple other diseases like cardiovascular disease, end-stage renal disease, among others.
On World Diabetes Day 2018, we bring you 10 effective tips towards a diabetic-friendly diet and lifestyle.
Now there’s another reason to include milk and cheese in your diet. Whey protein, which is found in these, can help keep diabetes away, even in those who are obese. While most dairy has some whey, Ricotta cheese contains the maximum amount because it is made from whey protein. Opt for the low-fat version, is Devgan’s advice.
Dahi Deal
High yoghurt consumption as compared to no consumption at all can help prevent diabetes by 28 per cent, according to a study published in the journal Diabetologia, February 2014. So try to have yoghurt every day – in any way you like it – as plain dahi, vegetable raita or a yoghurt based smoothie. Here’s a quick recipe from Devgan:
Blend 1 cup yoghurt with 1 cup cut pineapple and enjoy. Or churn 1 banana with a bit of ginger and honey with 1 cup yoghurt. Yum!
Breakfast Is Important
If you are in a habit of skipping breakfast, stop now. Begin your day with a high power breakfast. Those who have high-protein breakfasts maintain better glucose and insulin control than those who have lower-protein or no-protein meals. Eggs, sprouts, oatmeal, daliya and lean cuts of meat are good options to include in the breakfast.
If you have type 2 diabetes (T2D), breakfast is necessary and it can have real benefits says research. A study highlighted that a high-energy breakfast of around 700 kcals (vs a low energy breakfast of 200 kcals) decreased the overall high blood sugar in patients with Type 2 Diabetes over the entire day.
Walking every day, or in fact, any kind of physical exercise helps in breaking down insulin resistance and maintain sensitivity to insulin – which helps ward off diabetes.
Stop Lighting Up
Smoking raises the risk of diabetes as it can increase blood sugar levels and lead to insulin resistance. The more one smokes, the greater is the risk of diabetes. And improved insulin sensitivity has been found among individuals who quit smoking, despite weight gain. Passive smokers are not safe either.
Check Your Weight
Being overweight can keep your body from making and using insulin properly, leading to diabetes. And reducing weight by as little as 5-10 per cent can also have a significant impact on your sugar levels.
Get Your Omega On
Studies published in the journal Cell show that DHA, a type of omega 3 fatty acid is the key to taper down the inflammation thus lowering risk from diseases ranging from diabetes and cancer to cardiovascular disease. It is found throughout the body and is the major fat in the brain. Oily fish, such as mackerel, herring, salmon, trout, sardines are it’s the richest dietary source; for vegetarians, algae and seaweeds are the only vegetarian sources, so check with your doctor for available supplements if needed.
Cinnamon activates essential enzymes in the body which stimulate the cells to respond more efficiently to insulin, and also inhibits the enzymes that cause insulin resistance. The active ingredient in cinnamon — hydroxy chalcone — has high antioxidant activity and enhances insulin sensitivity, decreases fasting glucose, thus helping prevent diabetes. Plus it also contains a lot of trace minerals like chromium, copper, iodine, iron, manganese, which are all essential to help prevent diabetes. So add it when baking, or best to add a pinch to your morning or evening cup of tea.
Ditch The Extras & Have Food At Regular Intervals
Extra sugar in the form of excess coffee, tea, sweets, glucose, honey, jams, jellies, candies, ice creams, soft drinks and other sweetened beverages should be avoided, says Dr. Priyanka Rohatgi, Chief Clinical Nutritionist and HOD, Dept. of Nutrition and Dietetics at Apollo Hospitals, Bangalore. Cultivate the habit of having food at regular and shorter intervals and in small quantity, like 3 major meals and 3-4 small snacks in between. Select snacks that are roasted like steamed sprouts, poha.
Go Green & Step Up The Fibre
Ensure liberal intake of green leafy vegetables in the form of salads, soups, cooked vegetables as sabzis etc. Be moderate with roots and tubers (like potatoes, colocasia (arbi), sweet potato, yam, etc.). Use whole grains and pulses rather than refined cereals like maida (all-purpose flour). If mixing cereals with pulses for chapatti, use in the following proportions(4 parts of cereal + 1 part of the soya atta).
Images courtesy Pixabay & Wikimedia Commons
What’s a rainbow diet and how can it add better nutrition to your food? Nutritionist and author Kavita Devgan explains.
A rainbow never gets old, so why should you? A natural phenomenon, there is much that can be learnt from a rainbow about your nutrition. A diet high in colourful fruits and vegetables has been shown to provide a variety of minerals, vitamins, antioxidants, bioflavonoids and other nutrients that support a balanced diet. What to eat and what to avoid becomes simple if you remember your rainbow colours. Here’s a simple, easy to remember guide.
Violets & Blues: Foods containing blue/purple pigments such as jamun (Indian plum), damson plums, beets, purple grapes and purple cabbage all contain antioxidant compounds that protect your body from the damaging effects of free radicals (atoms that can damage cells, causing illness and aging), keeping your corporeal machinery running smoothly over time.
Greens – The pigment chlorophyll present in all green plants has anticancer and detoxifying properties too. In addition to chlorophyll, green leaves are high in carotenoids, bioflavonoids, vitamins and organic mineral complexes. In short, a prescription for a healthier, longer life!
Yellows & Oranges – These fruits and vegetables are high in carotenoids, which are primarily immunity boosters. Orange foods such as carrots, pumpkins, yellow capsicums, mangoes, papayas and cape gooseberries (rasbhari in northern India) are great for you.
Reds – The red colouring in natural foods is from lycopenes, which are proven to prevent heart disease and prostate cancer. They also prevent tissue degeneration. Tomatoes, watermelons, pink grapefruits, apricots and pink guavas are the must-haves. Cooked tomato products are also beneficial as lycopene is better absorbed when it has been heated! So tomato sauce, tomato paste and tomato puree are all good.
Hot tip> Buy the reddest tomatoes you can find. They contain the most lycopenes.
Say NO to whites: A rainbow does not have white in it, and neither should your diet have much of it! This pallid colour represents all the white flour, salt, sugar and butter we should avoid. The predominant component of most simple carbohydrates is white refined sugar, which is unhealthy for your digestive system, causing rapid wear and tear.
All images courtesy Pixabay
Suicide among elderly in India is on the rise and depression is often one of the factors, say experts.
In the first week of October, the month that begins with World Elder’s Day, a retired 65-year-old judge from Andhra Pradesh killed himself by jumping in front of a moving train. His 56-year-old wife did the same too. The suicide note left by the former judge revealed that he was taking the extreme step because of a kidney ailment he had been suffering from for the past few years.
The Global Burden of Disease Study 1990-2016, published in the Lancet journal found that the suicide death rate is increasing in the elderly, especially among those above 80 years. Alarmingly enough, the Indian elderly population has a significant risk of suicide when compared to other age groups.
Depression, often due to a chronic illness or some kind of functional impairment is one of the main risk factors for suicide in the elderly.
A 2015 study on Risk factors for suicide in elderly in comparison to younger age groups, which studied 1159 suicide attemptors, including people over 65 years found that physical illness, depression and a family history of psychiatric illness were the main predictors of suicide. The study noted that about one in five of all successful suicides are committed by individuals above the age of 65.
“Once an elderly person decides enough is enough and they are done with life, often because they don’t want to be a burden on others, financially or otherwise, they follow it through,” says Dr Soumya Hegde, Geriatric Psychiatrist.
“In fact, some of these studies show that the elderly people who committed suicide were in touch with medical professional a week before they did it,” says Dr Hegde who feels medical professionals need to be more aware of this and “ask elderly people if the thought has ever crossed their minds when they come for other check-ups.”
Elderly people are also less likely to report suicidal intention as compared to younger people, she adds. “Their attempts are more planned and they compete it.”
Depression and a sense of alienation, coupled with a lack of desire to go on living if the elderly person is suffering from a chronic ailment are often factors that prompt elders to attempt suicide. In fact, depression is an emerging mental health problem among elders in India. ‘The median prevalence rate of depression among the elderly Indian population was determined to be 21.9%’, according to the study: Prevalence of depressive disorders in the elderly (2011). Worryingly enough, India has a higher rate of depressive disorders among the elderly because the world-wide numbers stand between 4.7 to 16 per cent.
Dr Hegde warns that signs of elderly depression are often missed by both medical professionals and family as normal complaints of ageing. “Depression also manifests itself differently in elders as aches and pains and can be confused with other medical conditions,” she adds.
Medical health professionals treating geriatric patients need to be sensitized and aware. Families need to pay attention to the elders in their lives.
So if you find that a loved one at home is low someone low, take some time to sit down and talk to them and find out what is going on, is the expert advice. Families need to be aware, says Dr Hegde. “Find out if the elderly person is taking their medication properly and check their mood and seek help.”
Depression in elders is treatable too and it shouldn’t lead to an extreme step, even if the person is suffering from a chronic ailment. The Indian elderly population is expected to rise to 340 million by 2050. Mental health issues among the elderly and its repercussions like suicide is a much-neglected area and it is time that both medical professionals and families become aware of it.
Supervision and support are two main aspects of caregiving, which is often a challenging task. Here are few gadgets that can help dementia caregivers and ailing elders.
If you are a caregiver to a loved one with Alzheimer’s and Dementia, you know how mentally and physically challenging it can be sometimes, even with help. It is impossible for a caregiver to have eyes and ears everywhere, all the time. That’s when assistive technology can come to your aid. Here’s a list of gadgets that can be used by dementia caregivers as well as elders who may be home alone or ailing.
GPS Trackers: Wandering is one of the most worrisome issues for Dementia caregivers as people with Alzheimer’s and Dementia may tend to wander off when agitated or restless. A GPS tracker could help you keep that in check or at least alert you on time. GPS Trackers allow you to set up Geo-fencing, which means you can set boundaries or safe zones around specific locations on a map using a corresponding smartphone app. You can be instantly notified when someone moves outside these designated safe areas. For example, you can create geo-fencing around your parent’s walking routes in the neighbourhood park so that you are immediately alerted if they wander off somewhere.
There are many GPS Trackers in the market. Here are two that could be of use to families of people with Dementia. The TigerTrack Smart SOS Tracker by Tiger Tech Labs is a GPS Tracker, cell phone and SOS button all rolled into one tiny wearable device. You can easily hook it into clothing. It allows you to track your loved through a smartphone app, set safe zones so that once they cross it, you get an alert, after which you can track them in real time. The built-in cell-phone allows you to hear all sounds and conversations surrounding your loved one, just in case you feel the need to. In case of any eventuality, what we felt could potentially help was a 30-day tracking history that allowed families to see the various locations their loved one had visited.
Silver Talkies users can use the Promo Code Silver10 and get 10% off when they shop at tigertechlabs.com.
Another GPS Tracker we liked was ResQ Button’s Indoor asset tracker tags. These too are unobtrusive and designed to be used with the accompanying ResQ Button App on a smartphone. You can attach the tag to your loved one’s clothing. Use the app to set up alerts for you and other caregivers if your loved one wanders away from the configured device signal ranges. “The tracker signal can also be picked up any ResQ Button app device (on a smartphone or tablet) in the vicinity and its location will be updated in cloud,” says Parthi Munusamy, Director, ResQButton India Pvt. Ltd. This is useful if you live in a small community and could request friends in the neighbourhood to download the app. The product is also dust resistant and water-proof, with an operating temperature range of 0 – 50C. It also gives you the last known location, in the worst-case scenario where your loved one has wandered away. You could also get a ResQ Getaway Switch which works on Wi-Fi and can be installed in your home. It can pick up the Tracker Tag signals and forward it to cloud. “It’s ideal for places where using a Smartphone is not an option,” Munusamy adds. To buy ResQ Button products, click here.
Panic Alarms: Sometimes in an emergency a caregiver may not have the time, energy or quickness of response to pick up the phone and call someone. Pressing a button is a simpler option. That’s exactly how panic alarm or SOS buttons like the Panic ResQ Button work. A small wearable button, it activates a distress signal when you press and hold the logo for just three seconds. Like the ResQ tracker, any smartphone or tablet nearby with the app will pickup the signal.
TigerTRACK also also comes with a Panic Akarm. It includes a ‘one touch’ SOS button that allows the user to instantly signal for help.
You could also check out the Juvo Panic Alarm, which is retailing on Seniority and comes with a 3 foot chord that can be pulled to activate the powerful siren. The product is wall mounted and can be installed in an area that is accessible by all.
If you are buying on Seniority, don’t forget to use the Coupon Code ST10 that offers Silver Talkies readers a 10 % discount on Seniority.
Fall Sensors: Falls are responsible for 20 to 30 per cent of injuries among the elderly age group. They are also responsible for 50 per cent of injury-related hospitalization among people of 65 years and above according to Center for Disease Control and Prevention (CDC), US.
Fall sensors and preventive measures can alert you in case of a fall and get immediate help. TigerTrack Pro from Tiger Tech Labs comes with a Fall Sensor alert that immediately alerts the family about a loved one’s fall and even the location. Worn like a watch, the Tiger Track Pro also includes a Heart rate and BP Monitor that measures and keeps track of the users Heart rate and BP several times a day. Other extras that could be used by a caregiver to monitor the health of an elder include a Pedometer and Medication reminder.
Silver Talkies users can use the Promo Code Silver10 and get 10% off when they shop at Tiger Tech Labs.
And while these gadgets are no replacement for human care and supervision, they could help ease the burden. “It provides them and their families with peace of mind, knowing that they can always be heard, protected and found, under any circumstances. It gives them a critical, life-saving line of communication with their families at all times, lets their family and friends know that they are okay, or if the worst should happen, sends their GPS location to them – all with the push of a button,” says Aamod Wagh of TigerTech Labs.
Most falls happen at home. While reworking your entire flooring is an expensive option, what could work out to be cost-effective is a floor solution like Lizard Grip that could be applied to the floor to prevent falls. This isn’t a gadget but an effective anti-skid solution caregivers could look into if they have a loved one at home prone to falls that could complicate matters further. You can buy Lizard Grip here and use our Coupon Code ST10 that offers Silver Talkies readers a 10 % discount on Seniority.
Security Cams: Many people with dementia are home alone with a paid caregiver. And while trust and faith in them is important, supervision is too. A security camera would give you not just peace of mind but may also keep untoward incidents in check. One of these is the SharpNode 3S Camera that not just comes with live video streaming like all security cams but also a real time alarm that can alert you to any untoward incident. Here’s where you can buy the cam and get a 10% discount too if you are a Silver Talkies reader and use the Coupon Code ST 10.
Time Keepers: People with memory related problems could often have trouble figuring out the time. Poor vision is another huge factor that not just irritates an elder but also hampers their functioning. This Talking Alarm Clock comes equipped with a projector and tells the time out loud. It also has a hourly chime that helps you keep track of time. Buy it here on Seniority and avail your discount now.
You can also find Dementia Clocks on Amazon.in that mention the day, time and year as well as whether it is morning, afternoon evening or night. Click the link below to buy:
Lighting Up: Motion sensor lights could be extremely useful for older people who often need to get up at night to use the bathroom or other needs. Instead of grappling for a switch in the dark, these motion sensor lights switch on automatically when they detect movement. Find it in the link below:
Are you a caregiver or an elder living on your own who has used some of these products? Is there any other product that has been of great use to you? Email us on connect@silvertalkies.com about these and we shall include them here.
Memory loss is a common problem associated with ageing. But when is memory loss and forgetfulness a cause for concern? Are there signs of Dementia you should watch out for in an elderly person? Experts and caregivers weigh in…
“My father often forgets to shut off the gas after making his morning tea. At first, I thought he was just being forgetful given his 73 years but now the frequency is making me wonder if there’s something more…”
“My mother is very forgetful and tends to forget all her grandchildren’s birthdays. I send her a separate Whatsappp message whenever there is a birthday in the family.”
“Few days back, my father went to the phone to dial his best friend’s number. They speak every morning. That morning he couldn’t remember the number, something that hasn’t changed in the last decade. It’s come back to him now but was worrisome for me and I have been asking him to go for a check up.”
Memory loss is a common problem associated with ageing. “My memory is not what it used to be,” is something we often hear from elders. While forgetfulness could be a normal sign of ageing, memory loss could also be an early sign of Dementia and Alzheimer’s Disease. Alzheimer’s is one of the most common forms of Dementia, which is an umbrella term signifying a decline in memory and other abilities that can hamper a person’s daily life. One of the greatest risk factors for Dementia is age, though memory loss is also a common fall out as people grow older. However, when is memory loss something to worry about? When should families think of approaching a doctor to figure out if there is cause for concern? We spoke to experts like Amrita Patil Pimpale of Echoing Healthy Aging and long time Dementia caregivers who shared some advice on what to watch out for.
Signs That Your Loved One May Need A Checkup
• Increased Forgetfulness: All of us have moments when we have forgotten something. Person’s with Alzheimer’s may forget events that are important and ask for information again and again. “My mother’s forgetfulness is what stood out the most. When I visited her, she would often forget which day had I come, despite having been told the date repeatedly. She would also ask us to repeat conversations, even though these had happened right in front of her,” says Sharvani, caregiver to her mother with late stage Alzheimer’s and Parkinsonism since 2014.
• Misplacing Objects: People with Alzheimer’s may often misplace things or keep things in unexpected places (e.g., house keys in the fridge) and not be able to think back to find them.
• Daily Chores Get Difficult: Difficulty in coping with daily chores or familiar tasks could be another sign. E.g., if they are finding it difficult to finish daily chores such as housework, cooking, etc, something they did at ease earlier, it could be a sign that something is not right, says Pimpale.
• Difficulty in operating familiar objects: Pimpale also adds that people with Alzheimer’smay suddenly find themselves unable to do things they have done before, such as operate a mobile. Often older people do get confused about handling gadgets and may have problems handling something new but if it is a familiar object they have handled earlier with ease, and are unable to now, it is worth looking into.
• Lack of hygiene: A disinterest in personal hygiene could be another sign. In normal ageing, a person may find taking a bath a struggle because of the risk of fall or other physical factors but they are aware of the process of taking a bath. In case of a person with Alzheimer’s, the person does not remember the process and gets confused about what to do next. Hence hygiene often suffers. Lack of poor hygiene could be an indication that there is something wrong that the family needs to address. “My mother’s reluctance to bathe or keep herself clean and well-groomed is what got me worried the most when I would meet her,” says Manisha, a caregiver who lived in another city earlier and only met her mother twice a year.
• Problem solving and calculation difficulties: Difficulty in handling personal finance and banking are often signs that something is amiss, Pimpale adds. Many people find it difficult to handle banking related work, something they may have done with great ease and interest earlier. “Forgetting where the checkbook is kept or not remembering installment dates once a while is fine but very often a person with dementia may struggle to calculate or even forget the name of the bank or branch he has his account in. That is a matter of concern,” she says. Pimpale feels family members should pay attention to such matters and cites the example of an elderly gentleman who withdrew Rs 20,000 from the bank and lost it on his way home, without any memory of how it happened. Her mother’s increasing inability and confusion with finances was also a warning sign for Manisha, who noticed that her normally alert mother suddenly wasn’t able to remember where she had spent her money or how much she had withdrawn from the bank.
• Change in habit & lack of involvement: In some cases, the person may gradually stop doing things they’ve done their entire life. “My mother stopped exercising and listening to music, two things that were extremely important to her,” says Sharvani, who noticed these changes over time and was worried. She also felt her mother was distracted and not as involved in things as she used to be. For instance, her mother was an avid news watcher but as she came closer to the disease, she would just sit and watch, without really being involved in it.
• Communication impairment: In some cases, the person could find it difficult to explain things or communicate what they need. “My mother would start a conversation and get distracted midway or somehow be unable to explain things to us, which added to our worries,” Manisha adds.
Wait For The Right Diagnosis
While these are some possible red flags families could watch out for, Pimpale warns people not to jump to conclusions before thorough tests and check-ups.“Becoming a bit more forgetful does not necessarily mean that you have dementia. Many people notice that their thinking gets a bit slower or their memory becomes a bit less reliable as they get older,” she says, adding that, Depression, Delirium, certain vitamin deficiencies and UTI could have similar symptoms like Dementia. All these conditions are treatable or get better over time whereas dementia is incurable and progressive.
One of the reasons for certain changes could also be attributed to Mild Cognitive Impairment (MCI), which causes a slight but noticeable and measurable decline in cognitive abilities, including memory and thinking skills. A person with MCI is at an increased risk of developing Alzheimer’s or another dementia.
A family’s best bet, according to Pimpale, is to visit a doctor. “Your doctor will evaluate your overall health and identify any conditions that could affect how well your mind is working.” She further adds that, your doctor may refer you to a specialist such as a:
• Neurologist – specializes in diseases of the brain and nervous system
• Psychiatrist – specializes in disorders that affect mood or the way the mind works
• Psychologist – has special training in testing memory and other mental functions
• Geriatrician – specializes in the care of older adults and Alzheimer’s disease
Screening Tests That May Be Needed
There is no single test for dementia. A diagnosis is based on a combination of things:
• Taking a ‘history’ – the doctor talking to the person and someone who knows them well about how their problems developed and how they are now affecting their daily life
• Physical examination and tests (for example, blood tests) to exclude other possible causes of the person’s symptoms.
• Tests of mental abilities (for example, memory, thinking) – simpler tests will be carried out by a nurse or doctor, more specialist tests by a psychologist
• A scan of the brain, if this is needed to make the diagnosis.
In case the family gets a diagnosis of Dementia after following this process, Pimpale wants to mention that it is only just the beginning of the process. “Once the family has found out their loved one has Dementia, they need to seek help from counselors to understand the disease and family members need to seek help and focus on the safety of the person with dementia as well as focus on maintaining their quality of life.” She also feels that it’s important for families to involve more people and let them know that a loved one has dementia. It will not only provide them with much needed support but also help put an end to the stigma.
Experts and Caregivers Spoken To:
Amrita Patil-Pimpale: Amrita Patil Pimpale is a Dementia Care Consultant based in Mumbai. She is founder, lead consultant in Echoing Healthy Ageing, a social enterprise working in Dementia care sector, focusing on home based therapies, counselling & Dementia care training for family carers and professionals. She’s the Winner of Social Entrepreneur ‘Unltd India Award’ for 2012 and 2013. She’s a Certified Trainer of Person centred dementia care from University of Bradford, UK and a Dementia care mapping advance practitioner. She has designed and delivered training for care staff (dementia care), NHS nurses in England and has internationally published research papers on dementia care.
Sharvani Basu: Sharvani is a caregiver to her mother and a communications consultant based in Mumbai. She has been looking after her mother since 2014 and has made significant changes to her personal an professional life to become her parent’s primary caregiver.
Manisha: Manisha is a former banker who moved cities to help and support her family as her mother battles Alzheimer’s Disease. She feels creating a circle of support around you by informing everyone you come in regular contact with about the ailment can take a lot of the load off the primary caregiver.
You’ve probably noticed those WhatsApp forwards and Facebook posts with details of missing seniors many times. Wandering is a common problem in people with dementia. Here’s a guide from experts on wandering behaviour and how to prevent a loved one from going missing.
In June 2018, Johnes Kottana, 78, went missing from his daughter’s home in Bangalore. Kottana was having memory issues but could do simple, familiar chores on his own, like visiting the medical store opposite his daughter’s apartment.
One afternoon, he stepped out to buy medicines and didn’t return. He was found almost close to midnight, 32 km away from home. He had been searching for an address that was later discovered to be in Vizag, his hometown, and had boarded two buses and one autorickshaw in the process.
The autorickshaw driver, after taking Mr Kottana around for a while, realised something was wrong and took him to a doctor, who ascertained what the problem was and took him to a nearby police station, from where his family was finally contacted. While Mr Kottana was lucky to have encountered two good Samaritans, not every senior citizen who wanders comes back home, leaving families stranded between hope and despair.
Jashoda Merchant, 70, has been missing from Vapi, Gujarat since 2016. It’s suspected that she is suffering from memory loss. Vinod Kumar Bassi, 69, from Delhi went missing on January 2017. Despite his family spreading the information everywhere, he hasn’t been found. Bassi has Alzheimer’s Disease.
Why Do Seniors Go Missing?
The National Crime Records Bureau reported more than 13,000 senior citizens (60+) missing in its 2016 report Crime in India, of which 30 per cent still remain missing. While it’s hard to tell whether all senior citizens who go missing are suffering from dementia, a group of symptoms associated with a decline in memory and other cognitive skills, most experts in the field believe so. Most of the missing seniors listed in Missing Senior Citizen Alert , an online initiative founded by Sailesh Mishra of eldercare NGO Silver Innings Foundation, are suffering from some kind of memory related issue.
There are no statistics on dementia-related wandering for India, but the Alzheimer’s Association, US, says 60 per cent of people with dementia wander.
Dr Soumya Hegde, a Geriatric Psychiatrist says there are “no symptoms” of wandering. “Wandering is not specific to any stage of dementia. I have patients who have wandered off but were functioning normally otherwise. In fact, very often, families realise there is something wrong with their loved one because of an issue like wandering.”
Why Do People with Dementia Wander?
Persons with dementia may wander for many reasons, says Swapna Kishore, a dementia resource person who runs the website, Dementia Care Notes. She gives some possible reasons as, “Confusion, restlessness, desire to go somewhere, discomfort, need to use the bathroom, stress, and distraction. They want to go home and do not know that they are already at home. They forget that they have retired, and want to take the bus and go to office. Wandering is a very common problem in dementia.”
For caregivers of persons with dementia, Kishore suggests they try and understand why their loved ones may wander. “Wandering patterns are connected to the personality and earlier life habits and needs. The behaviour of a person with dementia depends on the state of dementia, on what is happening, on the person’s needs, surroundings, and other factors. You can use changed behaviour to understand the person’s situation, abilities, and needs.”
Prevent Wandering & Stay Alert
Dr Hegde recommends that families stay alert if they become aware of a memory related problem. “As soon as you know that there is a memory issue, you start putting things in place to prevent a chance of them wandering off or going missing. There isn’t one solution to this as it varies from person to person. “The steps you take also depend on how functional you want to keep the person. For example, if he/she runs some daily errands, you don’t need to stop that and keep him/her restricted at home for fear of wandering.”
It can take a momentary lapse for an older person with dementia to get lost. “Usually people go missing early in the morning at the time the milkman or some other delivery person comes and the door is left unlocked for a few minutes,” says Sailesh Mishra, who has helped several families look for missing older people. “Or they go missing late evening when they go for a walk after dinner and never come back. It takes one moment of inattention on the caregiver’s part and they are gone,” he adds.
Sometimes restlessness or agitation, often precursors to wandering, are caused by certain triggers. Kishore suggests changing the environment at home to reduce those. “If mirrors confuse the person, remove or cover them. If TV programs disorient, remove the TV or lower the sound volume. See if putting up childhood photos and old, familiar objects in the room will help convince the person she is already at home. Look for other triggers and habits and make changes.”
“Any change from the normal routine may increase disorientation and therefore increase the chance of wandering,” writes Kishore in a detailed account on her website. ‘Many wandering cases happen when a family is on a train. The person gets off the train at some station at night while the family is sleeping. If you are travelling with someone who has dementia, be careful about this.’
Staying Occupied
While some families can afford paid caregivers, it is not always a practical and affordable solution for all. What else can one do? Mishra asserts that someone has to be available at all times as a caregiver, though it remains a challenge for the middle class. He suggests getting over the stigma and asking the community around for help. If your loved one has a memory issue, informing your neighbours, the apartment security guard and the community around may help prevent your loved one from going missing.
Dr Hegde also suggests activities that caregivers can do at home with someone who has dementia to reduce their restlessness or agitation. You can read her suggestions here.
“Remember that wandering is a behaviour where the person doesn’t know what to do. Keeping the person occupied can help bring down a lot of the wandering behaviour.”
It also makes sense to declutter and create enough safe space inside the house to walk around. “Persons with dementia can be more confused during sundowning (it’s a condition where the patient’s condition may get more confused or agitated during late afternoon or early evening) and can become more aggressive so be aware of the time when they are likely to be more agitated and less likely to listen to you,” Dr Hegde suggests.
This is where day care centres for persons with dementia can help, especially for families where the caregivers may need to go to work and supervision may not always be possible. Day care also means social interaction and activities that could help ward off agitation. But remember, as a caregiver, the best thing you could do is to observe your loved ones, try and figure out what triggers their wandering behaviour and more than anything else, stay alert.
How to Prevent & Deal With Wandering
Here are some suggestions from our experts, Sailesh Mishra, Swapna Kishore and Dr Soumya Hegde on how to deal with wandering and the worst-case scenario, your loved one going missing.
How to prevent wandering:
1. Always ensure there is some form of ID on the person.
2. Make a note of the outfit, colour and other details when they step out.
3. Remember the destination and mentally note the time it will take to return so that you have a time frame in mind and can act once that’s exceeded.
4. Stitch an ID or tag to a part of the clothing to prevent it from getting lost.
5. Use tracking devices that can be synced to your phone.
6. However, do not get complacent with tracking devices as they may not work beyond a certain range; or the person may just remove them.
7. Reduce chances of exit from home by painting the colour of the door the same as the wall to make it less visible, placing a black foot mat near the door as it may appear as a hole to a person with dementia.
Here’s what to do if a person with dementia goes missing:
1. First thing – within 5 minutes – start looking in the neighbourhood thoroughly.
2. Take a photo and go to the police station. This is an important point of communication even if the policeman is not helpful or sensitive. Lodge an FIR.
3. Mumbai Crime Branch has a Missing Persons’ Bureau located in the Mumbai Police Commissioner’s office. Find out if your city has one. Take the FIR and go there.
3. You could also take the missing person’sphotographs and go to your local Doordarshan channel. They can issue a ‘Have you seen this person?’ alert on TV.
4. After this contact your local cable operator and release the same ad. This activates the local community immediately.
5. Next, print posters with the photo and information of the missing person – what they were wearing, age, any identifiers, whom to call, etc., and put them up everywhere – from train stations to bus stands to gurudwaras, temples, churches and local markets.
6. Don’t forget to inform the Railway Police. Many people are found on the tracks and if you live in Mumbai, the Railway Police in Mumbai alerts everyone down the line.
7. Use the power of social media and WhatsApp to your advantage. Put the photograph with details (make a poster as that’s easy to read) on WhatsApp and start forwarding. Inform organizations that work with the elderly in your city and they will help you spread the word. Social media has tremendous reach. Many missing person cases have been solved because of it. It is the fastest means of communication.
8. Divide family and friends into groups to look for the missing person in different areas, especially the ones the person may have frequented earlier — like stores, temples, a friend’s house, among others.
9. Go to the Municipal Hospital and check as sometimes the injured or ailing are admitted there. A survey by Tata Institute of Social Sciences (TISS) found that in Mumbai, many missing elderly people were found in Beggars’ homes. Another place where they were found were Missionary Homes. In Bangalore, the Beggars’ Colony and the RVM foundation Hospital on Bannerghatta Road for people with mental health issues would be two places to look.
10. Look for them at places where food or water is distributed because they are likely to be hungry and thirsty
11. Sometimes a missing person may also go to a place that is associated with his or her work. So, a person who has worked as a mechanic may be found at a garage or someone from the garment industry at a tailor shop. If a person is very religious they may be found near a temple, church, gurudwara or mosque.
12. “An interesting find by Silver Innings after speaking to psychiatrists is that if a person is right handed, he will only take right turns and vice versa. So, one can try and track them in a similar manner,” says Sailesh Mishra. “Sometimes, they may hate to cross the road because they are very afraid of the traffic so they will keep taking right turns.”
Never Delay In Starting Your Search
Time is crucial here. “The time to look for them is in the first 24 hours. First 3-5 days are crucial. After that they are rarely found,” says Mishra. “It is common for families to think that their loved one will not get lost because the person has never got lost before,” Kishore points out, reiterating on the need for quick action.
“Remember, if the person boards a bus or train or catches an auto, she may have gone quite far away and in an unpredictable direction by the time you realize. The person may be injured trying to navigate traffic. Seeing how confused the person is, someone may take them to a nearby police station or some ashram or some such place. All these mean you may need to look around quite a bit. And as more time passes, the person will get more confused and upset, more unable to answer questions of helpful strangers, get tired walking, get too hot or too cold, and not be able to find things like food, water, and toilets.”
The ideal thing to do, if you see an elderly person looking confused or seeming lost and unable to really recall their whereabouts is to take them to the police station and ensure the process of help starts from there. Sailesh Mishra also suggests that you take her photo and circulate it via WhatsApp and Social Media. Being sensitized about behaviours related to Alzheimer’s and dementia as a community could go a long way in helping find a missing senior citizen and bring relief to many families.
— By Nishi Malhotra & Reshmi Chakraborty.
Featured image used for representation purpose only.
Image courtesy: Pixabay
Ayurvedic home remedies have always been used by Indian grannies to cure everything from aches and pains to coughs and colds. Granny Asha of Varanasi home stay Granny?s Inn shares some from her kitchen with Manisha Panwar.
The West has been raving about the curative properties of their latest foodie discovery ? Turmeric Latte, or in other words good old ?Haldi Doodh.? Long before the Starbucks Turmeric Latte had such a cult following, our grannies were spreading the goodness of Ayurvedic home remedies on a daily basis. Granny Asha from the cosy Varanasi home stay Granny?s Inn is one such granny. In fact, this feisty granny epitomises the adage ? Age is just a number. This enthusiastic 67-year-old began her entrepreneurial journey at the age of 64 to battle depression. Talk to her for the first time and you feel that you have known her all your life. Apart from running an award-winning home stay, Granny Asha is also an ardent follower and admirer of Ayurveda and has several Ayurvedic home remedies up her sleeve than just ?Haldi Doodh.? We took the opportunity of asking her a few ?Gharelu nuskhe? or Ayurvedic home remedies for senior citizens that can keep them healthy and energetic.
Granny Asha from Varanasi?s Granny?s Inn shares some Ayurvedic home remedies for ailments with us. Image: Granny?s Inn
While Granny Asha?s tips are largely focused on senior citizens, these also come in handy for people of all age groups and ensure a healthier and fitter body.
Memory
As people grow older, the nervous system begins to weaken thereby causing normal forgetfulness. Granny Asha suggests that Brahmi and Ashwagandha be added to the diet to ensure faster memory. These two are available as tablets. Also, add 5 to 8 soaked and peeled almonds to your daily diet. Why soaked almonds, you ask? The brown, rough skin of the almond contains an enzyme inhibitor that the human body cannot break down, making digestion difficult and restricting the body from absorbing its nutrients. Soaked and peeled almonds on the other hand, help with digestion.
Are you retired, have space and time to spare and wish to start a homestay like Granny?s Inn in your own city? Asha and Aruna granny can tell you how. Write to us on connect@silvertalkies.com to know more.
Digestion
Take 5-6 tulsi patta (Indian Basil leaves) + ½ inch Adrak (Ginger) + 2 cups of water. Boil all for 15 minutes or till the quantity of water reduces to half. Drink this concoction twice a day for better digestion.
Bone Health
Add Ragi Atta (Finger millet flour) to your diet to strengthen your bones. This is especially good for people suffering from arthritis. Rich in calcium, Ragi atta takes care of the bones (Incidentally, the same atta is given to toddlers during their growing years). Also, add Aloe Vera juice to your diet for stronger bones.
Add fibre and nuts to your diet.
Image: Pixabay/CC0 Public Domain
Constipation
Add high fibre food to your diet. Eat daliya (broken wheat), oats, rajgiri (amaranth flour) and nuts on a regular basis. Daliya can be made sweet or salted according to taste. Have plenty of fruits.
Cough and Cold
Have Ginger juice ? ½ teaspoon with 1 tsp of honey to keep the cough at bay. Boil Licorice or Mulethi (about 2 sticks) in 3 cups of water. Boil till the quantity comes to half and drink at regular intervals to cure a persistent cold. (Granny Asha believes mulethi has a 100 per cent strike-rate to cure your cough!) Have tea made with all herbs ? Ginger, Cardamom, Licorice and Cloves.
Add tea made with all herbs, says Granny Asha.
Image: Pixabay/CC0 Public Domain
Detox
Detox the body on a continuous basis. Half a glass of Aloe Vera juice taken with ½ tsp of tulsi (basil) juice is the best detox concoction.
Pains and Aches
For regular pains and normal aches, add haldi (turmeric) to the diet. Milk should be had with good quality haldi every night before retiring to bed. Turmeric is a natural antibiotic. For gout, have garlic pods (2 or 3) early morning on an empty stomach. For toothache, rub clove oil in the affected area or chew on a single clove for instant relief.
Exercise and taking care of oneself
Regular exercise of any kind is a must every day. Whether it is a small stroll, walk or swimming, physical activity aids healthier living. Go for regular massages (Ayurveda with its natural remedies are the best suitable. If you visit Varanasi, don?t forget to visit Granny?s Inn and ask Asha Granny for some nice places to get the best Ayurvedic massage in Varanasi.)
And while Ayurvedic home remedies will keep you healthy and happy, meditate, meet positive people, have fun and most of all laugh out loud, Granny Asha signs off!
Starting today, Silvertalkies will be running a two week long campaign to spread awareness about Alzheimer’s Disease. It is estimated that there are about 18 million people worldwide with Alzheimer’s Disease and this figure is expected to double by 2025 to 34 million. In India, there are about 4 million people affected by the disease according to reports and the number is on the rise. With World Alzheimer’s Day on September 21, we will be bringing you articles that explain everything you need to know about Alzheimer’s Disease. This will include interviews with experts, caregiver accounts and information on support groups. Do write to us if you need to know more on silvertalkies@gmail.com.
A guide to understanding Alzheimer’s Disease
Around four million people in India suffer from Alzheimer’s disease, which is two to three times more common in older women than in men. Our expert Dr Anil Chawla explains its symptoms.
ALZHEIMER’S AND ITS SYMPTOMS
Alzheimer’s disease is a type of dementia. It is also called Senile dementia and is characterised by the impairment of memory, intellectual abilities and associated personality and behaviour changes that occur among elders usually after 65 years of age. It is generally slow in onset and is a progressive, primary degenerative cerebral disease of unknown aetiology. Alzheimer’s disease occurs in a small percentage of individuals of advancing age. According to one study in US, Alzheimer prevalence was estimated to be 1.6% in the year 2000, in both overall and in the 65–74 age group, with the rate increasing to 19% in the older 75–84 group and to 42% in the greater than 84 group. According to 2010 estimates, about 5.4 million people in US suffer from Alzheimer’s. In India, the rough estimate is around 4 million. Alzheimer’s disease is two to three times more common in women than in men. The symptoms of Alzheimer’s include:
a) Forgetfulness or memory impairment
b) Functional and behaviour changes which may be noticed by the family members, like poor judgement, difficulty in making calculations and handling money, inability to write cheques or use public transportation, etc.
c) As the disease advances, the person becomes confused, disoriented and incapable of doing activities of daily living like eating, grooming or using the toilet.
d) Some people develop personality changes like becoming aggressive, suspicious, delusional (holding strange beliefs), quarrelsome and agitated while some develop apathy and become socially withdrawn. Anxiety and depression and sleeplessness can also occur.
e) Mis-identification of objects are common, like the washing machine detergent may be mistaken as wheat flour; a round tablet may be picked up as a key to unlock the door. It goes to the extent that the person may fail to recognise himself or herself in the mirror and say there is someone else.
f) Some people with the disease tend to wander away from home as they hear voices (Auditory Hallucinations) and think that someone is calling them outside. Many get lost as they are confused and disoriented and can’t find their way back.
g) With further advancing disease the control over urinary bladder and bowel is lost leading to incontinence.
h) Total dependence on caregivers develops eventually.
Warning Signs
Forgetfulness or memory disturbances which are becoming perpetual, inability to learn something new or recall recent events are the things which should ring a warning bell. It’s all right if you forget whether it is Monday or Wednesday, why you went to the next room or where you left your keys. It’s not all right if you forget that you have already had breakfast and ask for it again or don’t remember how to make a telephone call; how to find your way around your home or the way upstairs; the names of your spouse or children or whether it is summer or winter.
Cause and Risk Factors
Unfortunately , the cause of Alzheimer’s disease is unknown. A small percentage of Alzheimer’s (less than 1%) which begins early, that is before 60 years of age, may have a genetic basis. Alzheimer’s is largely sporadic and not familial. The main cause is advancing age of the individual. The risk factors are advancing age and family history plus genetic factors in some. Some probable risk factors are also lack of education, oestrogen deficiency, viral brain infections, aluminium toxicity and head injuries.
Dr Chawla has 37 years of experience in the medical field. His work has ranged from being a full-time senior consultant in Medicine at IBRA, Oman; Royal Hospital, Oman; Salmaniya Medical Center, Bahrain to being a lecturer-professor at reputed institutes like Oman Medical College; AIIMS and Maulana Azad Medical College in India. He is M.B.B.S, M.D (Medicine-PGI, Chandigarh), M.R.C.P (U.K), F.R.C.P(Glasgow)
Vardaan Senior Citizen Centre in Delhi has created a home away from home for many medically challenged seniors whose families live far away.
Mrs. Kaur has made Vardaan her home now Pic: Silver Talkies
Ashima Puri* (65) suffered from paralysis soon after she retired and had to be moved to Vardaan Senior Citizen Centre due to difficulties in climbing up to her kin’s first floor home. Kuljeet Kaur’s* (76) children stay abroad, so she has made Vardaan Senior Citizen Centre her home for the last 4 years.
Similar are the stories of all residents staying at the Centre as is also the sadness that shadows their face at the mention of their families. However they are all happy to be in the love and care of Vardaan Senior Citizen Centre in New Delhi, which is one of its kind.
It is not often that you come across a home meant specifically for medically challenged seniors. While today’s market is flush with retirement homes of all types and sizes, most of them refuse people needing serious medical attention.
Dr Rekha Khandelwal
True to its name, Vardaan Senior Citizen Centre is a blessing for the elderly riddled with physical challenges. Pioneered by Dr. Rekha Khandelwal, a gynaecologist by profession, the facility run in conjunction with Vardaan Nursing Home, can house up to 12 patients and offers both short and long-term stay facility. Each patient is provided with an AC room, access to doctors and nurses 24/7, food and laundry facilities and an attendant to take care of all needs of the patient including feeding and dressing among others. A month’s stay at the Centre costs around Rs. 45,000, excluding medicines and specialist consultations.
Initiated at the behest of her staff and some patients, Dr. Khandelwal, together with her husband, started by taking in an acquaintance’s father for a fortnight as the son had to travel overseas for an official assignment.
The patients staying here suffer from a variety of ailments – dementia, paralysis, tube feeding and bed sores are only some of these. Doors are open to terminally ill patients requiring palliative care as well. The only limitation being that the Centre can handle medical needs within the infrastructure of the nursing home. Patients requiring ICU need to be shifted to a hospital. Hence while admitting every patient, the guardian is required to fill up a form stating which hospital they would want the patient to be moved to in case of medical exigencies.
A double sharing room
While the families stay in regular touch with Dr. Khandelwal, it is largely the patients keeping each other company at the Centre. There are small celebrations when some caring samaritans come visiting. A regular companion for all the residents is Kalyani, a residential nurse’s daughter, who has many surrogate mothers at the Centre.
Talking of future plans, Dr. Khandelwal says, “Real estate prices are a deterrent as is also the need to be in the proximity of big hospitals. If we find a willing partner we would definitely expand.”
Vardaan Senior Citizen Centre is located at B-100, Malviya Nagar, New Delhi – 110017
Phone no. – +91-11-46018201, +91-11-26689911
Web: https://www.facebook.com/VardaanSeniorCitizen
*names changed on request*
Eating right in the summer months is a must-do for energy and good digestion. Nutritionist and author Kavita Devgan shares tips on foods that work well.
Summer time is usually when infections are rampant and immunity is at an all-time low. Avoid heavy meals to ease out the digestion process during summers. Don’t make your body work too hard to process what you eat. Here are some basic guidelines:
Have pro-biotic foods: Avoid difficult to digest foods like meat, dairy, alcohol, coffee, and processed foods that can increase inflammation in the body and bust our immunity during these months. Incorporate fermented foods in your daily diet. These are easy to digest, are teeming with enhanced micro-nutrients, and also restore the proper balance of bacteria in the gut. Drinking Buttermilk or chaach twice a day is the best way to fix this. To make: Beat yoghurt, add water, add black salt and roasted jeera, or jaggery, shake. Include pro-biotic and fermented foods – in your daily diet; have it every day. Home made curd, buttermilk, pickles, South-Indian dishes like idli, dosa, appam, dhokla, uttapam, and kanji are good options.
Pair your fruits with some nuts: So whenever you have a fruit, have a few nuts along with them. In fact always carry some nuts with you, so that you can munch on them whenever you are feeling giddy or feel that your sugar levels are dropping; also helpful if there are long gaps in between meals. A banana or a boiled egg is a good idea too to tide over such times. If you are outside and need to eat, then a sweet potato or shakarkandi chaat, which releases energy slowly, is a good plate to pick up.
Follow meal patterns: Follow three main meals and two small snacks pattern of eating. Better to eat small portions every few hours, so that the blood sugar does not drop and remains stable.
Boost iron in the diet: Have at least three iron rich foods from the list below everyday: quinoa, sea food, eggs, dried apricots, pomegranate juice with lemon juice, chickpeas, nutri nuggets (soya), almonds, pumpkin seeds.
Have adequate salt: Don’t try to cut salt from your body during these months. Add black salt to fruits, have it in nimbu pani (lime juice), etc. In fact, whenever you feel exhausted or tired due to dipping blood pressure levels, drink a glass of lemon juice mixed with a little sugar and salt to control your blood pressure.
Eat cooling fruits & veggies: When the temperature begins to rise, it’s important to keep your body cool. Focus consciously on eating foods that cool from inside, naturally. Thankfully, this time of the year offers an endless variety of veggies and fruits, so make the most of these summer gifts. Try to include one summer vegetable or fruit in every meal and snack on these too.
Most vegetables are cooling, but because of their exceptionally high water content, these five veggies are especially good at bringing body temperature down: cucumbers, radishes, lettuce, bottle gourd, spinach. Eat more of these.
Fruits are equally cooling for our system, and there’s a a lot to choose from during this season (different melons particularly). While you can always snack on them, try to increase their consumption by having them in interesting ways: make a dessert, or a smoothie, cook with them (for example with a raw papaya salad or a cold melon soup) or chop them small pieces and add to water to make infused drinks, which you can sip through the day to stay cool.
Change your meat: Eat more fish compared to other meats. Fish is a cooling food that helps counteract the heat lingering in our system, and help bring about an equilibrium on a hot summer day.
Use cooling spices: Opt for fresh ginger, marjoram, cilantro, lemon balm, peppermint, and white peppercorn as they are cooling; avoid cinnamon and dry ginger as they are warming.
Include these three in your diet:
Bitter gourd (karela): This humble vegetable, not liked by many can be your saviour during summers as it takes away the heat from the body, even if you indulge in heating foods occasionally. So try to have it two to three times a week, or incorporate a table spoon of karela juice in your diet everyday.
Bottle gourd: Delivers lots of water (is 96% water), is inherently cooling, loaded with potassium that helps keep the blood pressure down and electrolyte balance maintained, prevents fatigue and keeps the body cool and refreshed during summers.
Watermelon: Totally fat-free sweet, juicy watermelon is packed with some of the most important antioxidants in nature. It provides vitamin C, beta-carotene, B vitamins necessary for energy production, magnesium, and potassium, among other nutrients. As it has a higher water content and lower calorie content than many other fruits (a whole cup of watermelon contains only 48 calories), it delivers more nutrients per calorie – an outstanding benefit!
Photograph: Steve Evans; Wikimedia Commons
Beware of food poisoning: Do not leave food unrefrigerated longer than one hour at a time or the chances of dangerous bacterial growth increase. Store and serve cold foods at temperatures below 40°F. Some popular cold picnic foods are potentially hazardous and require special care. Be particularly careful in handling any homemade food that contains eggs, mayonnaise or salad dressing, such as potato salad. Water for drinking, cooking and dishwashing must come from a safe and approved source. In Summer viral, amoebic and bacterial infections are rampant and food and water are most convenient carriers for these. The symptoms of most types of food poisoning include severe cramps, abdominal pain, nausea, vomiting and diarrhoea. Symptoms begin from one-half hour to three days after eating contaminated food. Most cases of food borne illness are mild, and the symptoms disappear in a day or two. If symptoms are severe or last longer than two days, contact a physician.
Robots caregivers are the latest on the block for elderly and are being used extensively in care homes in Japan, Germany and elsewhere. We take a look at the trend.
Loneliness and social isolation are leading to several ailments among the elderly but a new form of support is gradually emerging. Service bots or robot caregivers are increasingly being used in countries like Japan to help care for elders. Now, a Hong Kong based inventor is also building affordable multi-functional wearable devices for patients and senior citizens to help them regain agility according to a report in South China Morning Post. One of his latest products is a walking aid system targeting patients with Parkinson’s disease.
In Japan, across various care facilities, robots are used for care-giving. According to reports, robot caregivers offer geriatric patients a variety of services that fall, generally, within three categories: serving and fetching, communications and emotional support. In fact, Tokyo’s Shin-tomi nursing home uses 20 different robot models to care for its residents.
VOA news reports that the Japanese government has been funding development of elder care robots to help fill a projected shortfall of 380,000 specialized workers by 2025. While Japan goes the robotic way, the global market for nursing care and disabled aid robots, made up of mostly Japanese manufacturers, is still tiny at just $19.2 million in 2016, according to the International Federation of Robotics.
In India, we seem to be far away from the thought and robot caregivers may even be frowned upon, though loneliness and lack of adequate care remains an issue here too. In fact, according to a report by the NGO, Agewell Foundation, India’s ageing population is struggling with loneliness and every fifth senior citizen in the country is in need of some kind of psychological counselling.
Not everyone is in favour of robot caregivers though. Some think it would remove seniors farther from the human touch. “Social isolation of seniors is a significant concern amongst gerontologists and caregivers alike and robot care, in my mind, would only compound that issue,” says Susan Madlung, gerontologist and Clinical Educator for Regional Programs and Home Health Re-Design at Vancouver Coastal Health, in an article in AgingCare.com.
The question remains whether robots can replace humans when it comes to providing real emotional support to elders. While we in India may still be many years away from employing robot caregivers to look after seniors, here’s a list of robots that have provided/or promise to provide many an elderly person emotional support and the much needed helping hand.
Care O Bot: A German manufactured robot, it has been used in a number of German assisted living facilities. It is able to ferry food and drinks to residents from the kitchen as well as keep them entertained by playing memory games to help keep their minds sharp. It is also programmed to behave like the perfect gentleman grandma would easily take to.
Dinsow elder care robot: This one is a personal assistant of sorts and can help elders take their pills, track their health and answer calls from family and doctors. You even get a mini version that can be on your nightstand.
Elliq: Yet to be released, this is an interactive robot with an integrated tablet. It tracks pill regimens and connects elders to family, friends, and medical professionals through video calls and social media. It is also smart enough to check the weather and suggest outdoor activities. It also tries to figure out the users likes and dislikes and suggest activities accordingly.
The Paro: Employed in Japanese nursing homes since 2003, the Paro is a robotic ball of fur designed like a huggable, pet-worthy seal. It’s a therapy robot that responds with lifelike movements to stimuli, recognizes temperature, posture, and light and even responds to praise! Why get a dog when Paro is here!
Buddy: Buddy is a companion robot that can provide seniors social interaction and assistance by hooking them up (with family and friends) on Skype or FaceTime; reminding them of upcoming events and even monitoring the homes of seniors who live alone. It is also designed to detect falls and unusual activities like most robot caregivers.
Photograph courtesy: http://www.parorobots.com & https://www.dinsow.com
Summer can be draining in more ways than one. With the rising temperatures, it’s important to stay hydrated as much as you can. Kavita Devgan, nutritionist and author of Don’t Diet! 50 Habits of Thin People, tells us how to stay hydrated in summer.
It’s important to know how to stay hydrated in summer, especially for senior citizens. Water is an important nutrient. Our body uses water as well as expends it and if we fail to replenish these losses, we set ourselves up to become dehydrated. During summer it is easy to get dehydrated without even realizing, so it is important to make up for the extra fluid one is losing.
One early sign of dehydration is feeling light-headed upon standing up. Another is passing dark-yellow, highly concentrated urine. If you’re drinking enough fluids, your urine should be almost colourless. Dry lips and tongue, headache, extreme fatigue, nausea and muscle cramps are some more telltale signs.
Take water breaks throughout the day; always carry a water bottle when travelling; have a glass of water, tea or juice with meals. Remember – your thirst may not keep up with your need for fluids so play it safe by drinking as much water, iced herbal tea and juice as you can stomach.
Also stay away from sugary fruit drinks and caffeinated sodas as they actually dehydrate your body and can make you feel worse.
Have fruit or herb infused water to stay hydrated
Eat something: Food not only provides water, but also holds more of the water in your system longer. There are several types of foods that hydrate the body – broths and soups; pudding and gelatin desserts; ice cream and yoghurt; fruits such as watermelon, muskmelon and apples; vegetables such as lettuce, broccoli and carrots; and milk and juices.
If you don’t like plain water, then flavour it with fruits or herbs like saunf, mint and dhaniya, among others.
Fresh coconut water: Make this natural drink your best friend in the summer as besides hydrating it is also loaded with essential minerals that help the body maintain its electrolyte balance.
Drink right: Include coconut water, bael ka sharbat, kokam squash and aam panna in your diet. These will give you the necessary electrolytes required to maintain the fluids in your body. Sattu sherbet is also a good idea. Pomegranate juice is rich in antioxidants called polyphenols and is good to keep blood pressure and blood sugar stable – always have it with a vitamin C rich source though. So add the juice of a lemon or sweet lime (mosambi) or even an amla to it.
Carrot juice helps improve blood circulation along with regulating your blood pressure levels. Add two tablespoons of honey to a glass of carrot juice and have 2-3 times a week. A cup of raw beetroot juice twice daily also helps. It is in fact one of the best home remedies for stabilizing low blood pressure.
You can always depend on ginger. It contains plant chemicals such as gingerol, shogaol, and zingerone, which help prevent fluctuations in the levels of blood pressure. So a cup of ginger tea is always a good idea. Best to begin your day with it.
A strong cup of aniseed (saunf) tea is also a good idea as it’s a good source of essential B vitamins – like riboflavin, thiamin, niacin, and pyridoxine, and the link between deficiency of B vitamins and low blood-pressure is clear and proven.
These age old remedies also work well for seniors in the summer
Chew five to six tulsi leaves every morning. Tulsi leaves have high levels of potassium, magnesium and vitamin C, which can help in regulating your blood pressure. Tulsi leaves act as mood stabilizers too.
In addition, you can soak 3-4 raisins or munaka overnight and then boil them with milk and have in the morning or even at night before going to sleep. This helps increase circulation.
Fractures and injuries caused by falls are very common among people aged above 65. But several recent studies have shown that yoga helps prevent falls among elderly people.
A new study conducted in Hyderabad, titled, ‘A mixed methods evaluation of yoga as a fall prevention strategy for older people in India’, shows that yoga helps prevent falls among elderly people.
The three-month study involving 50 people aged between 60-81 years, had participants attend 27 yoga sessions, with each session lasting for about an hour. The research showed there was an improvement in time taken by the elderly in rising up from a chair and an increase was observed in the length of steps taken by them while walking.
Speaking to The New Indian Express, Dr D Praveen, Programme Head-Primary Health Care, TGIGH-India said, “Lack of coordination between mind and body along with problems like poor bone and muscle strength are some of the main causes behind the elderly people falling and injuring themselves. Exercise improves muscle and bone strength.”
Added certified yoga trainer, Mansi Gulati, “There is no age restriction as to who can do yoga but one has to ensure that they learn yoga from a trainer who is knowledgeable and experienced, especially when it comes to the elderly. As many hold the notion, yoga is not just about performing asanas but is also about breathing and concentration, which makes the body fit, improves mental health and also improves confidence. For the elderly, it will provide a holistic approach to being fit.”
An earlier study conducted by University of Wisconsin–Madison professor of family medicine Irene Hamrick also reported that the number of falls in older adults dropped 48 percent in the 6 months after a yoga class began, compared to the 6 months previous. The study was published in Complementary Therapies in Medicine.
“Yoga makes you have a strong core,” said Anne Bachner, a member of the study’s community advisory board, “so when moving around in your daily life, you are not just flapping around. You are stable, in control.”
Yet another study conducted in France showed that yoga, tai chi and even waltzing not only helped prevent falls but also lowered injury rates, particularly for the most severe fall-related injuries such as fractured bones. All of the exercises found to be effective for the prevention of injury in the latest study focused on balance training, providing “ample evidence” that they are effective at improving people’s balance, researchers from Hôpital Paul Brousse in Paris said.
Diabetes Type 2 can be a difficult health condition to manage but help may be at hand right in your kitchen – the humble Tulsi can help reduce high blood sugar.
Researchers have found that the herb Holy Basil, better known as Tulsi in India, can help reduce high blood sugar, according to a report in www.express.co.uk.
Tulsi or Holy Basil has long been known in Ayurvedic medicine as one of the most important medicinal plants. It belongs to the mint family and has been part of Indian homes since ancient times. Tulsi can improve health conditions of those with Diabetes Type 2 by lowering blood sugar, reducing high blood pressure and relieving inflammation.
Research suggests that the herb improves pancreatic beta cell function and insulin secretion, apart from increasing the uptake of glucose by muscle cells, according to UK-based Nutritional Medicine specialist Sarah Brewer.
As part of a trial, 40 people with Type 2 diabetes were given either holy basil leaves or a placebo (spinach) for eight weeks. All their other medication was stopped under medical supervision. When taking holy basil, average fasting blood glucose levels fell by 17.6 percent and glucose levels after a meal fell by 7.3 percent compared with those who were taking spinach.
Another study had 60 people with Type 2 diabetes who continued taking their usual medication throughout the trial period. Half of them also took two 250mg capsules of holy basil per day for a duration of 90 days. Dr Brewer observed that those taking holy basil plus their usual medication had significantly better levels of glucose control.
The Dangers of Diabetes Type 2
Diabetes Type 2 can increase your risk of heart disease and stroke. Under this condition the body doesn’t make enough insulin. The result is chronic high blood glucose.
According to the official WHO data, India tops the list of countries with the highest number of diabetics; China, America, Indonesia, Japan, Pakistan, Russia, Brazil, Italy and Bangladesh follow. In the year 2000, the total number of diabetics in India stood at 31.7 million and is expected to rise by more than 100% by the year 2030, accounting for a whopping 79.4 million.
Diabetes prevention includes making lifestyle changes by improving diet, incorporating more exercise and losing weight. And as research suggests, incorporating the humble holy basil in your diet can be a big help. You can add Holy Basil or Tulsi to your tea or food or take as a supplement.
Laughter, an expression of joy, is a healing agent that doesn’t cost anything. In fact it is as free as air or love, as are these laughter clubs that will help you laugh your way to good health.
In 1999, speaking at a seminar in Mumbai, Dr. Dale Anderson, a physician with 36 years of practice all over the world, said, “Laughter is a great medicine…A smile can produce immediate change in the physical, mental and emotional state. Laughing improves face value, reduces stress, enhances body posture, relaxes muscles, improves immunity functions of the body and reduces pain and tissue inflammation.”
One of the stories in the book ‘Chicken Soup for the Soul’ is about the famous writer, Norman Cousins, who was diagnosed as “terminally ill“ and given six months to live. He reasoned that if worry, depression and anger were the cause of his illness, could wellness be created by positivity? He resorted to laughter as a way out of his illness. He saw funny movies, read funny stories and asked friends to call him whenever they said, heard or did something funny. He recovered completely and lived 20 more happy, healthy and productive years.
There is a saying that when you cry, you cry alone but when you laugh, the world laughs with you. This is the rationale behind the laughter clubs that have multiplied all over the world over the past 25 years. They work on the principle of collective laughter.
How I discovered laughter clubs
My tryst with laughter clubs started one morning in the late 1980s as I headed out for my morning walk at the Gateway Garden in Mumbai. An elderly gentleman named Mr. Shahani, an insurance agent, stopped me on the harbour-front promenade and invited me to join the laughter club session being held on the Radio Club Pier, starting at 7 am. I explained that I had to get back to my flat in Strand House to make bed tea for my wife and children. He wouldn’t hear of it, saying: “What difference will it make if you join us for 15 minutes?”
I gave in and joined the laughter club session, which I enjoyed thoroughly and started attending regularly. Soon, we had to abandon our old location at the Radio Club pier due to some problem but that did not deter us laughter-cracks. We simply regrouped and moved on to a new venue – the Gateway Garden (now a vast plaza that was used by reporters and TV crews during the terror attack on the Taj) in front of Gateway of India. Now at the forefront of the laughter-cracks, I jockeyed to be the lead anchor of the Gateway Garden Laughter Club.
In the meantime, the BBC had visited our laughter club to shoot a session for their programme Outlook. However, on getting back to their studios in London, they realized they had not activated their audio during the shooting. So, one night, around 3 am, I received a phone call from BBC explaining their predicament and requesting me to demonstrate the laughter sequences, including the loud and lusty Patiala Laughter, over the landline phone so they could record it in their London studio. While I was doing so my wife woke up and concluded that I had indeed gone bonkers with my laughter club obsession.
Spreading the laughs
As an anchor at the Gateway Garden Laughter Club, the laughter bug had truly bitten me! One day, I demonstrated the Patiala Laughter in the Covenanted Comfort Room (toilet) of my office to my colleague Jairam. The exploding noise brought employees working on the floor rushing to the washroom in alarm, convinced that there was either a violent fight or heart attack happening behind the closed door. When we came out smiling there was relief all around.
But this incident sowed the seed for the start of a lunch-time laughter club for office-goers in the original business district of Ballard Estate. At 1 pm sharp, employees from L&T House and nearby buildings joined in for the short pre-lunch sessions, which lasted 10 minutes instead of the normal 20 minutes.
Both the Gateway and Ballard Estate Clubs were the darlings of the media, especially the foreign TV crews that came to stay at the Taj and other star hotels. The two clubs were featured on many national and international TV channels – BBC, German, Italian and Japanese TV, and CNBC. The Gateway Club also became a tourist attraction. For instance, batches of South Korean tourists staying a nearby hotels were shepherded by their tourist guides to participate in our laughter club sessions. This would be followed with still photography and video shoots of the tourists and hosts together.
The session starts with a silent prayer followed by Aha-ha, Ho-ho, in a clapping mode, with participants moving in circles (chakra). Then there are a series of light physical and yogic exercises lasting about seven minutes. This is a type of foreplay for the laughter proper.
• The Laughter Proper: Starts with greetings/welcome laughter when participants approach each other with folded hands and light laughter coupled with exchange of high-fives. Then there is Aha-ha, Ho-ho in the laughter mode with related body movements.
• Social/Drawing Room Laughter: The third laughter is mild and interactive.
• Patiala Laughter: This is followed by Patiala laughter, named after the famous Patiala peg. It is full-throated, accompanied by upward movements of upturned hands.
• Mouth-open-no-noise Laughter: This is the fifth in the sequence and is as described.
• Pigeon Laughter: Also called beauty laughter, this comes next – mouth closed, head turning up and down as when pigeons are in a romantic mode.
• Crescendo Laughter: The hands move upwards, the laughter intensifies from low to high.
• Vowels Laughter: Two bursts of laughter after calling out A E I O U. The participants step forward and backward after each laughter.
• Tiger Laughter: The participants put out their tongue and imitate a tiger jumping at its prey, with forward stretched paws (hands). It bars the touching of fellow participants. Physical contact is limited to initial high-fives.
• Cocktail Laughter: The last laughter is called cocktail wherein the participants can laugh as they please to their heart’s content.
At the close of the laughter sequences start the self esteem declarations. These are based on the belief that one is what one thinks. These declarations are: 1. I am the healthiest person in the world. 2. I am the happiest person in the world. 3. I am the luckiest person in the world. 4. I forgive every one. 5. Every day and every hour I feel better and better. 6. I am not alone; God is with me. 7. We are members of the Laughter Club. The declarations are made twice each, followed by bursts of laughter. The session closes with rhythmic clapping to the words “One, two, three; laughter is free. East or West, laughter is the best,” five times. The anchor concludes with: “Thank you for coming. Have a nice day. We will meet tomorrow.”
Moving to Mangalore
I continued to be in the forefront of the Gateway Garden Laughter Club till I retired to Mangalore in 2000 and lived in Johnlyn Cottage at Bondel. It took me some time to assess the potential of Bondel as a laughter club venue and, finally, I launched Bondel Laughter Club in 2002.
Bondel Laughter Club received generous projection from print and electronic media. As a result, I have been approached to demonstrate laughter club sessions and provide guidance in starting laughter clubs. It is against this background that I ventured into offering a CD titled Laugh Your Way to Health –An Operational Manual for Starting, Anchoring and Sustaining Laughter Clubs. You can view it here: https://vimeo.com/8267104
Finally, some questions and answers
Where should one hold sessions? Ideally, it should be an open space like a garden, playground or park so that public has easy access to it.
What is the ideal time? It is best to hold it in the early morning between 6 to 7 am so that it can be combined with morning walks; else in the evening between 6 and 7 pm. It is important not to have the session on a full stomach. The duration can vary from 15 to 25 minutes and include a set of physical exercises.
What is the ideal number of participants? A minimum of 10 would be good, 20/30 ideal, and the more the merrier.
There is strictly no physical touching others except during the initial greetings with high-fives. Some amount of synchronization is good but you can’t put participants into a straight jacket. Laughter is no joke. There is a method in this seeming madness. People stimulate each other, specially their neighbours, by body language and eye contact. There are laid down sequences. They are flexible depending on the anchor’s ability to manage change. These sequences can be painted on a billboard (flex) and displayed at the venue.
The initial launch is very critical. Ideally one should take the help of an experienced anchor for launching a laughter session.
I have given enough low-down. Go ahead and laugh to your way to good health and to your heart’s content.
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In a research breakthrough, Indian scientists are using artificial intelligence to predict Alzheimer’s disease early.
There is good news coming out in the area of Alzheimer’s Disease research. Alzheimer’s is the most common form of dementia and a progressive degenerative brain disorder. It is irreversible and can impair a person’s cognitive behaviour and daily living. Now scientists in India are using artificial intelligence (AI) to develop a smart diagnostics system that can predict Alzheimer’s disease early.
Early detection of Alzheimer’s disease can help individuals achieve better quality of life by identifying the cognitive impairment and taking preventive measures to slow down the process. It can also lead to more appropriate treatment.
In a report published in the Journal of Alzheimer’s Disease, Professor Pravat Mandal and other noted scientists from the National Brain Research Centre (NBRC), Gurugram and Neuroimaging and Neurospectroscopy Laboratory (NINS) are together working towards this. They are developing a model to map metabolic patterns in different brain regions in healthy and pathological conditions.
Alzheimer’s disease accounts for 60 to 80 percent of dementia cases. The greatest known risk factor is increasing age, and the majority of people with Alzheimer’s are 65 and older. According to the ‘Dementia India’ report published by the Alzheimer’s and Related Disorders Society of India (ARDSI), India has an estimated 4.1 million people suffering from dementia, a number expected to double by 2035.
“Laboratory research and longitudinal clinical studies have helped to reveal various information about the disease but the exact causal process is not known yet. Patterns from alteration of neurochemicals, hippocampal atrophy, and brain effective connectivity loss as well as associated behavioural changes have generated important characteristics features. These imaging-based readouts and neuropsychological outcomes along with supervised clinical review are critical for developing a comprehensive artificial intelligence strategy for early predictive AD diagnosis and therapeutic development,” Dr Mandal wrote in the Journal.
He also mentioned using the data information from a large data set from various diagnosis procedures to create an artificial intelligent system, which would help with the diagnosis of a new unknown case of Alzheimer’s disease using machine learning approaches. “Such an integrated multi-modal predictive diagnostic system for Alzheimer’s disease diagnosis would aid the clinician in early differential diagnostics to deliver the most appropriate treatment,” he said.
Dr Mandal and Deepika Shukla of NBRC are developing an integrated framework called GAURI with statistical and predictive diagnostic capability that could indicate chemical changes in the human brain. Alzheimer’s Disease can lead to not just cognitive impairment but also affect the life of the person and others around him. A breakthrough in early prediction can result in not only better focused treatment but also improved care and life condition for both the person with Alzheimer’s and the caregiver.
Dementia caregivers need support from medical experts and other caregivers the same way as the people they look after need treatment. In Part 2 of this feature (read Part 1 here) on support for dementia caregivers, Swapna Kishore of Dementia Care Notes highlights the role online support forums can play.
Caring for someone with dementia often takes years and poses many challenges. In order to do this effectively and with less stress, family caregivers need information and support. As discussed in Part 1, in addition to getting reliable information and answers from experts, caregivers can also benefit from connecting with fellow-caregivers.
Typically, caregivers expect health professionals to provide all answers for any medical condition. But most professionals lack experience in handling dementia challenges 24×7. And relatives and friends who want to help may lack the required personal experience to appreciate the care situation or give effective suggestions. So, listening to the personal care experiences of fellow-caregivers can be very helpful.
Aparna Mittal, Founder and CEO of PatientsEngage, a large online healthcare platform, says, “The knowledge gained by caregivers through experience of handling day-to-day issues of taking care of their loved one and of themselves is just as valuable as medical inputs from healthcare professionals.”
Caregivers can connect with others through face-to-face caregiver meetings and online support forums. Face-to-face caregiver meetings were discussed in Part 1. And though most caregivers in India are unable to attend caregiver meetings, fortunately anyone with Internet access can benefit from online forums.
What are online forums?
Online forums are Internet-based communities available 24×7 where caregivers share experiences, issues, suggestions, information on resources, and so on. Caregivers can participate at any time from the comfort of their homes, even if they have only a few minutes at a time. Participation doesn’t require any travel or arrangements. Good forums can provide very effective peer support.
Available options for online groups
Large dementia support groups: There are some large, well-moderated online groups that focus on support through shared experience and peer support.
One group is Memory People (MP), a closed Facebook group, where members include people with dementia, caregivers, advocates, family members, and professionals. This group focuses on providing a safe and respectful place where members can talk about the reality of dementia and memory impairment and share suggestions. Participation is active.
Leeanne Chames, one of the leaders, explains: “We’re over 18,000 members now and rarely, if ever, does a post go without any comments offering suggestions or support.”
Another very useful forum is Alzheimer’s Society, UK’s Talking Point. Its entries can be viewed by any Internet user but only members can participate. Again, most posts get several responses. Forum sections include support from other members, information and resources, Alzheimer’s Society news, notices and videos. The forum’s structured format makes it easy to locate relevant posts.
Another large online group is AlzConnected (this is managed by Alzheimer’s Association USA).
Large online forums offer a wider base of caregiver experience compared to face-to-face caregiver meetings. Caregivers sometimes stop attending face-to-face meetings because they can no longer get suggestions for their issues, but online forums continue to prove useful for a wide range of situations.
One caregiver who joined Memory People says she does not feel the need for any other forum. “Whenever I face a difficult situation I usually find something useful in the forum. I read almost every post. That is the main thing helping me understand and cope with behaviour problems.”
Special dementia forums for specific types of dementia are also available, such as groups for early-onset dementia, Lewy Body Dementia, Fronto-Temporal Dementia, etc. Interactions in these may be fewer but more relevant for persons concerned about the specific situation.
Other online forums may be available on general health resource sites addressing multiple medical conditions. One such site, currently aimed mainly at India and Singapore, is PatientsEngage.
More information on existing online forums can be seen at Informational websites on dementia/caregiving.
Tips for using an online forum
Some suggestions for joining and participating in an online forum:
Smaller online groups
There are also small online forums created for a selected set of caregivers. These may be created by a caregiver meeting’s coordinator to provide continued connection and support. Or they may be created by caregivers who want to stay in touch. Several such groups exist in the form of email groups, closed Facebook groups, and Whatsapp.
Such groups can be effective in creating a helpful caregiver community for mutual support. Mangala Joglekar, a social worker associated with Deenanath Mangeshkar Hospital, Pune, arranges regular caregiver meetings in Pune, and moderates a Whatsapp group to supplement these meetings.
She observes, “Caregivers interact on this Whatsapp group. They may sometimes talk about their caregiving situation. Sharing information and resources is quite common. For example, about some useful program in town, or asking if someone knows a doctor who visits at home or contacting each other when they need assistants.”
Some tips if you want to set up an online group with fellow caregivers:
To conclude, dementia caregivers please know that connecting with fellow caregivers has made a lot of difference to caregivers who have tried it. Please attend a few face-to-face caregiver meetings if you can. And join a reliable online group. You may be surprised at how experiences and suggestions from even a few fellow caregivers can be a turning point in your care approach.
Acknowledgements: Special thanks to the caregivers, volunteers, professionals, and group coordinators who generously shared observations and ideas about face-to-face and online support forums.
For more articles related to Dementia and Alzheimer’s Disease, click here.
© 2018 Swapna Kishore
Dementia caregivers need support from medical experts and other caregivers the same way as the people they look after need treatment. In Part 1 of this feature on support for dementia caregivers, Swapna Kishore of Dementia Care Notes highlights the role face to face meetings can play.
People with dementia face many issues — memory problems, confusion, communication problems, mood and personality changes, and so on. They find it difficult to do their normal daily activities. Their situation gets worse as their brain deteriorates. Family caregivers need to support their loved ones through these years of decline and they often juggle this responsibility with other responsibilities of their own. This can make them feel overwhelmed, stressed and isolated.
When looking for ways to cope, family caregivers usually search for information and medical advice, as well as services, but often don’t realize that connecting with fellow-caregivers will reduce their isolation and strain and provide them with a shared pool of practical tips.
Dr. Sridhar Vaitheswaran (Consultant Psychiatrist and Coordinator, DEMCARES, Chennai) explains the importance of peer interactions with an example: “As a professional I can tell a caregiver to get a GPS tracker for someone who wanders, and it can be helpful information. But I have not used one personally. Families that have faced this situation and have the experience of trying out various things can share more powerful information on what they have tried and what worked.”
Hearing peers describe how dementia is affecting their loved ones also helps with the emotional acceptance of dementia realities. One caregiver, who had been feeling overwhelmed and frustrated, says that when she attended a meeting and heard others talk of similar situations, something started “clicking” in her mind. Before the meeting she had understood dementia only at an intellectual level. Listening to peers brought emotional acceptance about her father’s problems and changed behaviour. After that turning point, she felt less pressured and became a more effective caregiver.
One beneficial way of getting information and peer support is using a ‘support group’, which may be available in the form of face-to-face caregiver meetings or as online forums. Part 1 of this two-part article discusses face-to-face caregiver meetings.
What is a caregiver meeting (support group meeting)?
Caregiver meetings for dementia caregivers are available in a few cities in India. A typical meeting anywhere in the country starts with an informative talk and Q & A (question and answer) session on a specified topic by a doctor or some other expert, followed by caregivers sharing experiences and suggestions. Or a meeting may just be an “open session” for caregivers to talk and share.
Benefits that caregivers report from attending such meetings include:
• Getting reliable information and answers from experts
• Hearing the experiences of other caregivers and getting tips and suggestions from counsellors and fellow-caregivers
• Feeling less isolated after the meetings
Amrita Patil-Pimpale (Founder, Echoing Healthy Ageing, Mumbai) coordinates a professionally-led monthly meeting for family caregivers at Holy Family Hospital. The focus of these meetings is guidance in treatment, support for caregivers, and peer learning for caregivers so as to improve the quality of life of persons with dementia and their caregivers. She says that caregivers benefit a lot from better understanding of medication. “Based on this, some go back to discuss medication with their own doctors.” Caregivers also realize that they should take care of themselves.
Reduction in their sense of isolation is a very common experience.
Saadiya Hurzuk (Coordinator, ARDSI Hyderabad-Deccan Chapter) says, “At an open session of caregiver sharing, many caregivers kept nodding and saying — I can relate to that.”
Unfortunately, many caregivers are not able to attend such meetings, either because face-to-face meetings don’t happen in their city or because they are not able to make the required arrangements and get the time to go for such meetings.
Sometimes, caregivers also hesitate to go for meetings. One caregiver says, “I don’t get much time outside the home. Why use it to listen to depressing things about dementia?” Never having attended such meetings, they are unaware that meeting fellow caregivers with similar experiences and concerns can be valuable for them. At the very least, doing so will help them realize that they are not alone
Tips for selecting and attending caregiver meetings
Caregivers can also arrange their own face-to-face meetings.
Caregivers sometimes try to arrange their own meetups, either for exchanging caregiving experiences or for social outings. Such meetings have some limitations. For example, they usually won’t have presentations and answers from experts. The meeting may not have a moderator to provide balance and perspective. There is a danger of sharing wrong medical advice too. Please note that it is best to avoid discussing medicinal approaches and miracle cures in such meetings. Even if some caregivers share personal experiences with medicines, others should not make changes based on them. Instead, they should talk to their respective doctors. Practical problems in self-arranged caregiver meetings are mainly around coordination, such as finding a date, time, and venue that suits everyone. Also, caregivers still need to make arrangements to attend the meeting. In practice, such informal caregiver meetups rarely continue beyond one or two meetings.
Attending caregiver meetings is a very good way of getting support but given that very few cities have such meetings and that caregivers may not be able to make arrangements to attend them, they can look at available online forums for support. Part 2 of this feature talks about that. Click here to read.
Acknowledgements: Special thanks to the caregivers, volunteers, professionals, and group coordinators who generously shared observations and ideas about face-to-face and online support forums.
For more articles related to Dementia and Alzheimer’s Disease, click here.
© 2018 Swapna Kishore
Friends of Parkinson?s, an initiative by the Parkinson?s Disease and Movement Disorder Society, provides an opportunity to all, including senior citizens, to come forward and make a difference in the lives of People with Parkinson?s.
Research over the past few decades has consistently shown the positive impact of friendship on levels of happiness, general, and psychological well-being in older adults. Especially among the elderly, friendships serve as a protective factor against depression and loneliness. It?s where programs like The Friends of Parkinson?s (FOP) help. FOP is an initiative by the Parkinson?s Disease and Movement Disorder Society (PDMDS), Mumbai, providing an opportunity for the community to come forward and make a difference in the lives of People with Parkinson?s (PwP, is how we refer to them) and their families.
Parkinson?s is a chronic, progressive, neuro-degenerative illness caused due to a chemical imbalance in the brain. In India, more than 2 million people have been diagnosed with Parkinson?s and this number is rapidly rising.
A diagnosis of Parkinson?s can be life changing; not only for the person diagnosed with Parkinson?s but also for their families. People with Parkinson?s suffer from an array of symptoms, the collective effect of which is an inability to perform even essential daily activities like eating, bathing, dressing, walking or even sitting down and getting up from a chair. Their ability to speak usually gets affected, limiting their ability to communicate with others. They may also suffer from cognitive and mood impairments like memory loss, depression, hallucinations, delusions and anxiety. All this greatly affects their quality of life and that of their families. Medications are available to control some of these symptoms but unfortunately there is still no cure for Parkinson?s.
The Friends of Parkinson?s is a versatile program involving people of all ages from the youth to the elderly. Volunteers in this program help raise awareness about Parkinson?s in the community, they assist PwP during the group therapy programs and they spend time with PwP who are home bound. Volunteers who are older are welcome and FOP has already had some of them. We spoke to them about their experience of volunteering for this initiative.
Mrs Talwar is one of the volunteers
?My husband who recently passed away had Parkinson?s. Being among people with Parkinson?s has given me so much comfort. It takes me away from all the pain,? said Mrs Talwar, a senior who volunteered with FOP. ?I especially felt empathy towards the partners of PwP. I knew I had to help them understand their spouse better so that they would have no regrets later. Today I feel happy and satisfied that I?m giving back in my own small way.?
For many it is the joy of giving back.
?I first saw people with Parkinson?s performing at an event and I was taken aback with
Mr Louis, a senior who volunteers
their positivity in spite of their difficulties. I knew I needed to help them in some way. I started volunteering at the groups three years ago and I enjoy myself. Every week they wait for me to come and it gives me so much joy to see them improving,? said Mr Louis, another senior volunteer. Mrs Biyani, another 50+ volunteer has even started a Parkinson?s group in Vapi, Gujarat, where she lives, after attending the sessions at PDMDS.
Mrs Biyani even started a group in Gujarat
?The very first Parkinson?s group session I attended gave me deep satisfaction. More than any volunteering work I?ve done earlier, helping people with Parkinson?s, knowing each member by name and face, gives the satisfaction of serving a family that is close to my heart. I look forward to my weekly sessions and with the help of PDMDS my family has even started a Parkinson?s group in Vapi, Gujarat. Service to others gives me great happiness.?
These people are just everyday people like you and me who have realised the value of empathy, understanding, patience, love and just being present. Their work has been appreciated both by the PDMDS team as well as all the patient members. But perhaps their greatest appreciation has come from people with Parkinson?s who are homebound. For most of them, these volunteers are their only social interaction and their visits are the highlight of their week. Caregivers also appreciate the respite they get for a few hours every week from these visits and the support they receive from a person who understands what they?re going through. These are people truly making a difference in the lives of those with Parkinson?s. I would like to end with a beautiful quote which says:
?The smallest act of kindness is worth more than the grandest intention.?- Oscar Wilde
If you are a senior citizen with time to spare, come spend time with a person with Parkinson?s. At PDMDS, we firmly believe in our motto ?Together we Move Better?. If you would like to be Friends of Parkinson?s do call us on 022-66106249/+91 9987216057 or you could email us at contactus@parkinsonssocietyindia.com
For related articles on Parkinson?s Disease & support groups available, click here: Parkinson?s Support & Caregiving Resources
To ask Dr Nicole D?Souza a Parkinson?s related question, click here: Ask An Expert
Friends of Parkinson’s, an initiative by the Parkinson’s Disease and Movement Disorder Society, provides an opportunity to all, including senior citizens, to come forward and make a difference in the lives of People with Parkinson’s.
Research over the past few decades has consistently shown the positive impact of friendship on levels of happiness, general, and psychological well-being in older adults. Especially among the elderly, friendships serve as a protective factor against depression and loneliness. It’s where programs like The Friends of Parkinson’s (FOP) help. FOP is an initiative by the Parkinson’s Disease and Movement Disorder Society (PDMDS), Mumbai, providing an opportunity for the community to come forward and make a difference in the lives of People with Parkinson’s (PwP, is how we refer to them) and their families.
Parkinson’s is a chronic, progressive, neuro-degenerative illness caused due to a chemical imbalance in the brain. In India, more than 2 million people have been diagnosed with Parkinson’s and this number is rapidly rising.
A diagnosis of Parkinson’s can be life changing; not only for the person diagnosed with Parkinson’s but also for their families. People with Parkinson’s suffer from an array of symptoms, the collective effect of which is an inability to perform even essential daily activities like eating, bathing, dressing, walking or even sitting down and getting up from a chair. Their ability to speak usually gets affected, limiting their ability to communicate with others. They may also suffer from cognitive and mood impairments like memory loss, depression, hallucinations, delusions and anxiety. All this greatly affects their quality of life and that of their families. Medications are available to control some of these symptoms but unfortunately there is still no cure for Parkinson’s.
The Friends of Parkinson’s is a versatile program involving people of all ages from the youth to the elderly. Volunteers in this program help raise awareness about Parkinson’s in the community, they assist PwP during the group therapy programs and they spend time with PwP who are home bound. Volunteers who are older are welcome and FOP has already had some of them. We spoke to them about their experience of volunteering for this initiative.
Mrs Talwar is one of the volunteers
“My husband who recently passed away had Parkinson’s. Being among people with Parkinson’s has given me so much comfort. It takes me away from all the pain,” said Mrs Talwar, a senior who volunteered with FOP. “I especially felt empathy towards the partners of PwP. I knew I had to help them understand their spouse better so that they would have no regrets later. Today I feel happy and satisfied that I’m giving back in my own small way.”
For many it is the joy of giving back.
“I first saw people with Parkinson’s performing at an event and I was taken aback with
Mr Louis, a senior who volunteers
their positivity in spite of their difficulties. I knew I needed to help them in some way. I started volunteering at the groups three years ago and I enjoy myself. Every week they wait for me to come and it gives me so much joy to see them improving,” said Mr Louis, another senior volunteer. Mrs Biyani, another 50+ volunteer has even started a Parkinson’s group in Vapi, Gujarat, where she lives, after attending the sessions at PDMDS.
Mrs Biyani even started a group in Gujarat
“The very first Parkinson’s group session I attended gave me deep satisfaction. More than any volunteering work I’ve done earlier, helping people with Parkinson’s, knowing each member by name and face, gives the satisfaction of serving a family that is close to my heart. I look forward to my weekly sessions and with the help of PDMDS my family has even started a Parkinson’s group in Vapi, Gujarat. Service to others gives me great happiness.”
These people are just everyday people like you and me who have realised the value of empathy, understanding, patience, love and just being present. Their work has been appreciated both by the PDMDS team as well as all the patient members. But perhaps their greatest appreciation has come from people with Parkinson’s who are homebound. For most of them, these volunteers are their only social interaction and their visits are the highlight of their week. Caregivers also appreciate the respite they get for a few hours every week from these visits and the support they receive from a person who understands what they’re going through. These are people truly making a difference in the lives of those with Parkinson’s. I would like to end with a beautiful quote which says:
“The smallest act of kindness is worth more than the grandest intention.”- Oscar Wilde
If you are a senior citizen with time to spare, come spend time with a person with Parkinson’s. At PDMDS, we firmly believe in our motto ‘Together we Move Better’. If you would like to be Friends of Parkinson’s do call us on 022-66106249/+91 9987216057 or you could email us at contactus@parkinsonssocietyindia.com
Summers can get scorching and dehydrating, leading to several health problems. Here’s a simple guide on how senior citizens can avoid heatstroke this summer.
Summer has barely started officially and parts of the country are already in the grip of severe heat. The mercury is soaring beyond 40°C in parts of South and Western India. Bangalore, known for its pleasant weather is witnessing dry hot days and cooler nights. The unpredictable climate and changing seasons need precautions, especially for senior citizens who may be at risk of developing Heat stroke. Here are few tips to avoid heat stroke in senior citizens and maintain good health.
Changes associated with the change in climate
*Fluid Losses via sweat: Our body cools itself by sweating; each litre of sweat dissipates almost 600 kilocalories (kcals) of heat, preventing a rise in the body temperatures of almost 10 degree C.
*Hyperthermia: In hot, humid weather, there is a risk of Hyperthermia or elevated body temperatures as the sweat doesn’t evaporate due to the moisture laden air and therefore little cooling takes place, despite excessive sweating. In such conditions, senior citizens must take precautions to prevent heat stroke.
Stay hydrated this summer.
Photograph courtesy: Anamika Sharma
Ways to reduce the risk of Heat Stroke
* Drink enough water before, during and after any activity.
* Rest in shade whenever tired.
* Wear lightweight clothing allowing evaporation.
Heat Stroke Symptoms to Watch Out For
* Headache
* Nausea
* Stumbling or Excess or insufficient sweating.
* Confusion or other mental changes.
How to Manage Heat Stroke
* Take sips of water.
* Stop working.
* Seek a shade and ask for help.
To prevent Hyperthermia, even on cooler nights too the body needs enough fluid. There is also the need to keep the body warm. In order to do that, avoid movement from extreme temperature zones. It is also advisable to avoid too much table salt as that may worsen dehydration.
Go for salads and fruits to stay healthy.
Photograph courtesy: Anamika Sharma
Maintaining Good Health in Summer
Our body needs to maintain enough fluid and salts. Sweat and urine losses lead to loss in these salts –e.g., Sodium (Na), Potassium (K) and Chloride (Cl) (also called electrolytes). Losses if not replaced can lead to muscle cramps, drowsiness, weakness and feeling of tiredness. Older people tend to be prone to dehydration, leading to abnormal electrolyte levels. Therefore the following dietary and health precautions must be taken by senior citizens to maintain good health in summer:
* Drink more water: Fluid is 55-60% of body weight. Depending on the climate, dietetic habits, activity and body build, normal urine output is between 1200-1500 ml, so fluid intake should be approximate 8-10 glasses i.e., 2400-3000 ml.
* Avoid heavy foods: Go for watery foods. Good options are juices, water, soups, limewater, coconut water, buttermilk, milk shakes and fresh lime soda. Salads that include cucumber, tomatoes and fruits like melon; sweet lime and oranges are great options too.
* Maintain a balanced diet: Adequate calories are required in a balanced diet with optimum vitamins and minerals to maintain a good health and fight disease. Emphasise on the quantity, composition and quality of food and avoid fasting and feasting. Avoid eating out if possible, eat small frequent meals and do not skip breakfast.
* Avoid late and heavy dinner: The time of eating is very important. Food eaten earlier in the day generates more energy than food eaten later in the day. Basal Metabolic Rate (BMR) is highest in the morning, so it burns off the calories. Contrastingly, some calories when eaten at night get deposited as fat. People with weight gain problems should ideally eat before 6-7 pm.
What to avoid this summer
Avoid caffeine if you can.
Photograph: Silver Talkies
* Alcohol, caffeine, (It’s a diuretic, i.e., causes increased passing of urine and induces fluid loss), tea, soft drinks with or without caffeine are also a bad choice as it makes one feel full quickly. Limited intake is advisable, with two drinks per day, four to five times a week for a man and one drink/day for a woman. One drink is equivalent to 30 ml whisky/Gin/Vodka or 120 ml of wine or 250 ml of Beer.
* Avoid excessive stress by doing some meditation and breathing exercises once a day and avoid heat exposure.
* Skipping meals is avoidable as it induces acidity and can precipitate gastritis.
* Smoking and tobacco use is avoidable.
Finally, nutrient requirements vary with weight, height, age, sex and metabolic rate and with the type, frequency, intensity and duration of activity. Because the emotional and physical stress and competition, combined with travel and other activities, affects dietary intake, adequate caloric and essential nutrient intake must be planned carefully to meet the requirements, especially for senior citizens.
* Some food photographs courtesy Anamika Sharma, a food photographer. You can see her work at Madcookingfusions.
Finding a dementia support group can help you deal with the challenge of caregiving for a loved one with dementia.
Seeing a loved one’s decline into dementia or Alzheimer’s disease can be heart wrenching. It can also mean that someone from the family has to take on the role of a caregiver. The task is challenging, rewarding and exhausting at the same time and several caregivers feel the need to connect with others in the same situation. Becoming part of a Dementia Support Group can help you learn to navigate the situation better and give you a peer group dealing with similar issues.
What is a dementia support group?
The aim of dementia support group is to provide the care givers an environment of support and platform to share their feelings.It is essentially a group for the people who are taking care of Dementia patients. The group helps the caregiver understand and cope with the complexities of the disease, provides them with a supportive atmosphere where they can express the stress of taking care of their loved ones with Dementia.
Why is it needed?
Dementia is characterised by a progressive decline in cognitive, physical and functional abilities. As a dementia patient loses one ability after another, a caregiver has to face tests of stamina, problem solving, and resiliency. With increasing responsibilities it is easy to become overwhelmed and neglect their own health and well-being. The burden of caregiving can put caregivers at increased risk for significant health and psychological problems. A Dementia support group is a safe place for caregivers to meet and develop a mutual support system. The care givers can gain information on methods of coping with the disease. We bring you some Dementia Support Groups across India.
Samvedna Senior Care
Gurgaon, Haryana
This support group is for families of patients of Dementia and the objective is to share knowledge and information on Dementia and help families deal with the challenges associated with this illness. A typical meeting involves sharing and participating in activities and singing and dancing together. Once in a while an expert is invited to talk about relevant issues at the meeting. Members are asked to share their story and instances like what were the first symptoms they noticed in their loved one and how did they accept when their loved one was first diagnosed with dementia. They are also asked to share instances of success or failures in caregiving that other members can learn from. Information on latest research in Dementia is also shared with the members.
Nightingales Medical Trust
Bangalore, Karnataka
Email: dementiabangalore@gmail.com
The support group meetings are held with minimum 15-20 caregivers at various locations around Bangalore for two to two and half hours, usually on a Saturday. It is open to all, family & caregivers, students working with elders or anyone interested in knowing more about dementia. The sessions begin with a group discussion and open forum where everyone is asked to share their experience, the daily schedule at home and other issues. All this is followed by a small talk by an expert who has been invited and deals with various issues over the different sessions. Members try to find a solution towards caregiving in the midst of busy working lives and share tips with each other on behavioural patterns, healthcare tips, etc. Members have even formed a group on the messaging service Whatsapp and stay in touch with each other. You can email them to find out the date for the next meeting.
ARDSI, Hyderabad, Deccan Chapter Office & Dementia Activity Centre
Hyderabad, Andhra Pradesh
Email: ardsihyd@gmail.com
9618527072, 9004528557, 9246519063
Alzheimer’s and Related Disorders Society of India Hyderabad (ARDSI) has a centre equipped for persons with dementia. It has an associated memory clinic. Please do check their very useful website listed above. For monthly caregiver support group meetings in Hyderabad, contact them on email or call.
Deenanath Mangeshkar Hospital
Pune
Tel: 020-40151000/66023000 (extension 1059)
The hospital conducts various Dementia Support Services. Memory clinics, guidance and counselling, memory improvement and memory exercise programs, and Alzheimer’s support group meetings, dementia research, and dementia awareness. Call them to know dates and timings.
Echoing Healthy Ageing,
Mumbai
E-mail: info@echoinghealthyageing.com, Ph: (+91) 9167 61 3665
Contact person: Amrita Patil Pimpale
Echoing Healthy Ageing is a social enterprise working in Dementia care sector, focusing on home based therapies, counselling & Dementia care training for family carers and professionals. This includes counseling after the diagnosis, training for family carers and healthcare professionals, care planning assistance, and activity planning. They have regular support group meetings. Contact them to know more.
Much of the information on this page is courtesy the website Dementia Care Notes, run by Swapna Kishore, one of the foremost dementia resource persons in India. For a complete and constantly updated list of city-wise dementia care resources, which also include support groups, please check https://dementiacarenotes.in/resources/city-wise/
Your age is only a marker along the Cycles of Development, says Anna Chandy, counsellor and top Transactional Analysis practitioner. Sandhya Rajayer meets her to discuss how Transactional Analysis can help as we age.
It’s official: Age is nothing!
First the good news. There’s no official retirement age. Not just because you are only as old as you think you are but, more importantly, because psychologically each of us is going through a cycle of developmental stages beginning right from the moment we are born to our last breath, explains Anna Chandy. Chandy is an acclaimed Transactional Analysis (TA) practitioner, author of Battles in the Mind, and Chairperson of The Live Love Laugh Foundation. So yaay for all those hobbies you thought you could never cultivate, skills that you thought you were past the age of acquiring and oh! running that 5 Km marathon just became a possibility; a slim one that needs to be gradually grown from a few steady steps to breasting the finish line, but a possibility nevertheless.
The bad news? Well, it’s all up to us folks; we’ve actually got to take advantage of this information and act on it. No pain, no gain.
So what is TA and what does it teach us about ageing?
Transactional Analysis, a model for understanding human personality, relationships and communication, was first developed by Dr Eric Berne and became popular with the publication of his book Games People Play. As described in the book TA Today, by Ian Stewart and Van Joines, TA’s theory of personality gives us an idea of how people are structured psychologically and how their behaviour is a manifestation of this structure. The TA theory of communication gives a method of analysing systems and relationships, both in personal life and in work situations. TA’s theory of psychopathology delves into personality development patterns and strategies that originate in childhood and which we tend to continue to replay in grown-up life even when these produce results that are self-defeating and painful. Thus TA offers a system of psychotherapy that helps treat all types of psychological disorders, from everyday living problems to severe psychosis. TA is used in educational settings and also as a tool for organisational analysis and training. Basically, TA can be used in any field where there is a need for understanding of individuals, relationships and communication.
Anna Chandy quotes Pamela Levin, TA theorist who articulated the Cycles of Development theory to further explain the Transactional Analysis (TA) perspective on ageing:
There are essentially seven stages of development:
0 – 6 months: Being or just experiencing the world;
6-18 months: Doing or exploring the world;
18 months – 3 years: Thinking or reasoning things out for ourselves;
3-6 years: Creating identity or writing the storyline we will fit our life to;
6-12 years: Skill development relevant to the identity we want to create;
12 – 18 years: Integration of all the previous stages, in addition to thinking about sexuality.
In the seventh stage of the development cycle i.e. during our 18th year we begin the second cycle in this spiral of development, known as the recycling stage. And we continue to revisit the various stages throughout our life.
Suddenly the retirement years that chorus with ’I wish I had’ feel like living in possibility. “Let me give you an example,” says Chandy, “if you came from a home that was very authoritarian, had a definitive structure which therefore gave no space for exploring other avenues; when you are in the exploratory stage of the development cycles you may want to try out painting. You may never become an artist but at the very least you will get a sense of what is it you want to get from painting. So rather than being in the space of ‘oh I always wanted to learn painting but my parents were so strict so I never did’; just begin your journey wherever you are.”
How TA looks at Age & Sexuality
Elders may struggle with the idea of an active libido as it clashes with our traditional beliefs regarding age. A 72-year-old client of Chandy was struggling with the same. “He was disturbed that while he was sexually active, his wife was not. It also troubled him that he liked to look at women in their 30s and 40s because it clashed with his value system and therefore he felt ashamed.”
Here’s how using TA helped him: “During our conversation we became aware that he saw his sexuality with a particular lens where he measured his physical ability through his libido. So his sexual drive made him feel youthful and he did not want to give it up because it helped him cope with physical ailments. We also worked on his belief system in which thinking sex at 70 is something to be ashamed of. Then we examined what he did as a young man and he was able to see that those were very natural thoughts. We analysed how our belief on ageing is also a cultural hand-me-down. Eventually, he became comfortable with the idea that he and his wife were at different stages in the cycle of development and the odd time he has a sexual need he would masturbate in his privacy and not thrust himself on his wife whose need in this area was over.”
Handing Over The Reins: The TA way
At a certain age our children start making the decisions for us and we end up resisting this change vehemently. TA offers a different coping perspective. “I think there are two aspects to this: we are losing physical independence, not psychological independence. What you think cannot be controlled but where you live, how you live these are being controlled by the next generation. There’s a tussle going on because the two groups – parents and children are not on the same page in how they view the situation. If there are unresolved issues between the children and the parents these are bound to surface at this time. So it’s important that parents exchange thoughts and feelings and engage with children on these issues when they are still healthy so that differences are ironed out.
“Also, remember that when we were children and our parents were looking after us the engagement was only between our parents and us. Whereas, when we are being looked after by our children we need to remember there is a spouse also who is important to our child. S/he may not feel for us the way our child does and those are realities we need to look at. To expect without understanding context is when there is trouble. Then there may be grandchildren who are going through the complicated process of understanding the world and it’s tough on them when we also expect them to understand someone who is one generation ahead” says Anna Chandy.
Post Retirement Blues: How TA Can Help
Our work provides a definitive structure to our life and also offers us validation. Does that structure get affected post retirement and if yes, what’s the solution?
“It’s important to cultivate interests and develop hobbies so that these will provide validation and provide structure to our day in the absence of a ‘job’ when we retire,” says Chandy. “The other missing aspect in retirement is mental stimulation as problem-solving is a core activity when you are in the active work force. You may know many people who take up playing bridge after retirement because it’s a brain stimulating activity.”
“For example, you may play chess or bridge every Thursday, walk every evening or morning, exchange ideas with your walking partners for mental stimulation and get validation when someone appreciates your ideas. Even becoming an integral part of a walking group is a form of validation; it does not have to be a commercial contribution. In recent years there is a lot of research being done on the potency and power of volunteering. And our elders can make a key contribution in that for who else has so many life experiences to share?”
Dealing With Social, Psychological and Physiological Conflicts
The anxiety of memory loss and loss of bladder control is the stuff of nightmares for seniors. What can help ease the mind once your body starts giving up and how does TA help in situations like these?
“We associate memory loss with being out of control. Similarly, incontinence with lack of muscular control. We associate diapers with infancy. So when we ask an elder to wear diapers, at a social level we are telling them to ‘take care’, at a psychological level we are telling them ‘you are like a child, you have no control and you may shame us’. This has a lot to do with shaming in early toilet training. And when seniors with senility issues pull down their trousers or even eat with their mouths open, you will notice that adult children are embarrassed because their parents are violating so-called etiquette. So while socially you are saying ‘I’m taking care of you’; psychologically you are saying ‘don’t shame me.’ I would educate the elderly by telling them these are natural processes of ageing because the body is getting old and tired. Also, it’s time we started having conversations among our elderly on what it means for them to become old. We don’t talk about ageing; we just become old,” says Chandy.
Anna Chandy.
Photograph courtesy: TLLLF
How TA helps with loss
Losing a spouse is tough because we spend more years with them than with our own siblings. Does TA offer a way towards acceptance of loss? “I think grieving is natural but in TA we talk about ‘physis’. For our elders the loss is two-fold when they lose their partners because it makes them not just lonely but also more dependent on children, with nobody to communicate with or support them emotionally. So yes, it’s true that you have lost the person you have cared deeply for many years but when you are ‘integrating’ (the third stage of the cycle of development) as an adult, part of your journey needs to be about a higher life. Physis means – the force of energy towards a higher life. So whatever form of spirituality attracts us is also the anchor for us because in the end that is the only part that actually belongs to us. This is a key area we need to be dialoguing about with our spouse and rest of the family,” emphasises Chandy.
Could TA be a tool for positive change?
“A simple exercise to do this is to take any experience from the past and ask yourself what does this mean for me now? For example, what does it mean for me now to walk along a straight line? What am I learning from that? I also think what they are doing in Amsterdam is good idea – housing where the old and the young live together. The philosophy behind that is that elder people are seeing younger people at different stages of life. And those young people are also seeing what it is to be old. And it encourages a mutual interdependence in such communities. So instead of living in a senior assisted community you could make the choice of living in a mixed community. For example in Chennai, the international YWCA provides housing where they have single people taking apartments alongside old people so there’s mutual interdependence between the neighbours. Otherwise, we are going to create ghettos of one demographic group. Also set up activity centres in such areas; sports, games, hobbies etc that are not age restrictive,” says Anna Chandy.
Featured image courtesy: Pixabay
Financial planning for dementia is one important aspect families tend to miss out on in the early stages. Experts tells us why it’s important to put a plan in place as early as you can.
“Care-giving came upon me gradually. When my mother’s health started deteriorating, it’s my father who took care of her. His sudden death meant that me and my brother had to share care-giving responsibilities. With everyone at home away on work, my brother needed to employ an attendant for half day. But we didn’t find the person reliable as my mother’s condition worsened, so I would travel 40 minutes one way everyday to look after her while my brother and his wife went to work. I did this for almost two years until my brother shifted to another city. Even now, I need to travel once in a while to help out. While we saved on the attendant’s cost, several costs did increase like the need for various aid products like a mobile toilet seat, absorbent sheets, diapers etc as my mother’s condition got weaker. We also needed to get physiotherapy done regularly for her. So overall the costs escalated much beyond our anticipation, including our personal costs such as cost of commute for me and cost of increased doctor visits, physiotherapy, increased hospitalisations, etc for my brother. There are hidden costs to care-giving that we do not anticipate at the beginning and it all adds up.” Sumeet Dhall, remote caregiver to her mother, 84.
“I changed my field from working for a magazine to joining corporate communications with a financial organization because I had to start earning more when my mother fell ill. I knew her illness was progressive and with both my parents growing older and limited income in the family, I had no option but to earn more. As my salary increased, so did my work responsibilities and an added cost was employing a caregiver throughout the day while I was at work or had to travel. Even then, I sometimes find it very hard to manage financially and I’m constantly worried what would happen if I lose my job. My saving potential isn’t much as the monthly care costs are very high given that my father also has health issues and I’m unable to cut down on certain necessities that are basic at this point.”
Sonia Parihar, caregiver to her mother, 77 years.
Sonia Parihar’s case is not a one off. While Parihar is lucky to have managed a higher source of income despite ongoing financial burdens, many caregivers find it hard to balance and retain work along with care-giving responsibilities. It may seem very matter of fact to discuss money when someone is diagnosed with Alzheimer’s Disease. But trying to take stock of finances and figuring out the best way forward is the smart thing to do, especially in the case of Alzheimer’s, which is a progressive disease where the person’s needs change over a period of time, resulting in an increase in costs, coupled with a possible shift in income levels or even loss of income in some cases. While we discuss about the increasing cases of Dementia in India and how to keep your mind active and alert, the discussion on its financial impact mostly takes a backseat. But it is startling when you see the facts.
What The Figures Say
The societal cost of dementia according to the ARDSI’s Dementia India Report 2010 was Rs. 147 billion. In 2010, when the report was published, there were 3.7 million Indians with Dementia. “Now the societal cost must proportionately have gone up, but without considering the cost escalation, and only taking into account the number of increasing people of 4.1 million (with Dementia) as of 2015, the societal cost is estimated at Rs. 163 billion,” Says R Narendhar, executive director, Alzheimer’s & Related Disorders Society of India.
What also adds to caregiver worries in India is that the government doesn’t have a medical care policy for people suffering from long-term illnesses like dementia. The Kerala government is an exception to this. “The Ministry of Health and Family Welfare does not consider Dementia as a health priority,” says Narendhar. “It is not part of any of its health schemes excepting skewed representation under mental health with no specificity. Dementia care must be considered at two levels. At the health ministry level, prevention (through awareness and research), diagnosis, treatment and care. It essential for the Government to run services for People living with Dementia. Whatever cost we may dwell about, they all relate to the population who can afford or manage to afford such costs (meaning that 2/3rd population). What about that 1/3rd population who may not be in a position to afford any of these envisaged costs? So services offered by Government is the only alternative for them, and that is why services from Government are required.”
What Should Caregivers Budget For
While budgeting for Dementia, the family members have to take into account all aspects. Some of these are:
1. Transportation costs: Trips to hospital are common and will vary depending on the patient’s mobility.
2. Cost of diagnosis tests
3. Cost of caregiver: This will depend on the nature of care provided. It could be part time care, daytime carer, a live in carer for 24 hours, etc. (Approximate cost of an eight-hourly attendant: Rs 10,000 to Rs 20,000 a month depending on level of expertise and area)
4. Cost of consumables such as medicines, diapers, disposable wet towels, cotton rolls, toiletries, among others. E.g., cost of a diaper ranges around Rs 2000/month
5. Costs of bigger accessories and home changes. These are usually one time costs and include remodeling toilets, including safety modifications at home, specialized beds, bedpans, commodes, wheel chairs, bathroom aids among others.
6. Dementia day care services if needed
7. Full time residential care services if needed.
8. Costs for physiotherapy and other associated care
Why You Can’t Put A Price To Everything
“Solitary care givers are the one who are worst affected. I know a couple who had two wonderful kids and the male member was diagnosed with early onset dementia, he had to forcefully leave his job due to losing his ability to work. Children were in their prime of their education and had recently shifted to places pursuing higher studies. Wife works with the election commission and cannot be at home caring for her husband, though she wants to. Here the point to be noted is the person affected himself has lost his livelihood, wife has been issued memos for being truant. Day care centre was a boon for her. But transportation cost was an additional burden, regular medicines, occasional visits to doctor all were not part of their planned budget or in consonance with her reduced income and increasing priorities of education of children, in the process she is also losing her quality of life due to the stress onslaught which cannot be quantized in monetary terms.”
–R Narendhar, ARDSI
Important Changes Caregivers Need To Factor In
Several factors may affect the finances of the caregiver or care-giving family directly or indirectly. As Swapna Kishore mentions in her presentation on ‘Under discussed challenges of Dementia Home Care in India’, presented at the recently concluded ARDSI National Conference in Kolkata on September 2017:
• Families may make many changes to take out time for care work. Such changes may reduce their income.
• Most Indian families cannot afford for a trained caregiver. So they give up their jobs or switch to part time jobs to do the care tasks.
• Even with a part time helper, family members may have to reduce outside work to manage care.
• Income (and maybe the job) is also lost during intense care periods and emergencies when caregivers have to take extended leave.
• When caregivers stop work for long periods, their ability to resume work later also goes down.
If you have ageing parents or want to safeguard yourself from financial setbacks in an older age, here’s what should go into a long term plan:
• Planning should be more for preventing health mishaps, than for impending costs. So, it is always good to invest for health care, in the form of health insurance, says R Narendhar. These days, there are smart policies which takes premium in monthly installments in EMIs. It is prudent for people in their 40s to opt for a minimum plan and move towards an optimal one when they reach 50.
• Figure out an income option where you can continue to earn some money even if you are home bound and busy as a caregiver. Sumeet Dhall works as a technical writer with a US based firm. She has intentionally taken on a remote working, home based role to accommodate care-giving even if it meant lesser pay.
• Ask your other siblings to share care-giving costs. Very often the financial burden falls on the person taking care as family living away from the situation is often unaware of the day to day expenses. Make sure other family members are clued in and that the mistrust between you and other family members is less. In case required, experts suggest bringing in a third-party adult, someone who is respected by all, to explain and give recommendations.
• Plan investments in a way that ensures liquidity when needed.
• Make a budget that factors in costs for long term care. Remember the hidden costs such as transportation and increased costs in other areas of life because of the ailment.
• Never leave financial planning until the end. Include it in your care plan and conversations around it right from the beginning.
(Ideas and suggestions from R Narendhar, executive director, ARDSI; Swapna Kishore, Dementia Resource Person and Dementia Care Notes; Sumeet Dhall & Sonia Parihar* (name changed on request) and other caregivers who have not been quoted here)
Financial planning and protection is one important aspect families tend to miss out on in the early stages of dementia. Experts tells us why it’s important to put a plan in place as early as you can.
There are an estimated 4.1 million persons with dementia in the age group of 60+ in India, according to a World Alzheimer’s Report 2015. The number is expected rise to about 7 million by 2020 and to 13-14 million by 2050. Financial planning or the lack of it is one aspect that is least discussed when a loved one is diagnosed with Dementia. As Mrinalini, 40, caregiver to her mother who has Vascular Dementia, points out, it can also take a backseat when the cognitive decline isn’t very slow and you are grappling with issues such as caregiving 24/7, balancing work and trying to figure out alternative care arrangements. Alzheimer’s & Related Disorders Society of India (ARDSI), Delhi, Executive Director R Narendhar agrees. “Normally caregivers are more overwhelmed by the effect of the disease and often miss this very important issue.”
Mrinalini was lucky to share a relationship of mutual trust with her sibling, which helped in tiding over the finances until they were able to sort out her mother’s financial affairs. In many cases, families leave financial planning for later, leading to complications not just in terms of having access to the locked up money but also in interpersonal relationships, mistrust between siblings, etc.
Incidentally, money problems could be the first indicator that something is wrong. ‘New research shows that one of the first signs of impending dementia is an inability to understand money and credit, contracts and agreements,’ says an article in The New York Times. Not having a financial plan in place could have severe setbacks, as mentioned in the website Dementia Care Notes. Here’s what it had to say after extensive research and interviews with caregivers:
‘Persons with dementia often make mistakes in investments because they no longer understand money transactions. People around may realize that the person with dementia is easy to cheat. They may make the person sign on power of attorney documents or property sale documents, or even taking away jewellery or cash. It is common to hear of persons with dementia giving away all their money to strangers or unknown charity organizations. Business partners may cheat the person out of the share. Because the person with dementia is active and has direct control of investments and property, the family may lose all its money and property.
Here are some guidelines for Financial planning & protection for a person with Dementia and their families and/or primary caregivers.
• We usually advise every person who has crossed 60 to make a will and an inventory of their assets and investments, says R Narendhar. Here are his four top requirements that a family should put in place: 1. An updated will 2. An Enduring Power of Attorney 3. A financial inventory 4. A Medical power of attorney
• If there is no will and the person has been diagnosed or is being treated for any memory related issues, ARDSI advises that a financial plan is put in place as early as possible. “The early stage is referred to as Mild Cognitive Decline and means that the patient is still cognitively able to decide what is to be given to whom. This is where a Financial Inventory helps,” Narendhar adds.
• Having a joint account with your elderly relative could be helpful in the long run. Ensure that you get this done early enough when the person is still able to visit the bank, sign and has the understanding to allow you to become the joint account holder.
• Banks are strict about their rules and even if you have a POA, they may still need to see proof of the original account holder in the interest of safeguarding their account. If the elderly person’s signature has changed due to the disease, they would seek a medical certificate. “There are lot of procedures involved and signatures required. So if you have the time, it’s best to plan this while the patient is still able to sign,” advises Mrinalini. She cites her own example. “We needed to consolidate all my mother’s accounts and had to close a Demat account as part of the process. Despite me having a POA, the bank refused to divulge the information unless the account holder, my mother, visited. Since it was impossible for my mother to visit the branch to close the account in person, finally, I spoke to a very senior person at the bank, explained the situation and even put her on a video call with the bank officials to solve the problem.” Mrinalini wants to share this example to highlight that while the banks are doing everything to the best of their ability to protect the customer’s account, it is a huge problem for the caregiver, who is already grappling with too many responsibilities. “A proper system to handle situations such as these will make it easy for all.”
• Build awareness and train everyone around you, suggests Amrita Patil Pimpale of Echoing Healthy Ageing. She cites the example of the senior citizen in the early stages of Alzheimer’s who visited the bank, withdrew cash and lost it on the way home with no recollection of who he gave it to. “In India, banks often operate on personal relationships. If the senior citizen has been a regular visitor to the bank, it’s best to talk to the people there and make them aware of the situation. Building a circle of trust and making people around you aware of the situation helps.
• Be very careful about cheating. Get involved in matters like investments, property, tax, etc if you weren’t earlier. Locate important papers, and keep them safely. If the person with dementia does not understand or cooperate, get the support of family friends and respected seniors whom the person trusts. These activities may be more difficult if you were not involved in such tasks earlier, and now have to do them as well as handle the workload and stress of caregiving as mentioned in Dementia Care Notes, an extensive resource guide on every aspect of Dementia.
• As advised by R Narendhar, create a Financial Check List with a list of payments to be made and taxes to be filed throughout the year.
• If the elderly person with dementia is still keen on handling the finances, ensure that a trusted family member has access to the investment accounts and is involved in all investment decisions. Stay alert that the illness could severely affect a person’s decision making abilities and that trusted person may need to step in.
The Legal Angle
What’s the difference between a Power of Attorney, a Medical Power of Attorney and an Enduring Power of Attorney? We asked Shiv Kumar, Senior Advocate with 40 years of active practice at the Karnataka High Court and one of the key people behind the Elders Help Line in Bangalore, to explain what it all means and what is advisable from a legal point of view.
A Power of attorney is a form of authorization, recognized by Law under which the person in whose favor it is issued ( Attorney) is authorized to act on behalf of the person who has executed the Power of Attorney, namely the Executant. The ( Executant) is free to determine the extent of powers to be conferred upon the Attorney. The Power of Attorney must be executed when the Executant is in a sound state of mind. It must not be executed under coercion pressure, duress or undue influence. It has necessarily to be a voluntary act and an act of volition by the Executant. If the Executant desires, the powers of managing financial and property affairs could be vested in the Attorney through appropriate provisions in the Power of Attorney.
An enduring power of Attorney is essentially a concept and practice prevalent in UK. In fact it is regulated by statute in UK. All powers of Attorney cease on the death of the Executant or on his/her losing mental capacity. Therefore, the concept of an enduring power of Attorney was recognised in the UK. This power of Attorney continues to to be valid even after the death of the Executant or even after the executant loses mental capacity provided such a specific provision is made in the Power of Attorney. Generally this is not recognised in India.
A medical Power of Attorney is a document under which a designated person is nominated as being authorised to take all decisions relating to the health, medical care of the Executant including decisions relating to institutional care, hospitalization etc. However this Power of Attorney also needs to be executed when the Executant is in a sound mental health.This practice is not generally prevalent in India considering that in most cases the family members are around and take these. calls. The New Mental Health Act now provides for a person to issue advance medical directives which is akin to the Medical Power of Attorney.
Suggestion for caregivers: We advise execution of a general Power of Attorney which would be be registered with the jurisdictional Sub Registrar. All powers that are required to manage the affairs of the executant could be included in such power of attorney including the contents of a Medical power of attorney. It would be a comprehensive document. This document would need to be executed while the executant is in a sound state of mind. It could also state that the Power of Attorney would be valid in case the executant loses mental capacity. But that clause may not be accepted as being valid. The new mental health act provides for these situations and it is recommended that instead of powers of attorney recourse be had to the Act.
Many senior citizens are addicted to alcohol, cigarettes, prescription drugs or substances. They want to quit but are afraid of the withdrawal symptoms. Sandhya Rajayer speaks to Dr Anand Jayaraman on addiction in senior citizens and how to tackle it the right way.
An elderly relative recently died of complications arising from an overdose of iron and calcium supplements. While clearing out his room, his children found three separate stashes of prescription medicines that were potentially fatal if consumed in a cocktail. They had no idea for how long he had been consuming this cocktail. Even though all his medicines were bought by the family, apparently the friendly neighbourhood pharmacist had been more than obliging to supply his prescription medicines without a prescription. “We had no time to undo the damage,” his daughter rued.
Across the globe, including India, addiction to cigarettes, alcohol, prescription medicines, opoids, morphine, cocaine and painkillers among seniors is on the increase and presents huge danger.
A community based study reported 10 % prevalence of alcohol use in the 60 plus population. Similarly, a study done on 1117 elderly in North India, 16.3% showed regular consumption of alcohol. A study done at a de-addiction treatment facility in Chandigarh reported 60 % abused alcohol while 35 % were addicted to opoids.
According to reports, addiction to a cocktail of prescription medicines is common among senior citizens. “By law, the pharmacist should sell medicines only on a fresh valid prescription and also maintain copies of the prescription,” says Dr Anand Jayaraman, Consultant Psychiatrist & De-addiction Specialist, People Tree Maarga Hospital, Bangalore.
“In my practice as de-addiction Specialist, I have seen that patients who were prescribed Benzodiazepines (drugs that act as tranquilizers) in their 40s, continue to have these even in their 60s and they don’t even realise they have got addicted. They will swear on anything you ask that they cannot sleep without these, they quietly admit that occasionally they have one in the morning and one at night, on further questioning they admit that on a bad day they have up to four or five a day…even when their system is not as robust as in their 40s. At that time, the doctor has prescribed these medicines to alleviate the patient from their suffering but somewhere along the line, they find these drugs are helping them in some other way and they drop out of treatment. And the friendly neighbourhood pharmacist is helping them.”
According to Dr Jayaraman, “As we age, our body is not able to physiologically tolerate the same amount of drugs or alcohol that it used to be able to. Lot of things are not at their optimum efficiency – starting from brain, liver and renal excretory function. In addition, you may have other risk factors such as hypertension, diabetes, cardiac disease and hypothyroidism…which make you even more vulnerable to fatal conditions.”
What Is Addiction & How do you know you are addicted?
Three of the following six criteria are all you need to fulfil for labelling consumption as addiction. These are:
*The individual must have been using a drug or substance over an extended period of time and continue to use it despite him/her getting psychologically and/or physically harmed.
* Prolonged use of the drug
* Developing drug tolerance
* Withdrawal symptoms
* Seeking the drug over alternative pleasure/interests constantly
* Craving the drug and having either physical or psychological harmful effects as a result. The activity of procuring and using the drug takes precedence over all other activities.
Can Addiction In Senior Citizens Be Cured?
Yes. Dr Anand Jayaraman cites a case study: “Not long ago, I had a patient who was a senior Scientist with a very successful business who had been using a mood elevating drug for two-and-a-half years. It had been prescribed for him when he had suffered a bout of depression earlier. He had a number of highly qualified people working under him but the buzz created by this drug was far more powerful than the work he was doing. And to settle down at the end of the day he would use a sleeping tablet. Unfortunately, his prolonged consumption of the medicines resulted in several mental issues such as mood changes, lack of anger control, sleep disturbances, getting agitated easily, restlessness, unable to concentrate.”
The patient was gradually tapered off the stimulants and his sleep rhythm was sorted out. “I made doubly sure that I did not prescribe any medicines which can be addictive. In order to ensure that he did not get back into the same patterns he also got extensive psychological counselling along with Cognitive Behavioural Therapy (CBT). To the patient’s credit, he’s worked out a way to manage himself while staying drug free. It took us six to eight months for the whole process. The initial three months were spent in getting him drug free then I gave him medicines so that his mood remained consistent without ups and downs; in the second stage he underwent psychological treatment. Now he drops in for follow-up visits just to make sure that he is doing fine. This is just one case I’m sharing here but there are umpteen numbers of stories of successful de-addiction,” emphasises Dr Jayaraman.
The Family’s De-Addiction Strategy
De-addiction cannot be achieved by force you must first take the individual into confidence. Educating people is of utmost importance. Since people fear the withdrawal symptoms, doctors try to keep it as bearable as possible.
*The most common challenge for families of addicts is getting him or her to a physician for the initial screening. Take the elderly person to a physician to check on some health issue and bring up the topic of addiction. E.g., telling the doctor, ‘I also think he has a drink problem, he may not acknowledge it but I think he has one and can anything be done about it?’ The doctor can then suggest a screening process. At least 20-30 per cent individuals make an attempt to quit at the screening stage because this advice comes through a trained professional.
*If this step doesn’t help, families can approach a counsellor or a psychiatrist. These two strategies usually help because you are trying to engage the individual rather than forcing him to change.
*Patient mindset: ‘This habit has worked for me all these years, why should I stop now?’ can be changed with education and counselling techniques. “Once you create an element of doubt, the patient’s resistance begins to crumble bit by bit. This process is called the ‘Cycle of Change’ wherein you drive the individual through a cyclical process that kick- starts the action phase.
Prescription drug abuse symptoms
The elderly usually have a long list of medicines; from a physician here, an urologist in a different hospital or a gastroenterologist somewhere else. Ideally, the primary physician should monitor who is prescribing what. Or at least the pharmacist should pick it up. But as that rarely happens. consuming a cocktail of prescription medicines could be harmful, even fatal. Here’s what families need to watch out for:
* Changes in sleep-wake up cycles and/or eating habits.
* Are the medicines that were prescribed being taken as prescribed?
* Are the medicines running out very quickly?
* Is the patient getting agitated, angry, unable to carry on with day to day activities?
* Have any long standing prescriptions been stopped abruptly?
* All these are reasons to consult a doctor immediately.
Should you get that drink in your retirement years?
Ditch that addiction; Image: Pixabay
Elders are at an age and stage when anything and everything can easily upset their system. “Smoking one or two cigarettes a day may be as harmful as smoking 10 or 20 a day at an younger age; ditto with alcohol,” says Dr Jayaraman. So what should the limit be? “Zero,” says Dr Jayaraman emphatically. “That is because anybody over the age of 60 has a very low threshold of alcohol consumption. Although people wiggle their way around saying it is cardio protective, but the general experience is putting a stop or controlling the urge is far more powerful because invariably people fail to control themselves once they get started. People usually start drinking in their prime, and if their system has had several decades of coping with alcohol then it is already worn out by 60 and they really have got to watch their backs. If not, the system will very easily decompensate. Likewise, tobacco; there are at least 120 carcinogens in cigarettes, why expose yourself to poison in your senior years?”
So should the drink at the retirement party be the last one? “No,” says Dr Jayaraman, “much before that. If you are knocking the doors of retirement, you are planning post-retirement years and that is already a difficult period to cope with. So well before your retirement think of completely coming clean, don’t have any source of dependence chugging along with you into your retirement years.”
Need to know more? Dr Anand Jayaraman can be reached at themindplace@gmail.com
Here are some tips for senior entrepreneurs on how social media and whatsapp can help leverage a home business.
Senior entrepreneur Madhu Mehra, who runs a home business of knitted products called She Who Knits, is never shy in giving out her visiting card. “I usually hand out my card and quite shamelessly ask people to like my page,” says Mehra. “Because, only when people will like and follow my page, can they see what new updates I have put such as new products.”
Madhu Mehra of She Who Knits
Like Mehra, Senior entrepreneur Jayashree Chakraborty runs The Sari Show. She creates hand-painted sarees and dupattas. She posts photographs of her work on the page as soon as it is done. “It helps to keep people updated about my work, otherwise they would lose interest as there are many pages.”
Jayashree Chakraborty of the Sari Show
If you are an entrepreneur running a home business and want to look at free and innovative ways to market your product through social media and tools like WhatsApp, here are a few tips.
Spread the word about your page
Always set up a Facebook page for your business. Share your page and get your family and friends to share the page on their timelines.
Put a few relevant posts on your page to get it started. It could be your latest products with good photographs from various angles. It could be a story on how you started your business, the motivation and the idea behind it. Personal stories which talk about struggles and people realizing their dreams, always work.
Make sure that the product prices or an email ID or phone number where people could find out more about the product are clearly displayed.
Don’t be shy and get your family to chip in. In Mehra’s case, her son-in-law and daughter, both designers, have helped to set up her page. Her daughter models the products while her son in law shoots the pictures. Her family also shares the page and invite their friends to like.
Chakraborty’s children too have helped spread the word about her Facebook page among their friends. In fact, some of her best customers have been friends of her daughter. Through them she has been able to reach out to and develop a wider network.
Keep your page active and interesting
Entrepreneur Radha Kunke, who runs The Soapnut, a handmade soap manufacturing business in Pune shares her tips for Facebook marketing. “I have kept my friends in the loop with stories of struggles and triumphs.” Kunke also makes it easy for visitors to her page by putting up a pinned list on how to buy her soaps. What also works in her favor are the wonderful photographs of the soaps that she puts up. For example, one of the recent pictures shows a soap called Bliss in the making. Other pictures focus on gifting ideas as well as naughty things you could do!
Mehra’s page has a section called ‘They who bought’ where she features customers who bought her products modeling them. “It not only keeps people interested in the page it also keeps my customers happy and engaged.”
If you are able to figure it out, remember to watermark all your pictures with your brand’s logo and name. More than stopping people from copying your product, it also gives people an instant recognition of your product. You could use applications like Canva or Befunky to do this.
Become part of relevant groups
There are several groups that encourage home entrepreneurs, crafters, as well as people doing one specific type of work such as hand embroidery, crochet, or fabric painting. Becoming part of such groups on Facebook or otherwise not only gives you access to the variety and quality of other peoples work but also helps to spread the word about your product.
For example, Madhu Mehra sold several Ajrakh neck warmers after her work was featured by A Hundred Hands, a community that celebrates handmade and holds a popular exhibition in Bangalore each year. Mehra’s work was part of their ME To WE initiative and once her work was featured on their Facebook page, it was much noticed.
Food writer Asha Satish Philar’s book on Konkani Saraswat Cuisine sold several copies after it was talked about in various Facebook groups and blogs run by the Konkani Saraswat community.
Creative artist Girija Ravindran started posting her artwork on Facebook recently. She has then shared her work and received feedback from other artists. She has also participated in an exhibition of which she came to know only via social media.
“I was encouraged to share my work by fellow artist Asha Shenoy, who said unless you share your work no one will come to know about it.”
Artist Girija Ravindran
Play Smart
Popularising one’s business on FB involves posting regular posts that are tailored to audience interest, says Manjul Madampath Menon of Bead, a social enterprise that makes skirts and quilts.
“The insights section of the page provides an understanding of what posts work for the specific audience for the page.” For instance, posts with photos or videos work best for my business,” says Menon. “It is also important to understand at what time of the day to post, what is your audience as defined by demographics and location and how frequently.”
A painting done by Girija Ravindran.
Read up on your page insight
Page insights are an analytical tool that you can access via your Facebook page. Learn to read and understand it to know what time your audience visits your page, what kind of posts get you the maximum likes and what is the best time to post about a new product. Also not all the posts need to be related directly to your product. You can share those that are relevant to your creative idea or in someway links back to what you do. For example, a senior entrepreneur who loves making pickles could also share a post on the various masala mixes that different parts of the country has to offer.
Should you advertise your page?
Menon thinks advertising or promoting a post to a selected audience can help occasionally. If you have a product promotion coming up, or a new collection that you wish to reach out to a selected audience, it does make sense to spend on Facebook advertising. But unless you are sure of reaching a specific audience, avoid spending big amounts. Instead select the right product and group, and spend a minimal sum just to see what kind of response you get. Depending upon the results you could always increase your budget or the duration of your ad.
Is Facebook your only option to market your business?
Not really. Many home run businesses use Whatsapp quite effectively. In fact a recent report in a The Times of India mentioned more than two million homemakers selling products through Whatsapp and doing business worth about $8-9 billion in gross sales! Madhu Mehra uses WhatsApp to send out a blast messages when she has an exhibition. “I create a WhatsApp group where I can post updates about the exhibition and once it is over I can delete the group. Not everyone is on Facebook very actively and this way I am sure that they do not miss out on any messages at all!
Recently Chakraborty started reaching out to her customers through WhatsApp. She adds customers to an existing WhatsApp list and when she has a new product available she sends out a blast message to all of them. The response is immediate and often she can have a more personalized chat then she can have on Facebook.
What are the other ways to grow your home business?
If you wish to stay the online route, you could look at sending out regular newsletters to your customer base. Make sure that you only send them once every two months or less or, depending on your product availability and usage. Example, tribal carpet collector and senior entrepreneur Danny Mehra uses his newsletters very effectively to spread the word about innovative exhibitions and new collections. Remember not to spam your audience with too many newsletters, email updates or WhatsApp messages.
Menon thinks to grow a business off-line, it may be useful to either secure a mention or advertise in neighborhood periodicals. You can also distribute leaflets with the local newspaper guy, or participate in local or popular fleamarkets. You could also connect with ventures like Granny’s Love, which encourage senior citizens to contribute their work.
Finally, here are some suggestions from Mumbai based Social Media Trainer, Ami Savla Hemani, who runs the Socialize Store:
1. You could use cross marketing with another business that is complementary and is also on social media. For example, if you run a jewelry business, you can cross promote it on a friends page if they are running a complementary business like clothes or bags.
2. Influence marketing can work very well. These are groups with a large number of members where they have special days when you can post about your business. Some of them charge a fee, but in exchange you get to spread the word about your business to thousands of group members.
3. Your Facebook page should always be the right mix of promotion and value-based posts. For example, you should ideally have 25% promotion and 75% value-based post to retain your audience interest.
4. Live videos work very well on Facebook. If you are able to do, create a video or a live video demo of your work on Facebook, such as a video of you creating a painting, cooking a recipe if you are running a food page, or doing the demo of some creative craft if that’s your business.
5. Get in touch with popular bloggers to write about your product if they like it. You could also give your product as a giveaway on your page or through a blog. This creates audience interest and popularity!
Photographs courtesy: She Who Knits; The Sari Show, Girija Ravindran
Scrabble & bridge are not just social games, they can also help seniors keep themselves engaged, sharp and active. We take a look at the various options available to those who love these sports.
When T.G. Srinivasan, 71, taught bridge to his wife S. Geetha, 64, in 1986, she laid the ground rules clearly: she would not deal the cards and he could not say she did not play well. Little did the couple know that thirty years later, at a retirement home just outside Chennai, the game would help them pass time in a relaxed and fun way, while helping them exercise their brains.
Suguna Rangaswami, 78, lives in Chennai and loves word games. She plays Scrabble and is also hooked to a game called CodeWords, which is a mash-up of Sudoku and Crossword. Her day is usually full, as she also makes soft toys. “I love crime novels, but how long can I read that? These games are easy on my eyes also,” she says. However, what she cherishes most are her Scrabble days with her 81-year-old sister- in-law and her 63-year-old daughter, with whom she sometimes also plays online.
The medical advantages of playing games that encourage mental activity, such as Scrabble, Bridge and Sudoku, have been well documented, as have the need for social interaction for seniors. A 2002 study by the National Institutes of Health in the US concluded that people with the high levels of cognitive activity—such as card games, Scrabble, crossword puzzles—had a 47% reduced risk of onset of Alzheimer’s.
Research has also shown that exercising your brain can delay the cognitive effects of dementia. While the strength of such research is still debated, it is generally accepted that keeping the mind active is a good way to stall cognitive problems. Walk into most retirement communities and the activities generally include Scrabble, card games such as rummy and bridge, and jigsaw puzzles.
What do these games provide seniors? And is there a reason seniors seem to enjoy these social mental activities?
Challenging Times
“For many, it is the challenge of it,” says Scrabble aficionado Neena Shahani, 64, one of the founders of the Pune Scrabble Club. She says Scrabble is one of those games where it is imperative that you learn new words all the time and the challenge of it keeps people going. “Every year, the list of valid words gets updated and you have to know it, otherwise you cannot play competitively,” she says.
Geetha and Srinivasan also point to the challenge of the game of bridge, especially when they play online, with teams from around the world. “There’s always something new to learn, and online playing has really opened up many more players to us,” says Geetha.
Bangalore’s Nightingale Medical Trust has adapted the UK-based ThinkingFit programme to Active Ageing, an activity programme for seniors. Active Ageing combines physical, social and cognitive activities for well-being and around 100 seniors are part of the thrice-weekly programme.
Dr. Radha Murthy, co-founder of Nightingale Medical Trust, says that the benefits of combining three types of activities—physical, social and cognitive—are immense. “The benefits are much more than if you were to only do one of them,” she says. She takes the example of a lady who would only remember five items in a shopping list prior to the programme; she now remembers at least twenty.
Games such as bridge and Scrabble help exercise more than one part of the brain, leading to increased brain activity.
For instance, bridge involves not just memory, but also risk evaluation, probability, and understanding of subtle cues, not to mention social skills such as coordination and decorum. Scrabble, while seemingly simple, involves not just remembering words from memory, but also rearranging them for maximum gain and calculation of points.
Most lovers of the games are not thinking too deep about the effects of the games on their mental health. “Now that everybody is talking about it, I think maybe my dementia will be postponed,” laughs Geetha.
However, Dr. Radha says that while mind sports have their own value, better value is achieved by encouraging seniors to perform activities they have not done earlier. “We don’t bother to exercise our neurons and they slowly degenerate. When we challenge our brain, and give it unfamiliar tasks, the corresponding neurons are exercised,” she says. “It’s like taking a new route to a familiar place.”
Learning a new language has been shown to be one of the effective strategies against cognitive loss, as has performing Activities of Daily Living (brushing teeth, etc.) with the hand that is not dominant: a right-handed person brushing their teeth with their left hand, for instance.
Social Medicine
For many seniors, though, what is important is simply the social aspect of the game: a.k.a. fun.
Chennai-based V. Vijayalakshmi, 74, author and investment consultant, says that it is difficult, especially for men, to deal with loneliness and games, whether mental or physical, provide much-needed social interaction. “It could be games, it could be having a cup of coffee at the library, or just prayer and slokas. It all boils down to being a social person in a calm and sweet atmosphere.”
“The social benefits are often overlooked but specially designed activities keep seniors away from depression as well,” says Dr. Murthy, of the Active Ageing programme.
Neena agrees. She says that one of the advantages of playing Scrabble face-to-face is the fact that you meet the people you play with. She adds that there are Scrabble Club picnics to strengthen the social aspect of the group.
“For a lot of us, it’s rediscovering the things we knew as young adults,” says Vijayalakshmi’s husband P.R. Venkateswaran, 77, who plays bridge at their retirement community, Serene Adinath, just outside Chennai. “Like a hobby you finally have time for.”
Here are some places where you can play the games on a regular basis. Some of the games can get competitive. Veterans of the clubs suggest seniors go with an open mind and a partner, if possible.
Scrabble:
Scrabble Clubs are present in almost all major cities. Please call to confirm schedule/venues. Visit https://www.facebook.com/scrabbleindia for more information.
Bangalore Scrabble Club: Meets every Saturday from 3 p.m. to 8 p.m. Rotating venue. Call Rex D’Souza, president of the club, at 080 20105627 or rexnd@dataone.in
Pune Scrabble Club: Meets every Tuesday from 6 p.m. to 9 p.m. at the Poona Club. For details, call Romilla Thakur at 9371030834 or romilla_thakur@yahoo.co.uk or Neena Shahani at 9823079676 / neena.shahani@gmail.com
Kochi Scrabble Club: Meets every Thursday evening from 6 to 8 p.m. and Saturday mornings from 10 to 11:30 a.m. Sam Joseph at 9846042421 or teamsamacademy@gmail.com
Chennai Scrabble Club: Ranganathan Chakravarthy at 98401 24750 or chakrang1@yahoo.co.in
Delhi Scrabble Association: Marisha Sharma at hansteraho@gmail.com
Hyderabad Scrabble Club: Shaik Ahmed at 9848865941 or shaikahmed@yahoo.com
Mumbai Scrabble Club: Nakul Prabhu at 9820454173 or nakulprabhu@hotmail.com
Bridge:
Tournament bridge is played at various cities. Please call to confirm schedule/venues. Visit https://www.facebook.com/bridgefederationofindia for information.
Delhi:
At Delhi Bridge Association, Lodhi Road.
Pairs: Wednesdays, 1 p.m. to 5 p.m. Contact: N.K. Jain: 8130689689
Teams: Saturday, 2 p.m. to 7:30 p.m. at Delhi Bridge Association. Contact: TC Pant: 9811094407
At Jawaharlal Nehru Stadium:
Pairs: Mondays, 1:30 p.m. to 5:30 p.m. Contact: Major Iyer: 98682723296
Bangalore:
At Bowring Institute, No 19, St Marks Road, Thursdays, 6 p.m. Contact C.M.Kulkarni – 9845022010 / pradeep_jyothi@yahoo.com
At Catholic Club, No 22, Museum Road (or) Karnataka State Billiards Association, Jasma Bhawan Road, Tuesdays, 6 p.m. Contact Girish Bijoor – 9739151610 / girishbijoor@yahoo.com
At Koramangala Club, 6th Block, Koramangala, Sundays, 10:30 a.m. Contact S.L. Sharma – 9880964719/ slsharma1941@yahoo.co.in
At KHB Games Village, Koramangala: Saturdays, 3 p.m. Contact: S.L.Sharma – 9880964719/ slsharma1941@yahoo.co.in
Bridge classes: Contact Manoj Nair: at joemanjo@gmail.com or Priya Ranjan Sinha at priras@gmail.com / 8041609134
Chennai:
IIT Alumni Club, Abhiramapuram, First Wednesday. Contact L. Ravichandran at ravi@chennaionline.com
Alumni Club, Alwarpet. Second Wednesday. Contact N. R. Krishnaswamy at nrk1946@hotmail.com
TNCA Club, Chepauk. Third (or sometimes 4th) Wednesday. Contact Arun Kumar at secretarychennaibridge@gmail.com
Gymkhana Club: Last Wednesday, TNCA Club, Chepauk. Contact Ranjit Raghavan at ranjit.raghavan@gmail.com
The schedule of events in Chennai is available here.
Mumbai:
At Lokamanya Sewa Sangh, Ram Mandir Road, Vile Parle (East): Sundays from 1 p.m.- 6 p.m. Contact Prabhakar Joshi at 9820392146 or Avinash Barve at 9820137397
Bridge events are held every day of the week at various venues. Please contact Daxindas at 9004022082 for information, exact timings and partners.
Mondays at CCI (Brabourne Stadium), Churchgate, at 12:30 p.m.
Tuesdays at Otters Club, Bandra at 1:30 p.m.
Wednesdays at Willingdon Sports Club, Mahalaxmi at 1 p.m.
Thursdays at All India Ladies Bridge Association (men welcome) at 1 p.m.
Fridays at Willingdon Catholic Gymkhana, Santa Cruz at 6 p.m.
Saturdays at Indian Gymkhana, Matunga; BARC Sport Club; CCI Churchgate and Malabar Hill Club
For bridge classes, contact Ravi Raman at 9820085046.
Kolkata:
At the following social clubs, regularly:
Calcutta Bridge Club, Bagbazar, Monday to Saturday, 6 p.m.- 9 p.m.
Contact: Ritobrota Datta at rito_datta911@yahoo.com
Union Club, Desapriya Park, Monday to Saturday, 6 p.m. – 9 p.m.
Contact: Siddhartha Roychowdhury at 9830119299
Hyderabad: The game is played on Sundays, at 10 am.
At Fateh Maidan Club: 1st Sunday of the month. Contact K. Nageswara Rao at 9848081692 or kollinrao@gmail.com
At Hyderabad Club: 2nd Sundays, At Srinagar Club, 3rd Sundays, at Maharashtra Mandal/Jubilee Hills International Centre: 4th Sundays. Contact C. Srinivasa Rao, at 9885117117/csrao@yahoo.com
Invest in your health, says Sharadha Nair, 63, who believes in green living and eating. Here she shares some simple changes in diet and lifestyle that can go a long way in helping you stay fit & active well into your silver years.
I strongly believe we all need to be our own investment banker. Invest in your health and only then can you bank on yourself to get things done and lead an enriched life. Most of us know the true value of good health only when we lose it and sometimes its too late.
A Good Beginning
I start my day at 5 am with half a litre of warm water with a dash of lime. This is followed by some meditation and then a 45-minute brisk walk. Once back, I read the newspaper and spend half an hour on my terrace garden watering the plants and checking on my little herb patch. This is really therapeutic!
Never Skip Breakfast
I believe in having breakfast like a king and it is my most favourite meal of the day. Usually, it is a bowl of papaya with a squeeze of lime, two egg whites with either toast, multi-grain dosa or home made granola. At 11 am, I have a cup of green tea with a few walnuts and almonds or a handful of roasted flaxseed and pumpkin seeds.
Go Organic
Eating organic and getting rid of pesticide-laden fruits and veggies does show on your health. Though getting your hands on good organic produce is expensive it does reduce a lot of your health woes in the long run. With space constraint it is still possible to pluck your own easy to grow herbs and veggies from your own kitchen garden be it even in a balcony or terrace. So make a start with that. To know more about organic gardening, read our article on it here.
Have A Balanced Meal
When I cook I always make sure to cover all food groups and get the goodness of healthy protein, carbs, fiber and water in every meal. I have switched to millets instead of rice for lunch (see recipe below) and rice is reserved for Sundays and special occasions. One teaspoon of organic ghee takes care of the good fats required.
There are many nutritional reasons for switching to millets. Millets are free of gluten unlike rice and wheat and have low glycemic index. Also, fewer quantities of millets are required to get the same amount of energy to keep us working. Regular consumption of millets is beneficial for post-menopausal women suffering from signs of heart ailments, high blood pressure and high cholesterol. They help women to combat the occurrence of gallstones because they are rich in fibre. They also reduce the risk of Type 2 diabetes because millets are rich in magnesium, which regulates the secretion of glucose and insulin.
Dinner is usually just grilled fish or chicken with a salad or soup. If you are vegetarian, you can substitute it with vegetables. I make sure dinner time is between 6:45 PM to 7 PM. And yes the last drink for the day is liquid gold or warm turmeric milk that helps me sleep better and wake up feeling refreshed.
Hormonal Changes Are Inevitable But Manageable
Life is not a downhill journey after 50 and menopause. The best way to tackle hormonal changes is to eat right and keep yourself active always. I make sure I am always up and about. I use the flight of stairs at home and do at least 10 sets of going up and down every day. A 45-minute walk in the morning and half hour walk in the evening along with very simple exercises and Pranayam done at home every day goes a long way.
Preventive Care Is Needed
Preventive care visits are a must in our silver years.I get regular health screening done to check for cholesterol levels and heart problems, schedule dentist visits and get my eyes checked annually to watch out for health issues if any.
Stay heart healthy & active
Image: Pixabay/CC0 Public Domain
Keeping The Mind Active
I love reading and you will always find me reading a book. Nowadays, in keeping up with the times, I have my headphones on and have hooked on to TED talks and podcasts. Every day is a learning and learning doesn’t stop at any age. It stimulates your mind and keeps you engaged with the changing world around you. Before I get to bed at night it’s a ritual for me to work on a crossword and Sudoku. It is my happy drug!
Don’t Forget To Indulge!
I love a good glass of red wine and dark chocolate. The tannins in red wine and polyphenols in cocoa powder and dark chocolate helps reduce the risk of cardiovascular disease by lowering bad cholesterol and raising the antioxidant capacity of good cholesterol. I treat myself to two pieces of dark chocolate every day and enjoy my red wine with my dinner.
Passing On The Baton
I try my best to make sure my daughter follows a healthy lifestyle too but I let her be. I know she is out most times and likes to live it up but growing up with a disciplined healthy routine right from her early years at home has made her make smart choices even while enjoying the fast paced, good life.
Stay fit and active, says Sharadha, whose interests range from gardening to Sudoku!
Here’s an easy to make a healthy recipe from my kitchen
Mutligrain Dosa – I buy readymade organic flour of different millets for my dosa batter. You can find them in many shops in Bangalore or even from online grocers.
Ingredients
1 cup Jowar flour (Sorghum)
1 cup Bajra flour (Pearl Millet)
1 cup Ragi flour (Finger Millet)
1 cup Maize flour
1 cup soya flour
1 cup powdered oats
Salt to taste (preferably Himalayan pink rock salt)
Method
Mix all the above flour & oats in a bowl with water and let the batter set overnight. Next day add required the salt, mix well and the batter is ready to make your healthy dosa. If you are pressed for time and want instant batter, add a little curd along with the above mix and your instant dosa batter is ready to make.
How to switch from Rice to Millets
I use foxtail millet instead of rice. They can be cooked in the same form as we cook rice or wheat. Here’s how to make it:
Open vessel cooking (1:2 ratio – 30 minutes soaking)
Method
• Wash Millet (Use a sieve to drain the water)
• Soak 1 measure of foxtail millet in 2 measures of water for 30 minutes.
• Cook on large-medium flame with a lid.
• When the water starts to boil, reduce the flame.
• When water evaporates (about 10 minutes), take it off the flame and firmly close the lid.
• Leave it aside for 5 mins for it to cool.
Featured images courtesy: Pixabay
Author image: Silvertalkies
Menopause can cause a lot of changes in a woman’s body. Yoga expert Rajvi H Mehta writes on how Yoga can help relieve the worries.
If there is one thing in life that is constant, it is the process of ageing. This process starts from the time we are born and continues till life ends. However, there are certain milestones, which signal major shifts in life. Of the different systems of the human body, the one which clearly shows these shifts is the reproductive system and more so in women. If menstruation marks the beginning of the reproductive phase, the end is marked by menopause.
Along with menopause comes in some major changes in women’s body, the functions of the organs, the brain and even their appearance. As the secretion of oestrogen by the ovaries ceases, many of the problems are associated with the lack of estrogen. A short term ‘treatment’ is to prescribe Hormone Replacement Therapy [HRT]. But, how long can one ‘push’ or turn away from the consequences of a natural process? Studies have shown that HRT for a prolonged period of time increases the risk of cancer. Therefore, it is logical that one faces and cope with the changes that menopause brings.
Problems of Menopause
Nature helps us too. A menopausal woman puts on weight. As the fats cells also produce oestrogen, this maybe nature’s way of giving women some ‘maintenance levels’ of oestrogen even though the ovary does not. However, sometimes, the weight gain can be enormous bordering onto obesity.
Menopause can have some undesirable side effects. Lack of oestrogen causes vaginal dryness and skin dryness. Women become more prone to osteoarthritis of the knees and osteoporosis. Add on to that the discomfort of hot flashes. If you are genetically prone to hypertension or diabetes then this is the time that the disease starts getting established. All these changes are not pleasant and therefore many women find the transition difficult to handle. And, this is the time that ‘medications’ and supplements become a part of woman’s diet.
It is common practice in many parts of the world to start women on calcium supplements to prevent osteoporosis. However, if one were to do a bone mineral density of menopausal women, you would find all the bones do not become weak at the same time. The hip socket and the lumbar spine are most prone to osteoporosis while the other bones remain healthy. Thus, just taking the calcium supplements is not the solution. How would the calcium know that ‘it needs to go to the hip and lumbar?’ How does it get depleted from that area first? If we were to notice, it is the region of the hips and buttocks that often ‘become loose’ and flabby. Physiologically this impairs the blood flow to hip and head of femur bones. And, taking any amount of supplements may not essentially help unless calcium reaches that area.
How Yoga Can Help
This is where Yoga can help. Practice of yogasanas offers relief and often prevents the onset of many of these issues. Guruji Iyengar says, “Yoga cures what need not be endured and endure what cannot be cured.” But, the problem with asanas is that it has to be done by you and requires effort and time. But, if you rest assured it is a healthy investment. Another important aspect of asana practice is that it has to be done accurately. If casually done then the effects are casual or even ineffective. Guruji Iyengar devised the use of props such as belt, chairs, blankets, pillows and other wooden supports to help people perform the asanas accurately so that they are efficacious. It is advisable to practice these under the guidance of a good teacher. Or in the absence of one, then a good book!
Supta Padangusthasana: One of the problems that surfaces with ageing and in menopausal women is that of the knee. If one finds some discomfort in the knee while going down the stairs, then this is the sign of an impending knee problem. One often tends to ignore or use the escalator or elevator. Bending or sitting on the floor gets painful and one stops that too! Restriction of activity is not the solution to the problem. But, it is the time to intensify the activities but with intelligence and awareness where yoga indeed helps. The two asanas that should be regularly practiced by women to overcome and even prevent an impending knee problem are Supta Padangusthasana and Utthita Hasta Padangusthasana. I will describe the former.
Supta Padangusthasana: One lies down on the floor with both legs stretched out. Bend the left leg at the knee and hold the big toe of the left with the thumb and index finger of the left hand. Then, gradually straighten the left leg keeping the right leg straight. If the left leg is not absolutely straight where there is no dent in the knee then the asana is not effective. What if one cannot straighten any further? If they force then they can pull their hamstrings! Here, the ingenuity of Guruji Iyengar comes in. You can loop any belt or rope around the arch of the left foot and then straighten the leg. Stay in this position for 30 to 40 seconds to start with and then gradually increase the duration of stay. Breathe normally. Then, bring the knee down and do the same asanas by taking the right leg up. Repeat this asana 3 to 4 times on both the sides.
How does this Asana help? This asana takes the load off the knee as the leg is inverted. Just lifting the leg without a belt does not have the desired effect and in fact would create pressure on the abdomen. While we are standing or walking, the load of the ‘heavy thigh’ muscle consistently falls on the knee. The poor knee cannot take the load any longer and shows signs of creaking. It’s advisable not to ignore such signals! In this asana, not only is the load taken off the knee but the muscles are extended especially the hamstrings; thus with regular practice over time, the muscles take over the load off the knee. The extension of the muscles brings them closer to the bone. A bone-muscle ‘friendship’ helps calcium in the blood to reach the bones. This is just one asana, imagine if one invests time in doing many more then the issues of menopause would no longer become an issue. If you wish to know more about Yoga asanas that could be effective for menopause, read the book, Yoga: A gem for Women by Geeta S Iyengar.
Featured Image: Supta Padangusthasana (Photograph courtesy author)
In Part 1 of our series on Grief In The Time of Conflict we looked at how to let go of grief, guilt, and resentment after the loss of someone you had been in a conflict-ridden relationship with. In Part 2, we look at how each individual’s grief can be unique and how to deal with it.
Each individual’s grief is unique, says Dr. Sandip Deshpande, Consultant Psychiatrist, Director, People Tree Maarga Hospital. “For example, when a parent with five kids dies, each child will grieve differently depending on what his/ her unique relationship was with the deceased. All relationships have their challenges. There is usually a mixture of emotional responses ranging from ‘good riddance’ to a ‘gap in one’s life' to a ‘great sense of yearning’ to do the unfinished business to feeling ‘I wish I had not been so nasty to her…’ It is difficult to predict which way the journey would go. At times the survivors’ anger may even be channelized towards the caregiver or doctors. However, in every case, our end goal is to get the survivor to healthy reorganized behavior.”
Dr. Sandip Deshpande speaks of one such case: A man in his early 50s, single, whose father had died early and who undertook the responsibility of caring for his mother even though he had four other siblings. On the mother’s first death anniversary, he made a serious suicide attempt. It turned out he had remained single due to the fear that his future wife would not accept his mother. And he had a highly enmeshed relationship with his mother. He suffered from clinical depression after her death, plagued by both guilt of omission and guilt of commission. He had his mother’s picture on his mobile screen and constantly looked at it for fear that he would forget her face. “Such intense grief reactions can usually be helped professionally in several different ways. Helping the client verbally sketch an accurate memory picture to see the good and the bad in the person to replace their own biased point of view; bereavement counselors also do a companioning model where they take them through the journey of grief and bereavement and get them to look back at the good times they had or recreate factual details rather than hold anger. There’s also the empty chair technique, which for example helped a woman who was very angry with her husband and who she never told what she always wanted to say,” adds Dr. Sandip Deshpande.
“Sometimes complicated grief can result in mummification as in the case of a wife who continued to charge the mobile phone of her husband even a year after he had died. She also set a place for him at the dining table, would not allow anyone to sit in his chair, and refused to dispose of his belongings.”
Recognizing The Signs
Is it possible for the family to sense that a survivor’s grief is showing pathological signs and needs professional help to heal? Dr. Deshpande says that generally speaking if the relationship has been abusive or had suppressed hostility, or if the person has suffered multiple losses, or if the death itself was violent, or there have been previously unresolved losses then it could lead to pathological grief. This would show up in severely negative anniversary reactions, total denial of either fact of the loss or irreversibility of the loss, or mummification of the deceased’s things, as we saw earlier.
“We need to perceive that relationships are not only black or white, they span a spectrum and when a person dies it is okay to say he or she had certain qualities that I was not comfortable with. Usually, the stock response to death of a person is to idolize him or her but it may not always apply and that’s okay too,” Dr. Deshpande adds.
For the large part, we have been speaking about couples’ loss because by the time one of the couple dies they have often spent more time with each other than with their own parents. However, several other relationships may also cause complicated grief, for example when an estranged adult child dies. Along with the grief and guilt on the death of an adult child, the parent will often feel anger that the child who walked away did not finally make the effort to come back. There is a sense that it was the adult child who walked away and it is also his responsibility to come back and this unfinished business can lead to complicated grief too. Again, what are the lessons for living in this? While you are still healthy, share your thoughts on how you want your body to be honored after your death – buried/ cremated, by strict adherence to rituals, by creating your own rituals, or by ignoring all rituals. Make a will that is clear about how you want your assets to be divided. When we have clarity on these crucial matters there is that much less opportunity for conflict and ambiguity in the survivors.
Steps to resolve complicated grief
John James and Russell Friedman in their book, The Grief Recovery Handbook, suggest writing a letter to the dead person detailing everything you wanted to say to him/ her: how did that person hurt you, what did you want from him/her? Ask a trusted friend to listen to you read out the letter with total presence and absolute absence of judgment. Then make a conscious choice to let go of all the resentment and burn the letter. Experience the peace of letting go. Then write a letter to yourself detailing why you had felt angry and bitter, why you don’t feel the need to hang on to those emotions, and how good it feels to be free of all those toxic emotions. Explore ways to live a happier life. It’s important to understand that each person’s grief is unique and complex and a different process may work for each individual.
The process of mourning
The Tasks based approach by William Worden
Task I: To Accept the Reality of the Loss
Task II: To experience and process the pain of grief
Task III: To adjust to a world without the deceased (the external, internal, and spiritual adjustments)
Task IV: To find an enduring connection with the deceased. Reinvest in the new reality: re-place not replace
Featured Image courtesy: Pixabay
RPG Ventures backed Seniority is India’s first omni-channel retail destination for seniors, meeting their every possible need. We take a look at what’s on offer and how they can help elders.
Mr. & Mrs. Sharma had been living with knee and shoulder pain for a long time in a Tier-2 city in Rajasthan. Lack of availability of the right products meant bearing with the pain. A chance introduction to Seniority and couple of calls later they ordered a knee heating and a shoulder heating pad that could relieve their pain better than the traditional hot water bags. Both have been feeling happier and healthier since.
Sourcing elder care products had been dependent on stockists and pharmacists until now as one had to depend on them entirely for making the products available. But now there are companies who sell these products online making them accessible at your fingertip.
Seniority is a new service provider on the block that offers you more than 2,000 products online across a range of categories – bathroom aids, daily living aids,
Women spend a lifetime looking after others and often ignore their own wellbeing. Here’s some good advice from our experts on women’s health issues after 55 and how to prevent them.
The silver years are getting better and better, thanks to advances in nutrition and medicine. Add to this a growing awareness to stay healthy and intentional lifestyles, and you have higher life expectancies and more full lives. But this doesn’t mean that the usual senior health issues are disappearing into thin air. In fact, it’s just as important today, for silvers of all ages to stay on top of their heath. We speak to experts on women’s health issues after 55 and how to prevent them.
“It’s important for women to take care of themselves. A lifetime of looking after their families, often means that they’ve neglected themselves, which leads to health issues as they grow older,” says, Dr. Sangeeta Gupta, a Chandigarh-based physician, who works extensively with women of all ages.
“Some of the common health issues that women above the age of 55 years suffer from include the flu, osteoporosis, heart disease and diabetes.”
Dr. Anupama Gangavati, MD and Geriatric Consultant with Apollo Hospitals, Bangalore, explains why this age group of women are more susceptible to health issues. “Ability of the body to bounce back to normal after an illness or a stressor is homeostasis, and this ability decreases as one ages due to decreased reserve and hence older women are more prone to diseases and complications of these diseases.”
So if you are looking for better ways to nourish yourself and prevent those age-related diseases, here’s how you can do so.
Older women are more susceptible to the flu
Flu/Pneumonia: The flu is a highly-infectious health issue, brought on by sudden symptoms like sore throat, body ache, fever, cough, stuffy nose and fatigue. While anyone can get the flu, the elderly are more susceptible to it because the immune system does become weaker with the passing years. It also means that the flu can lead to pneumonia, if not treated on time. The research done by Centers for Disease Control and Prevention, US, believes that 71-85 percent flu-related deaths in occur in people around the age of 65 or more. “Again, Homeostenosis and decreased immunity with ageing puts an older adult at increased risk of infections,” explains Dr. Gangavati, adding, “the immune system requires more time to be activated in an older adult and hence produces less responses to infection leading to more complications secondary to infections.”
Prevention:
If you feel that you’ve got the flu, visit a doctor right away.
Wash your hands frequently and if possible, avoid people who have the flu.
Get the flu and pneumococcal vaccines annually.
“Fortify your immune system with fruits and vegetables rich in vitamins and minerals,” shares Tenaz Rao, a 65-year-old silver who adds an assortment of vegetables to her soups, drinks homemade fruit juices, and takes care to eat a balanced diet.
Take a multi-vitamin.
Try drinking home-brewed teas made with medicinal herbs to keep your immune system healthy.
Diabetes: Though diabetes is a risk to anyone at any age, especially in our stressed-out urban lives, the risk is even higher for people over 55 years age. In countries like the USA, more than 25 percent people over the age of 60 have this health condition. When a person has diabetes, they have a very high level of blood sugar, which leads to complications like damage to the kidneys, nerves, eyes as well as stroke or heart disease. Some of the early signs to look out for are fatigue, extreme thirst or hunger, blurry eyesight, and a frequent need to urinate.
Prevention:
“Going for brisk walks; avoiding processed foods; regular check-ups to diagnose pre-diabetes, and controlling your blood pressure by limiting alcohol and smoking are some ways to keep diabetes at bay,” shares Dr. Gangavati. She adds that if your physician has recommended losing weight, then that should be taken seriously. Exercise regularly and eat whole foods rich in nutrients and low in sugar. Also, avoid deep-fried foods.“Moderation is the key to a healthy lifestyle,” adds Mita Banerjee, a 61-year-old silver, who leads an active lifestyle.
Heart Disease: As you grow older, your heart, which is a muscle, becomes less efficient and has to work much harder to pump blood through your body. Also, fatty deposits might build-up in the blood vessels of the heart, leading to loss of elasticity. This combination means a heart that’s not that efficient with blocked arteries that prevent the blood flowing properly throughout the body. This can lead to hypertension, stroke, and heart attack.
The classic signs of a heart attack include shortness of breath, discomfort, nausea or lightheadedness, but women in the throes of a heart attack may not experience very intense chest pain. They might experience more shortness of breath, sweating, sudden fatigue, and pain in the stomach, back, arms or the jaw. A stroke might include symptoms like difficulty talking properly, drooping of the face and weakness in the arms.
Prevention:
“Eat a wholesome, balanced diet that’s low in sodium and saturated fats,” suggests Dr. Gupta. Exercise regularly. Dr. Gupta suggests walking as this is the most affordable and best exercise for almost everyone.
Reduce alcohol consumption and cut down on your smoking.
Get your cholesterol levels and blood pressure checked regularly.
Incontinence: Women over the age of 50 are more likely to have urinary incontinence. This is because the pelvic muscles lose strength, and aren’t able to control the bladder as well as they did before. Some of the other reasons for incontinence after menopause include less elasticity in the vaginal tissue and thinning of the lining of the urethra. This leads to a few types of incontinence: stress incontinence, which means that you leak out some urine when you laugh, sneeze or cough; urge incontinence, when the need to urinate comes very suddenly; nocturia, where some women feel the need to use the bathroom several times at night; and, painful urination, which may happen because urinary tract infections that some may get more frequently after menopause.
Prevention:
“Tighten your pelvic floor by doing Kegel exercises,” suggests Dr. Gupta. Try to do three sets of 10 of these exercises every day.
Limit your consumption of alcoholic beverages as well as soda, tea and coffee as these will fill up your bladder more quickly.
Keep your weight in check because if you’re on the heavier side, then this will put pressure on your bladder.
Osteoporosis: When you age, your body absorbs your old bone tissue faster than it can create new bone tissue, which makes your bones weaker. This condition is called osteoporosis. The bones become so thin and fragile that they can easily break when you fall or sometimes, while you are going about your daily lives. It is estimated that 1.5 million fractures happen every year because of osteoporosis. Women are more susceptible to osteoporosis because they lose more bone mass right after menopause.
According to a study done in 2015 by Jyoti Thulkar and Shalini Singh, “one out of three women between age group of 50-60 years in India suffers from osteoporosis and Indian women have an early age of onset of osteoporosis as compared to western counterparts.”
Even though osteoporosis is common, there are ways to keep it at bay.
Prevention:
Since osteoporosis doesn’t have any symptoms, it’s a good idea to schedule a bone density test. This is called a DEXA scan and it checks your bone health.
Check with your doctor about taking calcium supplements.
Include milk in your daily diet.
Image: Pixabay
Also, include calcium-rich foods in your diet like green, leafy vegetables, milk products like homemade cottage cheese, tofu and yogurt. “Women, whether they are young or old, should drink a glass of milk everyday to get enough calcium,” advises Dr. Gupta, adding that including some kind of calcium-rich food in every meal, is a good idea.
“Include some weight-bearing exercises in your fitness routine as these help to build bone density and muscle strength,” shares Mita Banerjee, who does yoga asanas and exercises with dumbbells a few times a week.
Dr. Gangavati advises women to get adequate calcium replacement (1000 mg per day with diet and supplements) and Vitamin D replacement (mainly by supplements). “Sun exposure between 11 am- 1 pm for 15-20 minutes is also necessary,” she says, adding that if you’re taking Vitamin D supplements then it’s important to not over indulge in them as too much of it can be harmful.
Depression: Many women suffer silently as they battle with depression, which also impairs their daily functioning. It is estimated that 7% of the elderly population suffer from unipolar depression. Post-menopausal women are more prone to suffering from depression because when there is a dip in the level of oestrogen in the body, mood-regulating brain chemicals like norepinephrine, dopamine and serotonin also get disrupted, which can lead to depression. Also, women who’ve had hormone-related mood issues like severe PMS or postpartum depression, are at a higher risk of getting depression.
“The most common reason for depression setting in women over 55 is the “empty nest” syndrome as well as the hormonal upheaval of menopause,” says Prachi Vaish, a clinical psychologist who runs www.HopeNetwork.in. “Also, husbands and wives suddenly do not have anything to talk about when they kids leave home. This and the lack of life goals can lead to depression.”
Prevention:
Take some time out everyday to nourish yourself. This could be as simple as 15-minutes to read a good book, or listen to music. “Spending some exclusive ‘me time’ can help you rediscover yourself,” says Vaish.
“Take up a new hobby to ward off depression and feel good about learning a new skill,” suggests Dr. Gupta.
Make time to exercise regularly. Whether it’s a short walk, 20 minutes of yoga or even an hour of golf, exercise will trigger endorphins, those happy hormones that’ll help in preventing depression. “Yoga is one of those exercises that helps keep my body fit, the bones strong and the mind fresh and happy,” quips Rao, who has been practicing yoga for almost 10 years now. For you, it might be Tai Chi or Pilates that floats your boat. So make sure to find a form of exercise that you enjoy and make time for it a few times a week.
“Try re-connecting with your spouse by spending time together, traveling, learning a new skill or talking about any topic, except the kids,” adds Vaish.
Try talking to a therapist or even a good friend, if you feel an issue is weighing you down.
Ultimately, if you need treatment, don’t hesitate to reach out to a health practitioner or therapist for medication and therapy to treat your depression.
Reconnect with your spouse
Anxiety: Anxiety is one of the least talked about health issues that women over 55 suffer from. Often undiagnosed or undertreated, studies in the US show that 18 percent of people over 60 suffer from anxiety issues. A study published in 2011 using data collected by Collaborative Psychiatric Epidemiology Studies says that women are more likely than men to get anxiety disorders*
“Women have more anxiety disorders than men due to chemical differences, hormonal changes and different responses to neurotransmitters,” explains Dr. Gangavati. Anxiety is a mental health issue, wherein the affected person cannot stop worrying about a problem, situation or even the future, to the extent that sometimes it can hamper day-to-day living. Anxiety can even lead to panic attacks, high blood pressure, palpitations, dizziness and insomnia.
If you suffer from any of these symptoms or suspect that you have an anxiety disorder, do not hesitate to reach out for help. Visiting a psychotherapist or a psychiatrist is a good place to begin. If you can find a collaborative care model, where allied health professionals work in tandem with primary care physicians, then that might be one of the best ways to address anxiety issues.
Prevention:
If you feel yourself getting anxious about an issue, talk to a trusted friend, your spouse or even a psychotherapist. Don’t let the anxiety fester to the point that it leads to an anxiety attack.
“Stay social and meet with your friends regularly, to stay happy,” advises Dr. Gupta.
Try writing three pages in long-hand in a journal first thing in the morning. A technique that helps dump all those thoughts in your mind on a page, it’s known to calm people down and get a handle on their problem.
Take up a social cause. “Helping others who are in worse situations than us can often help one get a better perspective of one’s problems,” explains Mita Banerjee, who founded a social organization called Team Miracle in her fifties. “The feel-good factor of this kind of work also helps work through one’s own anxieties.”
“Understand what events causes anxiety and try to avoid these and if unavoidable, try to alleviate this by doing breathing exercises,” advises Dr. Gangavati.
So whether you are in your late 50s, mid 60s or early 70s, do pay some attention to your health. Arm yourself with information, re-create your lifestyle to stay more active, mentally and physically, nourish yourself with nutrient-rich foods, and nurture yourself by doing more of what you love. Stay healthy, stay happy in your silver years.
All photographs have been used for representation purpose only. The featured image on top depicts a group of active seniors participating in an exercise demonstration. Photograph: Silver Talkies
Shraddha Kinger, a psychologist working with Parkinson’s Disease and Movement Disorder Society, Mumbai, shares tips and strategies for a Parkinson’s Disease caregiver.
If you are a caregiver for someone with Parkinson’s, there are two roles played by you: Caring for your loved one and caring for yourself. While the phrase ‘caring for yourself’ may seem clichéd and hard to achieve, the important thing to remember is that it is one of the most accurate but neglected clichés. You can only productively take care of someone if you are taking care of your needs. Here are some tips and strategies that focus on both the roles that you play.
Caring for your loved one
1) Educate yourself about the symptoms, treatment and progression of Parkinson’s Disease. It is natural to have questions and feel apprehension, but it is only when you understand the disease well that you can respond to challenges more effectively. Staying informed about the possible progression of symptoms will help you feel more prepared.
2) Try to be as organized as possible – maintain a calendar or a notebook where you can jot down doctor appointments, medications and notes on any changing symptoms. Being organised with medical files and prescriptions will also help the team that you discuss your loved one’s health with.
3) Keep a watch over your loved one’s physical and mental health. The role played by exercise in Parkinson’s is an extremely important one, so motivating your loved one to exercise is crucial. Find ways to motivate the patient that go beyond reminding him/her about exercise. Join a yoga class or take a walk together regularly, set goals for him/her and appreciate every effort to do better, and take care of his/her diet. As a caregiver, you likely spend the most time with your loved one and understand his/her moods. If you notice any signs of depression or anxiety, talk with his or her doctor.
4) Encourage your loved one to participate in activities and let them try to do things as independently as possible (taking into consideration their present ability and safety). They might take some more time, and may struggle a bit more than usual, but will feel more confident and productive. Try to not highlight the difference of how well they used to do things and how they are doing now – the point is to encourage tasks done independently in the present. A sense of confidence comes from trust shown by family members and friends.
Caring for yourself
1) Your physical health is as important as your loved one’s health. Take time to go for a brisk walk or a run, join a group exercise class or enrol for a gym membership or relaxation class. Make sure that you get regular health check-ups and visit a doctor yourself. Vigilance and physical activity will help you relieve your stress and increase your energy.
Image courtesy: https://www.ebikeshed.com/
2) Take time out for yourself and engage in activities that you like. This could be for just half an hour a day. Continue to meet with friends, participate in hobbies or groups, and maintain a schedule as normal as possible. Do not feel guilty about taking time for yourself. It is only when you are less stressed that you’ll be able to provide the best care to your loved one.
3) Nobody can do everything at once. To feel less overwhelmed, set realistic goals for yourself (as well as for your loved one). Ask for help if possible when there is too much going on, and recognise that you are human and will feel burdened and stressed at times. Friends, family and other kinds of help are present and will show up for you so you can take a break.
4) Join a caregiver support group to remind yourself that you are not alone in your struggles and small victories. Sure, others’ experiences may not always and exactly be the same as yours, but there will still be a lot in common you may find. The very fact that some experiences will be different or the same means that there will be a lot to learn from each other, and a chance to support each other. Sometimes it can be hard to share everything you are feeling with members at home. A group will listen without judgment and be there for you.
5) Appreciate what you are already doing as a caregiver, which is a lot. If a friend were to come to you in your position, what would be the advice you would give them? Treat yourself the same way, with compassion and patience.
It is important to recognise that PD need not affect the relationship and bond that you have always shared with your loved one. It is good to do enjoyable things with your loved one, or even just talk to each other about non-PD related issues, from time to time.
Osteoarthritis in the elderly can be very common. Geriatric Physician Dr Satish Chawla talks about preventive measures and available remedies.
Osteoarthritis is inflammation of the joint. We know of over a hundred causes for the inflammation of the joint. Many are due to injury, infection, autoimmune disorders or due to accumulation of crystals in the joint among other reasons. Osteoarthritis or Degenerative arthritis is the commonest form of arthritis where we have not been able to find a cause. Since it happens most often in the elderly we feel that in some way it is due to the ageing process and or an accumulation of injury over the years.
Osteoarthritis in the elderly is most often seen in weight bearing joints, i.e., the knees, hips and lower back but may also be noted in joints of the hand especially the fingers which undergo high stress during our day to day activities.
All joints are composed of opposing bones held together by ligaments and muscles that bridge the joint. These tissues give stability to the joint while maintaining the ability of the joint to be mobile. The bones are separated by a cushion of a firm but compressible wedge of tissue we call the cartilage. The joint is enclosed by a thin but metabolically active membrane called the Synovia which secretes the turbid fluid called the Synovial fluid. This fluid keeps the joint lubricated and the cartilage healthy. In the knee, cartilage is kept in place by a ring of very strong tissue called the Maniscus.
Degenerative arthritis involves all the components of the joint. Initially, minimal inflammation is noted but with time, damage to the joint tissues result in misalignment and worsening tissue damage. Stiffness progressing to limitation of movement becomes prominent. Inflammation results in swelling and heat indicates inflammation has set in.
With time, quantity and quality of the synovial fluid decreases, resulting in the lack of suppleness and shock absorbing quality of the cartilage. In the early stages of the disease, early morning stiffness is common. The dryness inside the joint causes the grinding noise in the joints. As the cartilage erodes and thins, bone comes in contact with bone. It is at this stage the pain becomes intense and activity like walking become severely restricted.
How to Prevent Osteoarthritis
Since no definite cause for this kind of arthritis is known or theorised the recommendations for prevention are based on association only.
1) Perhaps the single most important preventive measure by far is maintaining normal body weight.
2) Maintaining good physical conditioning: As I have mentioned above the stability and integrity of the joint is for the most part due to the soft tissue surrounding it. If the muscles are strong and in good condition the joint will be protected.
3) Injury: Sport injuries at a younger age predisposes to degenerative arthritis later in life. Falls, accidents are other ways of injuring joints.
4) Alcohol: Some people feel that there is an increased risk of joint injury when a person is under the influence of alcohol although there is no direct or strong evidence to support this contention.
Available Therapies
The main goal of treatment is amelioration of symptoms. There is no known cure for this kind of arthritis. Maintenance of functions of the joint, lessening of discomfort and pain as well as slowing the degenerative process are the goals of therapy.
1) Range of motion both passive and active is essential part of the program. By passive range of motion we mean motion supported by another individual such as a physical therapist although this could be done by any competent individual with adequate training and precaution. Active range of motion is activity carried out by the individual using their own muscle power.
2) All range of motion activity is best done without weight bearing. Thus swimming becomes a wonderful way to achieve this end.
3) Exercise to assist in weight loss as well achieving muscle strength is important.
4) Keeping the joint warm with proper clothing helps with pain and stiffness. The use of hot and cold compresses is fine if they offer symptomatic relief.
5) The use of warm baths/salt water therapy among others has not proved of any value.
6) Wearing braces (well fitting) are helpful in maintaining alignment.
7) Use of crutches, walkers etc may help in maintaining ambulation and quality of life.
All images: Pixabay
Written by Dr. Satish Chawla MD, FACP, AIIMS, who is a retired Geriatric Physician from the United States Navy. He is an expert in geriatric medicine and associated with Samvedna Care.
Using paid attendants for progressive, degenerative disorders is a decision family members often delay until they reach a critical situation. Swapna Kishore of Dementia Care Notes on the reasons why it’s important to get an attendant for your ailing loved one.
When someone gets a fracture or a heart attack, family members rally together to provide the care. They employ attendants if needed. But the decision-making related to paid attendants for progressive, degenerative disorders like Alzheimer’s and Parkinson’s is often different. Families usually delay using attendants for progressive disorders till they reach a situation where an attendant seems unavoidable. For example, when the caregivers are elderly and physically unable to help with tasks like bathing and toileting. In one instance, a son, who downsized his business and adjusted his life to care for his mother was forced overnight to get a helper because he developed a slipped disc. Another typical situation is when the family has several critical responsibilities and not enough home caregivers, like families with young children, new-borns, or other seriously ill family members.
In most cases, families keep adjusting their work and using part-time informal help to be able to provide care. They keep hesitating to get attendants. Some common reasons are discussed below along with aspects worth considering when deciding on whether to get an attendant.
Families can’t decide whether their situation is “bad enough”
Initial symptoms of progressive, degenerative diseases like Alzheimer’s and Parkinson’s are mild, and care is low. Though the care work increases as the condition worsens, this decline may take years, making family members wonder about the need for a caregiver. The increasing impact of caregiving is absorbed by families by making many adjustments. These have a severe impact on various family responsibilities and work commitments, and on caregiver health and well-being.
For example, caregivers may reduce the time spent helping kids with exams. Work-from-home caregivers miss deadlines and important meetings and start losing assignments. Even going out for urgent chores becomes a struggle for a homebound caregiver. Busy caregivers may reduce necessary self-care activities. Morning walks get cancelled. Yoga classes are dropped. A perpetual sleep backlog is the new normal. They skip their own health check-ups.
In spite of this, caregivers continue to feel an attendant is “not worth it right now.” It seems easier to continue the current arrangement rather than find and train an attendant, make adjustments at home, get used to a stranger, and redo the household budget. And what if the attendant is not good? And so, the decision to get an attendant is delayed one day at a time.
The more the delay, the more difficult it becomes to effectively use an attendant. The loved one’s symptoms deteriorate and communication ability may reduce. A new attendant may not understand why Amma is upset, or how Amma indicates she wants to go to the bathroom, or how to coax her to cooperate for some daily task. If families periodically review the status and its impact, they can make conscious and timely decisions regarding paid attendants.
Getting outside help is seen as a sign of failure, neglect or lack of love
Caring for progressive conditions requires sustained effort for years, often without any break. It keeps increasing till it is full-time and exhausting. But family caregivers often try to provide the same intense care all through this as they would for shorter setbacks like severe infections. They may view the use of attendants as a sign of their failure.
Often, over time, one family member starts doing most of the care work. This person becomes indispensable and gets emotionally tied to the role. She feels that an outsider will not handle the work properly. Using an outsider may feel like neglecting the loved one.
Depending on a single caregiver is risky. The caregiver may sprain an ankle, fall seriously ill, or need to leave town for urgent work. No one else may know how to give Papa his bath or what his medications are. Even if an attendant is employed, who will train and supervise the attendant?
One such story is of an elderly husband who insisted he would look after his ailing wife because it was his duty. He refused to use helpers in spite of his daughter’s requests. When he got a heart attack suddenly, his neighbour rushed him to a hospital and informed the daughter, but could not help beyond that. The USA-based daughter struggled to arrange stop-gap help for her parents while arranging her flight back. Even after her return, she spent a frantic month coping with two ailing parents while trying to make suitable care arrangements.
Some caregivers feel that using attendants would stop their quality time with the loved one
This is not true. As care work increases, family caregivers spend more time on essential care tasks. Their quality time with loved ones reduces. If they are sharing care work with an attendant, they can (if they want) use some freed-up energy with Amma, listening to music, playing games, or whatever they enjoy.
A paid attendant can provide relief to the primary caregiver in the family
Ailing persons may reject paid attendants
Some say things like “I don’t need help” or “you want a stranger to sit on my head all day.” Some may push away attendants or be rude and aggressive. Families, therefore, hesitate to use attendants.
Often the ailing persons are in denial about their symptoms, the care needed, and the impact on the family. If they understood and accepted their situation, they probably would be open to using attendants.
Some ailing persons are open to getting help for specific tasks, like bathing or assistance for evening walks. Families can use part-time helpers to begin with, and as acceptance increases, use paid helpers for more tasks. Unfortunately, task-based part-time assistance is difficult to arrange. Most home-nursing agencies supply attendants only for half-day or full-time work. So, families have to find ways to use attendants without irritating or imposing upon the loved one.
Amrita Patil-Pimpale (Founder, Echoing Healthy Ageing, Mumbai) recommends customising the attendant’s training for the specific care-receiver. Attendants can be trained to maintain your loved one’s dignity and independence. They can respect your loved one’s personal space and remain “invisible” when not needed for active help, and also do passive monitoring as appropriate.
Practical adjustments required to use attendants seem intimidating
Arranging space for attendants is difficult in small homes. Cooking meals for them can be a problem. And family members also need privacy and safety given that there is an outsider present at home—this is especially challenging to arrange in homes with children or seniors. What families should remember is that attendants may be necessary for advanced stages when care is difficult. By starting using attendants earlier, you can find workable solutions before the situation gets overwhelming.
Families are concerned about the cost
Some family members can afford the attendant’s salary but feel that attendants are not worth the cost. Adult children often face this when they have one elderly parent caring for their other parent. The caregiving parent says, “Why pay so much for such little work! That attendant will be idle most of the time.” This “not worth the cost” perspective ignores aspects like caregiver health and stress levels, or the importance of sharing care work and having flexibility. Family members can discuss the workload and cost of the attendant along with the risks of not having one, to reach a suitable decision.
Maybe a family wants an attendant but cannot afford one. Not everyone can afford Rs 8000 to Rs 20,000 or more per month for an attendant. One possibility here is sharing the cost with siblings and relatives, at least for advanced stage care. Also, the family members can ensure that daily care tasks are shared amongst them to reduce dependence on a single caregiver.
?In summary
Using an attendant is very helpful but requires major adjustments. It is useful if the family periodically discusses the status of caregiving and other commitments. This helps them understand the decline and its increasing impact. Depending on the situation, such reviews may be quarterly, monthly, or more often. Periodic discussions ensure that all family members are comfortable with the decisions taken and can work together for more effective care.
For more information on the topic, please read Swapna Kishore’s blog which covers topics related to caregiving and dementia extensively, especially the article, Attendants for Dementia Home Care.
© 2017 Swapna Kishore
In a heartfelt, honest and useful post, Gurgaon’s Arun Roy speaks of his experience as a dementia caregiver.
My wife Mrs. Suchismita Roy, M.Sc. (Physiology), B.Ed suffers from Alzheimer’s disease for the last 8 years. She was a brilliant student and a rank holder in Kolkata University B.Sc. & M.Sc. exams. Later on as an educationist she was the Principal of DAV Public School, Ashok Nagar, Ranchi and DAV Kapil Dev Public School, Ranchi and was considered as one of the best principals in the DAV schools in eastern India.
Unfortunately family situation put a stop to her illustrious career and she quit her job to take care of my ailing, critically ill parents. Also my parents were not very supportive of her career. After my parents’ death she wanted to resume her career, but we had moved to a different city and it was difficult for her to explain her gap years. One thing led to another, our kids got married and moved out to pursue their careers. Suddenly she was left alone at home with no meaningful purpose and engagement. As a result she went into depression in 2006. Her treatment of depression gradually pushed her into Dementia, because of over medication, sleeping pills etc.
All through this I tried to keep my professional life intact, but soon I realized medicines alone would not help. I decided to take retirement to spend my time with her and we came back to Gurgaon. I continued to work part time for some more time but finally I called it quits.
Since 2007, I have shown her to the best doctors in NCR and have now finally settled for Dr. Manjari Tripathi, Neurologist, AIIMS. She has also gone through PET scans and Brain Imaging at NBRC, Manesar. She has also gone through a cognitive rehabilitation program.
Because of constant guidance from experts, medication monitoring and personal attention from me, by God’s grace my wife is still in the early Alzheimer’s stage even after 8 years. She has only problem of current day to day memory loss. Her long term memory, mathematical & calculating ability, singing & creative work, cooking habits etc. are all intact. Although there is a cook for our home for the last 6 years, Mrs. Roy cooks much better than the cook on days she decides to cook herself.
Mrs & Mr Roy
With my experience to take care of an Alzheimer’s patient, I can only advice the following:
1) Do not delay the treatment. As soon as the first symptom of memory loss, mood swing, depression and others are seen consult a good Neurologist.
2) Have a 24 x 7 supervision and care taking. This is very important. Dr. Manjari Tripathi told me that in this disease, medicine helps 50% and the other 50% comes from good care taking. Even with the best of medicines, patient’s condition deteriorates very fast if the care taking is not good.
3) Focus on their nutrition and food intake, set a routine and as much as possible adhere to the routine. Fruits & vegetables and fish (especially fish with high Omega 3) are good. I also continued to give her extra virgin coconut oil 15 ml with breakfast and 15 ml before going to bed in the night. Brahmi and turmeric are also very good.
4) Involve the patient in a variety of activities of his/her interest like music, dance, painting, socialising. If there are senior centres nearby enrol them to remain socially active. Physical exercise is very important for the loved one, take them for walks and outings. Take care that the patient gets enough sleep.
5) Be very careful so that the patient does not get lost. This very often happens with such patients. Mrs. Roy got lost twice and now I have got a stainless steel bangle on which the mobile numbers of four of family members are engraved. She wears it all the time. Keep a card with your address & phone numbers in the patient’s handbag.
6) Keep a large electronic clock in front of the patient where date, month & time are displayed.
7) Keep a large whiteboard with marker where the patient can write down anything for remembering.
8) Train the patient to keep wallet, keys, specs at the same place each day.
9) Modify environment keeping it bright during day and quiet and dim in the evening. For severely affected patients, put display signs to assist access & orientation to key areas like bedroom & toilet.
10) Most importantly take care of yourself, today although I am a 24×7 care giver I also take care of my emotional well-being. I volunteer with young kids from slum areas and teach them English and Mathematics.
Are you a caregiver of a person with a chronic ailment? Share your caregiving experience with us as it many benefit many others in the same situation as you. Write to connect@silvertalkies.com.
Getting medicines home delivered makes life easier for many senior citizens. PharmEasy, an online pharmacy, offers you flat 20 per cent discount on all medicines and delivers them home.
Ordering online for groceries, apparels, books and other consumables and getting them home delivered is fairly common phenomenon now. The latest to join this bandwagon are online pharmacies. Online pharmacies, that allow you to order medicines from the comfort of your home and have them home delivered. Best of all, they offer you sizeable discounts as well.
PharmEasy or Pharmacy Made Easy, is one such new service provider on the block that has been offering online pharmacy services in ten cities and discounted diagnostic tests in five cities. The founders of PharmEasy – Dr. Dhaval Shah, ex-McKinsey consultant, Dharmil Sheth, ex-MakeMyTrip, and Mikhil Innani, ex-Housing.com and CouponDunia, call themselves the Proactive Caretakers who will stand by a patient as a family member. Through PharmEasy they intend to make healthcare services affordable, available and accessible for all.
What’s in it for you?
An offline aggregator of local pharmacies, PharmEasy offers you flat 20 per cent discount on all medicines and delivers them at your doorstep, with no minimum delivery order and no delivery charges. This service is available in ten cities, namely Mumbai, Delhi, Noida, Kolkata, Pune, Jaipur, Bengaluru, Ahmedabad, Navi Mumbai and Thane.
The biggest advantage – you need not hunt pharmacies to source your medicines, as you can now order them while sitting at home and that too at discounted rates. All you need to have is a prescription from a qualified and licensed allopathic doctor and the PharmEasy app on your smartphone. In case you do not have a smart phone you can still avail the services by calling up their call center. PharmEasy commits to deliver the medicine within 24 hours, at your doorstep. PharmEasy services prescription drugs only and allopathic medicines prescribed by qualified and licensed doctors (M.B.B.S, MD, BDS etc.). They do not service OTC and psychotropic drugs and also allopathic medicines prescribed by Ayurvedic or Homeopathy doctors.
What’s more? PharmEasy allows you to set reminders for taking your medicines at the appointed hour. They also send you refill reminders to alert you when your medicines need to be reordered. For putting the anxious minds to rest, their medicine guide gives description of medicines, their dosage, contents, substitutes, uses and side effects, among others.
In addition to the pharmacy services the company also offers diagnostic tests at doorstep, at up to 60 per cent discount. Currently available in five cities, viz., Mumbai, Navi Mumbai, Thane, Delhi and Kolkata, the diagnostic services are expected to be launched in Bengaluru by January 2017. All you need to do is send them your diagnostic requirements through a photograph of your prescription or select the tests from a drop-down list on the app and choose a time and date slot as per your convenience. A laboratory agent will visit the designated address at the appointed hour and collect samples. The samples will then be processed at company’s partner labs, all accredited by NABL and test results will be sent via email the same day, wherever possible and a hard copy through courier the next day. All the services are available on cash on delivery. You need not worry about online payments.
Saumil Parekh, marketing manager PharmEasy says “The company has served more than 5 lakh orders of 1.5 lakh unique clients, till date. On an average they service close to 3,000 orders per day with an average delivery time of 22 hours”.
Pharmeasy has tied up with few senior’s associations in Mumbai – Seniors’ Paradise and AISSCON being some of them. Members of these groups have been ordering medicines via PharmEasy for almost a year and availing of the discounts and the easy service. Monthly refill reminders are used by most of the members which saves them the hassle of ordering medicines again and again. Also, children of seniors not living with their parents are able to order from other cities for their parents living in other areas.
So, if you are a senior and want to add some comfort to your life and get rid of the chore of remembering to ordering your medicines on time and having to visit a pharmacy repeatedly, you may want to try PharmEasy for your next order. Here is what you need to do.
a) Open Play Store / App Store or give a missed call on +91-88800 40000 to get the download link
b) Download PharmEasy app
c) Upload Prescription (a photograph of the prescription from your Camera gallery)
d) Enter your Details
e) Apply coupon code (If any)
f) Place an order
g) Get a confirmation call and free home delivery within 24 hours
Those who do not have smartphones or are not comfortable using apps need not be disheartened. You can still order on PharmEasy via e-mail, WhatsApp or call at 08999479994 (applicable only for Mumbai & Bangalore) to place the order. On calling you will be asked to send the photo of the prescription via e-mail or WhatsApp. If you do not use either email or WhatsApp, you can provide your name and address and a PharmEasy agent will come to your address to pick up the prescription. The prescription will be returned to you with the medicines. There are no additional charges for these services and you will still get flat 20% off on your bill.
For more details, visit http://www.pharmeasy.in/
Fiction and memoirs can sometimes help you deal with a loved one’s ailment in a more practical way than a medical guide can. Here are five books on alzheimer’s you need to read if you are a caregiver.
The other day, I walked into the living room and found my mother standing by her armchair, looking completely lost. She’d come to the room to sit down and watch TV, she told me when I gently questioned her. But then she’d forgotten how to sit. She didn’t know what she was supposed to do.
My mother has Alzheimer’s. I know this disorder’s most well-known symptom is memory loss. I’ve read as many medical papers on the subject as I can grasp. But if I’d limited my reading on Alzheimer’s only to medical and academic papers, I would have had little idea that the memory loss associated with Alzheimer’s can affect even the knowledge of something as basic as how to sit.
Even less would I have known how to help my mother sit down in such a way as to not make her feel weirder than it was clear she was already feeling. As I matter-of-factly positioned her in front of the chair without comment, and asked her to slowly bend her knees, I thanked my lucky stars that I had read fiction based on the subject of Alzheimer’s. These books may not have told me much about meds and diagnoses, but they told me a great deal about what a person with Alzheimer’s might be going through, and how to cope with situations that will probably come up.
Don’t get me wrong. The ‘how-to’ resources available for caregivers on the internet, the medical papers and the science behind Alzheimer’s are all tremendously helpful. But they have one problem: they talk about patients, not people. My mother may have Alzheimer’s but I don’t see her as a patient. She’s my mother. And the fiction I read helps me continue to see her that way. Here are four of the best novels I have read with Alzheimer’s as the subject, and one caregiver’s memoir. These are five books on alzheimer’s you need to read if you are a caregiver.
Synopsis: Maud has Alzheimer’s, and she’s desperately searching for her best friend, Elizabeth, who has vanished. But her mind is not in the present, and as Maud seeks clues to Elizabeth’s disappearance, she goes deeper and deeper into the past, uncovering the truth behind a family tragedy she has long forgotten.
Why it helps: Maud is the lead character in this novel, and the way she thinks her way to the truth about Elizabeth brings true understanding of what goes on in the mind of a person who has Alzheimer’s.
Synopsis: Dr Jennifer Wright is a brilliant surgeon in the early stage of Alzheimer’s, and she’s been accused of murder. The accusation is based on good evidence: the victim, Amanda, is Jennifer’s best friend, and four of her fingers have been surgically removed. Jennifer has no recollection of killing Amanda – but then, she has Alzheimer’s. She wouldn’t remember it even if she did it.
Why it helps: Because the story is told in the first person, you go deep into the mind of a person who has only flashes of short term memory, and therefore, much confusion about the present.
Synopsis: Alice Howland is a brilliant linguistics professor who is struck with early onset Alzheimer’s – the only kind of Alzheimer’s that is genetic. As she slowly loses her memory, she struggles to stay on top of her life. But it’s out of her control: tryas she might, she forgets to remember. This has profound effects on her family: her equally brilliant professor husband, and her children, who now understand that they have the Alzheimer’s gene too.
Why it helps: Though this is fiction, Lisa Genova wrote Still Alice as a guide to Alzheimer’s and the effect it has on the patient, the patient’s family, and caregivers. It is the most complete book available so far on this disorder, and I recommend it highly.
Synopsis: Katie is 17 years old and confused about love. She also doesn’t have much love for her mother, Caroline, a very controlling woman, who needs everything just so. Katie doesn’t know why Caroline is the way she is, until she meets Mary, her grandmother and Caroline’s mother. Caroline has always hidden Mary’s existence from her children – but now Mary has Alzheimer’s and needs a home. As Katie looks after her grandmother, she slowly begins to put her own world together.
Why it helps: Truthfully, there’s too much going on in this book for Alzheimer’s to really be in focus. But Mary’s character is powerful, and the book shows one thing that the other books I’ve described so far don’t: that taking care of an Alzheimer’s patient might mean labour, but it also means love.
Synopsis: This is the true story of Krishna, a woman with Alzheimer’s, and Ranabir Sammadar, her husband who cared for her till the end.
Why it helps: Sammadar details everything he ever did for Krishna, to make her comfortable, to keep her happy. Local context information like this is very useful.
Caring for a Dementia patient at home comes with several challenges including the need to keep their brain stimulated for a better quality of life. Here are guidelines from experts and caregivers on some cognitive activities with dementia patients you can do at home.
Every evening, Bangalore homemaker Mythili C and her mother-in-law Shantalakshmi have a small ritual. Mythili sometimes folds the clothes and asks Shantalakshmi to sort them out by colour. “I’ll say give me the red part or white hankerchief.” Sometimes they sit and sort through the kitchen utensils or even the kids’ toys. “There are times when she is irritable and unable to do anything beyond two minutes but I keep at it as I feel it keeps her involved and gets her to think, even if for a little bit,” says Mythili. Shantalakshmi has Alzheimer’s Disease and is one of the 4.1 million people living with dementia (Alzheimer’s is the most common form of Dementia) in India, according to the World Alzheimer’s Report 2015.
Dementia is an umbrella term that describes a wide range of symptoms associated with a decline in memory and thinking skills. A person with dementia needs mental stimulation and cognitive activities that could help stir memories, keep them engaged and sustain an emotional connect. The 2011 World Alzheimer’s Report says that routinely providing individualised cognitive stimulation to those with mild to moderate stages of dementia can produce short-term improvements and may reduce decline in cognitive function. It’s something that Mythili has been trying to do. While searching through the internet will throw up suggestions like solving puzzles, making a memory album, listening to familiar music among suggested cognitive activities, Dr Soumya Hegde, Associate Director and Consultant Geriatric Psychiatrist, Nightingales Centre for Ageing & Alzheimer’s, Bangalore says, caregivers need to keep in mind the person’s interest and familiarity with something before making a care plan including activities that can provide mental stimulation for a dementia patient.
Go Familiar
Selecting colours from a clothes pile.
Image: Pixabay
“A cognitive activity is any activity that makes you think. It doesn’t necessarily have to be Sudoku or a puzzle just because that was suggested. The idea is to stimulate their mind and keep them engaged,” she adds. When Dr Hegde helps families of dementia patients make a care plan, she keeps it practical. “The primary caregiver and the family need to sit back and see what was the person doing before this. You need to understand what the person enjoys doing. Many times, a puzzle or Sudoku is an alien concept to the person with dementia. Do remember that when you are introducing them to a new activity as it is difficult for them to learn new skills.”
Pune based marketing consultant Gail Sinha’s mother has Vascular Dementia brought on by a stroke. She tried out textbook cognitive activities (puzzles, craft, etc) with her mother for few months before realising it was leading to more irritability and anxiety. Now Sinha lets her do things at her own pace, while trying to keep her engaged in various ways. Dr Hegde often faces families who tell her the patient (their mother, a housewife all her life for instance) never did anything. In such cases, she suggests they involve the person in household chores that may seem familiar. “Don’t make it sound to the patient like they have to do this. Make it sound as if you need the help and that the person can help you do this. The choice of words is important to get them to start.”
Gardening or even watering plants can help.
“E,g, if the person is someone who was extremely involved with housework, you can make her sit comfortably, put a pile of dishes next to her, give her a dishcloth and ask her to wipe one by one. The idea is to engage them in activities they find meaningful and are familiar with,” she reiterates. Another activity could be watering plants or asking the person to pick out or suggests ingredients for a sandwich; asking them to pick out an apple or orange from a basket of fruits, among others.
Follow The Patient’s Pace
It’s important to remember that a dementia patient’s attention span may be as little as one minute. Dr Hegde mentions an important point: The person who is doing cognitive activities with the dementia patient needs to have the time to spare and be around. “They need to understand that what was planned as a half hour activity, may last only for 5 minutes. The person who is doing the cognitive activities with the patient needs to understand that the patient may not be willing to do it beyond few seconds and that they need to have the patience to wait and try again.”
Dr. Hegde’s first communication to caregivers is to ask them to get help. “If they are the primary caregivers of the patient like the wife for instance, then taking care of a dementia patient and engaging them in stimulating activities is a full time job. You cannot do this in the middle of household chores and need to engage someone else for it.”
Sinha does not push her mother to do things beyond a point. In the three years that her mother has had dementia, Sinha has tried doing things that her mother, an ex-teacher, previously enjoyed, such as simple word games and math problems. As her mother’s cognitive abilities have declined further, Sinha has tried to keep her brain stimulated in the simplest of ways. “When she is sitting down, if the TV is on and ads are playing, we will ask her which ad it is and she will sometimes recognise the logo and tell us. There are times when we give her a bunch of forks and spoons and ask her to separate them. We also ask her to help us arrange the clothes she wears. The idea is to bring in aspects of attention, organisation and decision making,” Sinha adds. Over the years, her mother’s attention span has diminished to a few minutes. There are times when she is angry and wants Sinha or the other caregiver to stop. They follow her lead and restart after few minutes. “We don’t know why she is angry or irritable, perhaps because she is unable to do these things, perhaps she is tired but we do not want to agitate her further.” Patience, in big doses, is the key here.
Dr Hegde says anxiety, anger and signs of irritability is a dementia patient’s way of communicating when they can’t find the right words. It is important for the caregiver to try and understand the reason. “E.g., many do not want to take a bath. Perhaps they feel embarrassed that they need to take off their clothes in the presence of someone, perhaps they don’t like the feel of water.” Instead of pushing, Dr Hegde suggest a different approach. “Have very few people around for this activity to make it comfortable for the patient. Avoid a bath instead and sponge if possible.”
The caregiver also needs to look at altering few household habits to make it easier for a dementia patient instead of pushing them to do things. “Think what can I do to make it simpler and easier for the patient,” comes Dr Hegde’s suggestion.
Ask them to help you do things, such as make an orange juice.
Here are some simple activities suggested by Dr Hegde that you or a primary caregiver can do to keep a dementia patient stimulated, engaged and connected to whatever extent possible at home. While these are proven methods tried and tested to target specific cognitive areas to prevent deterioration, remember that it could be exhausting. Keeping a dementia patient stimulated throughout the day is a huge task and it is enough, even if a small part of it is achieved.
* Involve the person in a process like making an orange juice. Right from identifying the fruit to cutting an orange under supervision and squeezing it if they are able to would be an activity involving cognitive and motor skills. It doesn’t have to limited to orange juice, it can be making sambhar or rasam or any activity in the kitchen.
* If you have a garden, talk about the flowers in it when you take them out there or when you are plucking them.
* Try and engage them in conversation if activities are bogging them down. The key is to keep them engaged. Initiate a conversation and give them a chance to talk and connect.
* Try and do something different everyday.
* If they enjoy music, listen to what they have enjoyed in the past and talk to them about it.
* If you wish them to do a puzzle, one good way to make them involved is with a child. Suggest that grandpa might like to help the child to solve a puzzle and ask if they could do it together. Or ask them to pick a colour and give the child while he is drawing. It would make the person feel like he is helping the grandchild out.
Involve them in family games
* If you are playing games as a family, like Pictionary or cards, try to involve your loved one with dementia or at least make them a part of the conversation.
* Encourage people to visit and talk to the person. Remember while having a conversation, you don’t have to greet or talk in a different way. Information is seeping in, though it takes longer for the person’s brain to interpret the information and process what to say. A smile on your face registers faster than words in the mouth. Look them in the eye and talk as that makes a big difference; keep your hand on their hand, it conveys warmth and that you are trying to be with them.
*For their evening walk, take them for a visit to a children’s park. Make them sit where the children are playing. The noise and hustle bustle can be stimulating.
Many senior citizens suffer from swallowing issues like Dysphagia, leading to various health problems. Dr. Sanjay Subbaiah, specialist in voice and swallowing problems, elaborates on it and suggests some solutions.
Many senior citizens find it difficult to swallow food, making the whole process of eating a meal a complicated, unpleasant activity for them. Swallowing is a function that all of us take for granted without understanding the complicated processes lying underneath for its smooth functioning. With age the swallowing function can deteriorate, leading to many eating challenges, which can in turn lead to issues like malnutrition, dehydration, weight loss and even aspiration pneumonia. It is estimated that 20 per cent of individuals over the age of 50 and most of the individuals over the age of 80 years, have some form of swallowing issues, medically termed as Dysphagia.
Common symptoms of Dysphagia typically include the following: coughs while or after eating or drinking; choking on food, fluid, or medication; difficulty in swallowing food or fluid; recurrent attacks of pneumonia; dehydration and electrolyte imbalance; malnourishment and facing loss of muscle mass.
An assessment and intervention by a specialised Ear Nose and Throat (ENT) doctor can help alleviate some of the problems with simple techniques like muscle strengthening exercises and change in consistency of food, among others.
This article explains Dysphagia, its cause and effect and the possible ways of treatment.
The Process of Swallowing
Swallowing is a semiautomatic process where an individual transports food from the mouth to the stomach. A normal person swallows roughly about 1500 times a day. The process starts with chewing of the food in the mouth, later this bolus [chewed food] is pushed to the back of the mouth. Until this step, it is a voluntary activity. From here the involuntary part of swallowing starts. As the bolus enters the pharynx, the entry is synchronized with the closing of the wind pipe [Larynx] and opening of the food pipe [Oesophagus], so that bolus is pushed into the opened food pipe. Once in the food pipe, peristaltic waves propel the bolus into the stomach. The second part of the process i.e., the pharyngeal stage, where the wind pipe closes and the food pipe opens is a highly sophisticated process, requiring the coordination of sensory receptors, nerves, muscles and the central nervous system. This stage witnesses the temporary cessation of breathing and opening of the food pipe [which is otherwise always closed]. Timing is clearly everything here!
Swallowing has 3 stages — the oral stage, pharyngeal stage and oesophageal stage. Problems can occur in one or more stages of swallowing. Derangements in the oral stage can lead to:
Derangements in the pharyngeal stage are common and dangerous, leading to:
Derangements in the oesophageal stage can lead to:
Reasons Behind Dysphagia
It is obvious that swallowing is a complicated process and small derangements can cause dangerous consequences. Reduced sensitivity and strength of the receptors, muscles and nerves are thought to be the main culprit behind this problem. Missing teeth and medications causing dryness of mouth can also add to it. Swallowing problems are also seen in individuals suffering from certain nervous disorders and those who have undergone head and neck surgery. The common nervous disorders with swallowing problems are Stroke, Motor neurone disease, Parkinson’s Disease, Alzheimer’s disease and tumours of the Brain.
The consequences of dysphagia are two folds, including safety and efficiency issues. Safety issues occur due to bolus or even saliva entering the wind pipe leading to coughing during or after eating, aspiration pneumonia and sometimes even death. Efficiency issues occur due to reduced amount of eating because of the problem, leading to dehydration, malnutrition, electrolyte imbalances and sarcopenia [loss of muscle mass with ageing]. Since many elderly people already have some pre-existing diseases, these problems only add to the deterioration.
Dr Subbaiah performs an endoscopic swallowing assessment on a patient.
The Solutions Available
Dysphagia is handled by a Voice & Swallowing specialist, which is a sub speciality of ENT department. The standard investigations include, Clinical Evaluation of Swallowing, Fibro-Optic Evaluation of Swallowing [FEES] and Modified Barium Swallow. These investigations help in deciphering which stage and process of swallowing is affected so that the management is tailor-made to the issue. Dysphagia treatment is broadly divided into Non-surgical and surgical and depends on the cause, symptoms, and type of swallowing problem.
Non-surgical treatment includes:
Surgical modalities include:
Any elderly individual with symptoms of Dysphagia must visit a specialist at the earliest for a swallowing assessment. After swallowing assessment, depending on what stage of swallowing is impaired, a tailor-made treatment is started. Most of the times it is managed by exercises and manoeuvres. Surgical methods are employed rarely. So if you or an elderly loved one feel there is a swallowing problem that is hampering your daily life, visit a specialist today for treatment and regain the pleasures of eating.
Simple memory games and word building activities can help senior citizens stay mentally alert and challenged. Radha Prathi works with senior members at Nightingale’s Elders Enrichment Centre at Sanjay Nagar and writes about simple mental exercises for seniors.
As people grow older, memory often starts failing them and so do their motor skills. Medical science has proved that it is possible to prevent Dementia and Alzheimer’s disease if we keep our brains exercised on a regular basis. While physical exercise helps the body, a daily dose of Sudoku or Crossword can do the needful for the mind. However not everyone can play these games for various reasons. They may simply not have the taste or knack for it, or may not be equipped with enough language or mathematical skills to play the same. Similarly, one may not have enough stamina or a conducive health condition to keep their hands flexible. Here are a few ideas to help the grey cells to exercise and to hone your motor skills while resting in an arm chair.
Word Building
Word Building is one of the oldest and commonest ways to learning words and their spellings. It also serves as a test of memory when played in large groups, because if a word is repeated then it will result in loss of points for the player. Usually, this activity needs at least two people to keep the game going and a little tweak can be added to it. It can be played in the written form, where you have to form a word chain on the principles of word building within a given time span. At the end of the session the chains could be evaluated by a friend or a member of the family in terms of rules, spelling and repetitions. The word chain could break at any point of time rendering the player with points as long as he/she maintains the chain. Keeping a score of the chains will see your points increasing magically over a period of time.
Family Tree
Sometimes family and friends may find it difficult to appreciate your oft repeated stories retold with great gusto. Nevertheless, they will be happy if you document the same stories for posterity and for the the extended family that is usually scattered across the globe these days. Jog your memory, take it back as far as you can and design a family tree. Pepper the characters with one or two well known anecdotes to make the person come alive. The exercise will involve getting in touch with people for procuring photographs, sharing memories and insights. This delightful project can not only help you spend your time in a pleasurable way but will also leave you with a sense of fulfillment for having done something productive. If you are computer savvy key in the details. If not, it is never too late to learn. S Thiagarajan, a veteran photographer featured in Silver Talkies, is creating his Family Tree at 97! You can too!
Atlas
Make a list of all the places that you have lived in or visited right from the day you were born. Rummage your shelf for the atlas you had stowed away. Get hold of an outline map of our country or the world based on the region of your travel. Trace the journey of your life. If you want, you can make brief notes about the place and your personal impressions and memories associated with the place. It would turn out to be a fun exercise and you can involve your grandchildren too!
Thematic Vocabulary
Buy a nice new notebook. Write out a theme on alternate pages. The themes could be listing out fruits, vegetables, animals, birds, places, metals, colours, professions, subjects, and language or for that matter anything under the sun. Then jot down the names that come to your mind. Initially, you might be able to fill a few lines immediately. The challenge begins only when you start trying to recollect all those other words stored in the backburner of your memory. The same Thematic vocabulary can be converted into a multilingual task. This game can prove to be a reality check of finding out how many equivalents you know for Okra or Butterfly!
Name, Place, Animal, Thing
The game called Name, Place, Animal, Thing, which filled you with joy as a kid is perfectly capable of unfolding its magic once again. Play it with your gang of friends, correct each other’s books and have fun all over again. Just in case you have forgotten the rules of the game you can consult children in and around your home. Yes, children of Gen X also play this game occasionally.
Note down new words in a journal every day.
Photograph courtesy: Anonymedu43, CC BY-SA 3.0, Wikimedia Commons
Dictation
If taking a dictation of grocery and laundry list has bored you, take a dictation of a different sort. Tune into your spouse’s favourite soap when he or she is away and note down all the key dialogues and punctuate them with suitable emoticons. Try creating some of your own, who knows you might get a patent for it. This is also an opportunity to exercise you ability to write in vernaculars.
Movies and serials
Make a list of all the movies you have watched. Try to recall the story line, the artists, songs and memories associated with it and document them in the form of short essays. If you find that you are shortchanged for memory, it will prove to be a good excuse to watch the movie again.
These are but a few ideas to help a senior citizen keep failing memory at bay and keep their brain challenged. It could be suitably improvised and worked upon according to the needs and tastes of the individual or groups. The ideas suggested does not hold good only for a specific language. The task can be carried out in a language you are familiar with. If you spend half an hour on these exercises, you are sure to keep your mind sharp and occupied.
Self-medication without the doctor’s advice can come with its own risks, especially for senior citizens. Lalitha Balasubramanian takes a look at what can go wrong and how senior citizens can stay safe.
It is not uncommon to see someone buying a strip of Crocin or Coldarin and stock it for use during a fever or cold. But the fact remains that even these commonplace medicines have side effects. Sedatives, painkillers and steroids are known to have dangerous side effects. The stocking and usage of over the counter drugs or painkillers without the supervision of a doctor has led to self medication and over medication being considered as a significant health concern for senior citizens, as in their case, the risks are enhanced due to age.
Repeating Medicines Without Supervision
Namitaben Shah (name changed) was prescribed a painkiller two times a day for five days for a backache by her orthopaedic surgeon. This was to be combined along with physiotherapy sessions on alternate days for a month. She felt much better after the treatment but after a lapse of about a year, there was a recurrence of this back pain. “Having kept the prescription intact in my medical file, I started taking the painkillers again without consulting the doctor. Within a week, though the pain became bearable, I was having bouts of giddiness and vomiting. As I stay alone, I consulted my family doctor, who advised me to stop the painkillers and immediately referred me to the orthopaedic surgeon.” She was lucky. If she had had a fall during the bout of dizziness, it could have led to unnecessary complications like fractures or broken bones.
Don’t pop pills without the doctor’s advice. Picture courtesy: Wikimedia Commons
Namitaben’s case is not an isolated one.
“Most elderly patients are on multiple drug therapy for various conditions like Diabetes, Hypertension or High cholesterol,” says Dr. S. Subramanian, a General Practitioner and Family Physician, practising for over 30 years in Matunga, Mumbai. “The risk of taking medicines by themselves without consulting a doctor is not at all advisable. With their age related ailments, it becomes essential for even physicians like us to apply ourselves before prescribing additional medicines.”
Everyone is aware that drugs save lives, but unfortunately their side effects could endanger the life itself or the quality of life. For instance, steroids are used to treat a variety of conditions in which the body’s immune system malfunctions and causes tissue damage to critical body organs. These steroids can be organ saving and, in many instances, life-saving. “Steroids are not bad, if used for proper indication, under medical supervision for proper duration. But most of the drug misuse is in the painkiller and steroid category,” says Dr. Subramanian. “They should be taken according to the physician’s advice.” Steroids have been known to cause weight gain, cataracts, weak bones, diabetes, hypertension and ulcers as side effects. Constant use of steroids, even under prescription, can lead to steroid dependency, while sudden stoppage can cause exhaustion, vomiting and nausea.
Elders are prone to aches and pains and many tend to depend on painkillers for relief. “Painkillers are prescribed to assuage pain. But anything taken in excess is bad and if the pain is chronic, an effort has to be made to find out the root cause of the pain. Continuous usage of painkillers can be dangerous and can cause side effects like acidity, nausea, vomiting, diarrhoea, dizziness, and can even lead to kidney or liver malfunction or failure at the worst,” says Dr. Ashwin Mohan, an Ophthalmalogist at Narayana Nethralaya, Bangalore.
Doctors prescribe antibiotics to treat infections caused by viruses or bacteria. “Antibiotics have to be taken at specific times for a particular duration under the supervision of the doctor,” says Dr. Mohan. There is a tendency among people, especially seniors to stop taking the antibiotic as soon as they feel better. “But it is absolutely essential that they complete the course and then stop taking the antibiotic. Taking inadequate doses for an incomplete duration could make the virus resistant to the drug and the same medicine may not be effective when prescribed for the patient at a later date.” However, if antibiotics are taken without consulting a doctor, the side effects can cause the patient to have loose motions, nausea, vomiting or even colitis. Some patients develop swelling of the lips and face.
Taking Precautions
The spate of deaths caused by overdose of painkillers and medicines prescribed for depression set the alarm bells ringing in various countries. The US Government recently published the first National Standards for prescription painkillers. These guidelines recommend that doctors should try normal pain relievers before prescribing an addictive prescription medicine. Policy makers in many countries, including India, are alarmed at the physical and mental deterioration caused by unnecessary use of over the counter drugs. The Indian Government has recently banned around 344 fixed dose combination drugs.
It is much easier to get patients to take one drug instead of many and such combination drugs are prescribed by doctors everywhere. But hundreds of combination drugs entered the market without the approval of the Central Government and many of them, like the popular Vicks Action 500 and Corex cough syrup, were being sold freely over the counter at all medical shops. The complete list of banned drugs can be accessed in this Indian Express Report. (Click here to read ). Many of the cough syrups used to treat dry cough or cough with phlegm are alcohol-based, and have side effects like drowsiness, dizziness, nausea, stomach pain, and sometimes uneven heartbeat too.
“Senior citizens have to be warned about the ban on these drugs and discouraged from using them,” says Dr. Subramanian. His advice: “Patients should understand the risk of taking medications by themselves not only in old age but even when they are younger. Every person, especially elders, should have a family physician. He/she should be consulted before taking any medicine. Even if they are consulting a specialist, it should be in coordination with the family physician, as he would have full knowledge of the patient’s medical background.”
So the next time you plan to pop a pill for the pain, think twice and preferably consult your doctor about it.
The Nightingales Medical Trust and The Nightingales Elder’s Enrichment Centre, had their 16th Anniversary Celebration in style last December. They not only bid 2015 a jolly goodbye, they also celebrated the various skills the senior club members had to offer with music and dance. S Radha Prathi sent us this writeup about this versatile and talented show by senior citizens.
Namma Bengaluru just proved that it has not lost its knack for springing its pleasant surprises on us in the most unexpected ways. Even as people resolved to attach the epithet Pensioner’s paradise to good old Bangalore, Nightingales Elders Enrichment Centres (NEEC) gently prompted its denizens to reconsider the old title. Accordingly, the members of the Malleswaram branch decided to have a gala time on the second Saturday of the last month of 2015. It was the sixteenth year of their collective identity. When they looked further north they sighted their two year old sibling branch in Sanjay Nagar whose members were also working towards making a statement of their existence. It did not
take long for the wise old souls to realize that more the merrier would make a more meaningful phrase if they came together. After all, the guiding spirit of the clubs is the same. NEEC serves as a haven to those who care to register themselves as its members to keep them engaged, educated, updated and entertained right round the year. The club has made it a point to culminate each such vibrant year by celebrating an annual day. The fact that they ensure that they make it the crowning glory of the year has now become a tradition unto itself.
This year around, they decided to gather at Seva Sadan at Malleswaram around mid morning and showcase their variegated and vintage talents. If it was a treat to the senses to watch them display their skills in Yoga or Tai Chi, sing, dance, play act and spoof creatively, the take away was homework for our minds and mindset. For all of us, who are under the impression that old age is a curse of sorts, beset by aches and pains and deteriorating strength, the show was stimulating. Do not for a moment think that all these glittering stars on the stage are blessed souls without a care in life. On the contrary they happen to be sensible souls who know how to put behind the setbacks of life and put their best foot forward to make life pleasant for themselves and those around them. The fact that they had meticulously planned, practised and played out their program with utmost enthusiasm and sincerity spoke in volumes about the wondrous qualities of sincerity and passion which must have been the guiding forces of their lives. Dedication and determination came through the veneer of the light heartedness displayed on stage in each and every piece. That was not all; while the souvenir brought out on the occasion celebrated their cerebral capabilities, the sumptuous lunch enjoyed at the end of the function gave a glimpse of the gourmets who had nurtured a fine taste for all the beautiful gifts that life has to offer.
The fun filled full house, the fanfare and the feverish fervor that ruled the day was fittingly presided over by its founder members Dr Radha S Murthy and S Prem Kumar Raja who had dreamed it all up for them. May their tribe increase manifold!
If you are a senior citizen who wishes to join the Nightingales Elders Enrichment Centre, visit:
No.149. 11th Main
Between 16th & 17th Cross
Malleswaram
Bangalore 560 055
Ph: 080-23342929
Brain Stroke is the equivalent of a heart attack for the brain. Timely management is of essence when dealing with stroke, hence understanding the ailment is the first step in the right direction. Dr. Pardasani decodes stroke for us in an easy to understand language.
Shitij Singh, a perfectly healthy man, experienced severe headache, accompanied by vomiting and dizziness suddenly one night two years ago. An emergency visit to the hospital diagnosed his condition as a case of brain stroke. Immediate treatment and many therapies later Shitij is on a slow yet steady path to recovery. But the path hasn’t been easy for him or his family. It has been tiresome and gruelling, needing a lot of patience and determination.
Stroke can happen to anyone of any age. Timely action is critical to avoid any lifelong impairment hence it becomes imperative to understand the signs so that one is better equipped to handle it. Dr. Vibhor Pardasani, Neurologist, Bombay Hospital, Mumbai decodes it for us in easy to understand language.
Stroke Defined
In simple words, Stroke is caused by interruption of blood flow to the brain, causing sudden damage to the brain cells due to deprivation of oxygen and nutrients. Depending on which area of the brain gets affected by this pathologic process, patients may develop various neurological deficits.
Similar interruption in the blood vessel of the heart is called HEART ATTACK. So a stroke can also be understood as a BRAIN ATTACK.
Types of Stroke
A stroke may be caused by a blocked artery (Ischemic stroke) or at times by the bursting of a blood vessel to the brain (Hemorrhagic stroke). Some people may experience only a temporary disruption of blood flow to their brain which gets spontaneously and completely restored in minutes without causing any permanent problem. This is called Transient Ischemic Attack, or TIA.
About 85 percent of strokes are ischemic strokes. These occur when the arteries carrying blood to the brain become narrowed or blocked by a clot causing severe reduction in blood flow to the brain. A clot may be caused by fatty deposits that build up in arteries due to long standing diabetes, high cholesterol or blood pressure, smoking and other factors. At times, a blood clot or other debris formed in the heart is swept through the bloodstream to lodge in narrower brain arteries. This type of blood clot is called an embolus and can cause similar symptoms as described earlier.
Hemorrhagic stroke occurs when a blood vessel in the brain leaks or ruptures. Brain haemorrhages can result from uncontrolled high blood pressure (hypertension) or at times from weak spots in blood vessel walls (aneurysms). Brain cells beyond the leak get deprived of blood and get damaged.
Identifying Stroke
If someone is having these signs and symptoms, he/she might be having a stroke:
You should seek immediate medical attention if you notice any signs or symptoms of a stroke, even if they seem to fluctuate or disappear. Current medical technology can at times completely reverse the effects of stroke in minutes in some patients if treatment is sought early enough.
Risk Factors causing Stroke
Strokes are caused by a multi factorial biological process. Risk factors for stroke include:
Diagnosing Stroke
The hallmark of a stroke is the sudden onset of symptoms like a “bolt from the blue”. Whether it is an ischemic stroke or a brain haemorrhage it is confirmed by a CT scan which then determines further treatment.
Managing the ailment
Improperly managed brain attack can lead to death or lifelong disability hence a sense of urgency is a must when faced with one.
In case of an ischemic stroke the first 3-4 hours are very critical. Once the CT scan shows the cause of symptoms to be ischemic and if the patient has reached the health facility within 3 hours of the onset of symptoms, the patient becomes eligible for thrombolysis which is an intra venous treatment to bust the offending clot. However it works only if administered within 4 hours or so of the onset of symptoms. Beyond that it can cause brain haemorrhage.
Once the 4 hours window period is over, the management of stroke rests on rehabilitation and prevention of further strokes. At times, large ischemic strokes can cause the pressure in the cranium to rise uncontrollably and may become life threatening. Such situations may merit surgery to release the pressure as a life saving measure.
Management of hemorrhagic stroke largely depends on the size of the haemorrhage. If large, immediate surgical evacuation of the blood is recommended in most situations. Small haemorrhages are conservatively managed. Immediate BP control is the key to limit further bleeding.
Prevention of Stroke
Recovery from stroke can be a long process and is highly dependent on therapies and rehabilitation. The key to management is to prevent stroke by risk factor control. This can be achieved by ensuring proper control of blood pressure, blood glucose and cholesterol; avoidance of smoking; regular physical exercise; adequate sleep; and minimisation of stress.
Prevention is better than cure this old adage is truer for stroke than any other medical illness. So take care of yourself, take care of your health.
Nidhi Chawla provided inputs for this feature
Safety in every aspect of their daily lives is imperative for senior citizens, especially those staying alone, away from their families. We look at safety tips for senior citizens to make their life comfortable.
Many seniors live alone these days, some out of choice while others live alone out of necessity. Whatever may be the reason, ensuring safety is imperative. Here are a few safety tips for senior citizens to lead a safe and independent life.
Stay healthy – Maintaining a healthy lifestyle is the key to leading an independent life.A healthy diet along with age appropriate exercise is a pre-requisite for maintaining good health. If on medication, follow the prescribed schedule of medicines and keep your date with your doctor as warranted by your health status. These days many products are available in the market that can help you remember your medication schedule by days of the week or time of the day. E.g., a simple pillbox with separators can help you arrange your medicines
according to day and time. Make use of these products if you are prone to forgetting your medication schedule. Reminders on your phone can help you remember not just your medicines but also your doctor’s appointments among other things.
Stay organized – A very important aspect of staying alone is also staying organized, especially with documents of importance like your medical reports, medical history, prescriptions, etc. Maintain a file with all these documents and keep it accessible. It is also important to keep the emergency contact numbers handy and in plain line of sight. Jot down your blood group, allergies, current medication and the telephone numbers of your physician, nearest hospital, near and dear ones to be contacted in case of emergency and place them in a visible location, e.g., on the fridge. An abridged copy of the same could be carried in your wallet as well.
Stay safe – One needs to safeguard oneself against both internal and external factors.
Most accidents happen at home in the case of seniors, so it is important to make your house less accident prone, to the best extent possible. Remove any rugs, wires or furniture that you may trip over. It is advisable to have anti-skid tiles in the bathroom or use ant-slip mats when using the bathroom. Installing grab bars in the bathroom can also prevent any inadvertent slips.
To ensure safety from external factors, ensure your doors and windows have good locking mechanisms. Get deadbolts installed on your doors and grills on your windows. Keep your nearest police station informed so that they can check in on you when on beat. Keep flashlights and batteries handy. Many mobile phones with an alarm facility for emergencies are now available in the market. They also alert the listed emergency contact numbers when activated.
Stay connected – Connecting with your neighbours and fellow seniors in the community will not only elevate your social quotient but can also be helpful in dealing with emergencies. It is a good idea to identify a couple of people in your community who you can check in with on a daily basis and who are likely to look out for you in case of your absence. They could even be entrusted with a spare key to your house if you trust them completely. You could include contact numbers of these friends as well on your emergency alert list.
Simple measures like the ones above can prove to be very effective in abetting an independent yet safe life. Be safe and be healthy!
Heard of Care Giver Burnout? If you spend a considerable amount of time taking care of an ailing loved one, be it a parent or grandparent, you need to take care of yourself too as it can result in significant emotional and physical strain.
In our Indian communities, caring for elderly parents is considered a core traditional value that we take pride in. Irrespective of the westernization of our societies, majority of Indians choose to care for their parents at home. With the age expectancy of our population increasing and the number of children in a family decreasing, the length of time that the parents are cared for and the intense pressure that results out of it, has increased quite significantly.
The demands of being the care giver can be quite high. It needs a lot of dedication, time and effort. The critical challenge, for many, is juggling a busy career, caring for their own kids and home plus the aged parents. The pressure from all sides can lead to a condition known as the Care Giver Burnout, which is defined as the physical and emotional strain that results from taking care of someone. Though it is a rewarding and fulfilling experience for many, it can take a toll on the quality of life for the entire family.
Care giver burnout could result from not sleeping enough, working too much, having too many tasks to attend to and just not having enough time to care for yourself. Add to it the financial implication or the emotional turmoil of watching the parent suffer from a degenerative condition like Alzheimer’s or the unresolved family issues that resurface and these are enough to leave anyone overwhelmed with the situation.
Care Giver Burnout can manifest as:
Depression – “ I am not interested in any of this”
Anxiety – “I cannot step out of the house, what if my mother needs me?”Guilt – “Am I doing enough?”
Exhaustion – “I am just too tired to eat”
Inability to concentrate – “ I completely forgot my spouse’s birthday”
Loss of sleep – “What if she tries to get out of the bed and falls down?”
Excessive irritability – “ I just need to be left alone”
Physically, it can present as headache, body ache, weight loss, weight gain or insomnia. Though our body is capable of handling stress for a short time frame, it loses the fight after some time and the stress starts wreaking havoc on our systems.
This is more common in women, as they are mostly more hands on than men. While men tend to involve with the coordination of care, driving to and fro hospitals and taking care of the financial matters, women tend to be the personal care givers and keep the relationship going within the family members, while attending to their own children and maybe careers.
The warning signs of Care Giver Burnout need to be taken seriously as the quality of the care you provide to your parent is directly proportional to your wellbeing. You need to take care of yourself as the stress can only be a detrimental factor in these situations. Let us now, look at a few tips to overcome the Care Giver Burnout
Give yourself priority: You should get away from the guilt and need to understand that you need regular breaks to keep you going. Do things that you love during those breaks. Set your mind free and come back refreshed. Simple relaxation techniques like meditation, going for short walks are great stress busters.
Seek Help: There are organized providers that provide at home healthcare. At home healthcar;e providers, give the same quality of care that you get in hospitals in the comfort and convenience of your homes.
India Home Health Care Pvt. Ltd (IHHC) is one such provider which takes care of the elderly through a wide range of care plans that is developed and customized to your parent. Dr. Anitha Arockiasamy , Head of Clinical Operations, IHHC points out that “Over 30 per cent of our patients come to us after trying to care for their parents by themselves. By the time they approach us, they are exhausted physically and mentally. They feel like they are fighting a losing battle. However, once they engage with us, they realize that they have a team that works with them for their parent and that they have someone with confer with. They understand that they can delegate the hands on care and get their life back.”
While starting a service for an elderly parent, IHHC administers a questionnaire for the patient’s family to deduce how much of psychological support they need, which helps in stemming the Care Giver Burnout.
Garner support: Accept help and support from other friends or family. Discuss the issues you have at hand and the specific tasks that they could help with. If you are open and honest about the situation, you will be surprised by the positive responses you will get. Create partnerships with other siblings. Even if they live far away, speak to them to relieve you for a few weeks. Try confiding in friends, unloading can make you feel a lot better.
Accept the reality: Things can go wrong and you cannot control everything. As is often said, there is no such thing as a perfect care giver. Do not feel guilty if you fall short of things, at times. Your house need not be perfectly kept at all times.
Take care of your health: Going for regular physical check-ups is even more important when you are a care giver. Make sure you get enough sleep, eat well and exercise regularly so that you feel fit and fine.
Remember that you parent wants you to be happy and healthy, above everything. It will hurt them to watch you weaken while taking care of them. So watch out for those warning signs, learn to lighten the stress and the risk of burnout.
Medha Irani is on a permanent high. The 60 year old cancer survivor was detected with breast cancer 12 years ago and has managed to live through it all. Now with a relapse early this year, she is no mood to do anything different. She has fought the crab with her positivity and will and continues to do so. Here’s her account on how she has survived these years with sheer will power and hope.
The day I felt a hard lump in my right breast, I knew instantly where I was headed. I was not shocked nor was I devastated when the tests confirmed I had stage 3 breast cancer. I just accepted it. I was told that it was curable, when detected early. I was 48 years old, had an 18 year old son at the time and my husband to stand by me.
Once the cancer was detected there was a sudden rush to want to get the lump removed. My husband was on a long flight out and I had no intentions of calling him back. I wanted to and I knew that I could handle this on my own. I managed the thousand and one pre surgery tests, the subsequent doctor visits, the booking of the operation theatre, appointments with the surgeon, the admission procedure, all on my own. My surgeon was anxious when he found out and took me aside one day and told me that he won’t operate on me till he meets my family. I assured him that my husband would be there to admit me, the evening before the surgery. I am not sure of his reaction. But he didn’t seem convinced till my husband finally did accompany me to help me complete all the formalities required before the surgery.
You would want to know what went on in my head. Yes I was a little nervous for a few minutes. Then I got hold of myself and told myself, since I am here I will eventually die some day. And that could be due to cancer or any other thing. And I don’t know when that will be. I kept telling myself that I had no control over my death. What I did have control of was my present life and how I chose to live it. I asked my son how he would cope without me, when I am gone. He said, “You are here now right? So I don’t know what it will be when you are not here!” Wasn’t that was profound coming from a teenager? So I reflected on it and decided that what I had with me was my life. I took a firm decision to live it the best way I knew how, by enjoying every moment of it. Death was a certainty. I accepted life. I embraced it as a beautiful journey until I reached my “destination” without worrying over how to go about it.
I got discharged from hospital two days after my lumpectomy was performed. I insisted on taking the lump home and keep it with me for a while. My surgeon agreed to my surprise. I was so happy. He said I could collect it after four days of my surgery. I went straight to the fish market from the hospital. I must have been a sight because there was a drain pipe jutting out of my upper part of my body for the serum to drip out into an attached container. I went home and cooked the fish and was back on my feet as if nothing had happened. I got up the next day and drove my son to college like always, cooked and followed my regular routine. I drove myself everywhere for follow ups, doctor visits, and even to collect the extracted lump! I remember when I went lab, the doctor on duty wanted to know who was the patient. When I said it was me, she asked, “Why do you want to take this home?” I said “because it is mine, it came out of my body didn’t it? “ She quietly handed it over to me cautioning me not to put it in the garbage bin. I promised to bring it back to her for a proper disposal of bio waste. And I kept my word.
The chemotherapy was started within ten days of the surgery. I was scheduled to have six cycles of chemo, with a gap of three weeks from each cycle. I had heard horrible stories from others who had gone through chemo. I kept pepping myself up but was very worried about throwing up. I was determined and told myself I would be ok. Which I was, and as a result, there were no puking episodes, not even once during or after my six cycles. There were no ulcers in the mouth, no constipation, no fever, no rushing to emergency due to sore complications, no depression, the only thing that happened is that I lost whatever hair I had. Also my taste buds were affected from all the medicines administered.
My son shaved off my head. There was nothing else we could do as my hair was falling off in clumps and patches. So it was quite ugly to see the scalp that way. But I loved being bald! I flaunted it totally. I refused to wear a wig as the purpose would be completely defeated. I did not want to wear a scarf either. I just believed that nobody has the time or the inclination to stop and watch. But I was wrong!
It turned out that I had a blast during my bald phase with all the attention I suddenly got! A “so called well wisher” called me and advised me to wear a scarf! “It doesn’t look good!” she said. But I was determined not to get one, I calmly said, “Look I can’t see myself so I don’t care how I look. If you find it difficult to look at me, then please don’t look at me!”
There was this person who kept staring at me and just wouldn’t stop. So I went up to him and said, “Ya, stare harder, maybe it’ll (my hair) will start growing!” Then again there were these two women, who kept whispering to each other, looking at my smooth, bald pate. I called out to them loudly for everybody to hear “I am going through chemotherapy hence the bald head! Want to know more? Ask me I am right here.” I am sure one of them nearly died of sheer embarrassment or shock! When people stared at me on the road, I would raise my eyebrow in question in the form of a silent ‘what’?
I actually felt like a celebrity. Or atleast felt like one with all the attention I got. I once told a lady, “I now know how Aishwarya Rai (the then reigning beauty queen) feels every time she steps out in public.” Even school kids did not spare me but I took it all in my stride. On the treatment front, radiation followed without too many events. I stayed happy, I remained my bubbly self, full of life, soaking in every minute, living every second I could, with great enthusiasm. I would even pull up my top or t-shirt and show my wound to whoever wanted to see it.
All this was so long ago, almost 12 years and I am still here. In January 2015, I found two lesions in my left breast, this time it was one stage lower than the earlier one. As a result I am now on a tablet, for the rest of my life just to keep that in check. You all must have already guessed how I am coping with all this. I am still on top of the world and I have no intentions of being any place else. I love it here. And it suits me just fine to be who I am.
This time around too my husband was out of the country, he was visiting with my son who is now pursuing his PhD in Australia. I insisted that he not come and let me do this on my own.
The difference this time round is that I am now working at a marvellous library called Mcubed in Bandra, here in Mumbai, and so am surrounded with people I have known since I started working here four years ago. Here I have the support of so many people who are more than willing to help me with anything I need. I am completely moved by this sudden generosity of people who have been mere acquaintances in my life. I used to think I do not need help. Then seeing all this love I decided to let people help me. Not because I needed it, but because I wanted them to experience the feeling of caring for someone who needs it.
I know CANCER will not consume my body – I do not care it does, for what use is my body if my spirit leaves it! What I will take along with me is my spirit. The love I get from everyone is what really counts. It is the positive energy that I get from everyone around me that will merge with all the thoughts that float around us as cosmic energy. Cancer or no Cancer, I am here to stay.
— Medha Irani spoke to Sangeeta John
Organ Donation is gradually getting acceptance among a section of aware and committed senior citizens in India. We bring you a report.
When Deepa Vaishnavi’s mother Usha Madhuranathan passed away suddenly at 78, even grief and the sudden jolt of shock could not keep Vaishnavi from fulfilling her mothers wish: To donate her eyes after death. Vaishnavi chooses not to take the credit for her thoughtful action in the face of extreme sadness. “The decision was taken by my mother. I simply chose to honour that.”
Usha, a founder member of Jnanajyothi, a South Bangalore group of senior citizens, belonged to the growing tribe of senior citizens in India who are pledging to donate their organs. The idea is to give life to another person by donating a part of the body; to make the body useful even in death. Recently, the donation of 77 year old deceased retired teacher Vir Bhan Choudhury’s liver, kidneys and cornea helped two patients at the All India Institute of Medical Sciences in Delhi.
Slowly but steadily, the willingness to know more and actually take a step towards Organ Donation by seniors is growing, after information on the subject has been spread among senior citizen groups, especially in states like Tamil Nadu, Karnataka, Maharashtra and Andhra Pradesh.
It’s a much needed change if you consider the facts:
* Of the 9.5 million deaths in India every year, at least one lakh are believed to be potential donors; however less than 200 actually become donors.
*Almost 1.5 lakh people in India need a kidney, however only 3000 of them receive one.
*India’s annual liver transplant requirement is 25,000, but we manage only about 800.
The changing mindset is a welcome departure from traditional Indian beliefs about rebirth and disfigurement that stop many from taking this noble and much needed step. Recently, about 20 residents of Brindavan Senior Citizens Foundation in Coimbatore pledged their eyes after an eye donation awareness drive. “We had to convince them initially but the mindset is changing,” says R Parthasarathy, co-founder of the Foundation, which runs a retirement home for seniors. In Mumbai, several NGOs and Rotary Club chapters have organised talks on Organ Donation with an aim towards busting the misconceptions.
What is Organ Donation?
Organ Donation is an umbrella term, says Dr Sumana Navin, course director, Mohan Foundation, a Chennai based not-for-profit, non-governmental organization that promotes organ donation.“The eye is often the starting point. Organ donation means giving any part of your body, it could be an organ or tissue. In case of natural death, all tissues can be donated. Skin donation is picking up (useful for burn victims and for skin regenration) and like the eye donation can be done at home. There is no risk of disfigurement,” says Dr Navin.
Organs that can be donated are heart, liver, kidneys, lungs and pancreas, while tissues that can be donated include cornea, skin, heart valves, bones and tendons. There are two types of Organ Donation. There are two types of organ donation, viz., Living Donor Organ Donation, under which a person during his life can donate one kidney, a portion of pancreas and a part of the liver. The other and much needed is Deceased Donor Organ Donation, where a person can donate multiple organ and tissues after brain-stem/cardiac death.The Transplantation of Human Organ Act 1994 makes the informed consent of the family mandatory in India for Deceased Organ Donation.
Can senior citizens donate?
Dr Navin asserts that all senior citizens in good health can think of organ donation. “Sometimes there are health issues with senior citizens but usually those do not matter. In case of each person who wishes to donate, the organ function is evaluated individually and then decided whether it can be used.” Dr Navin points out that there are lot of older recipients waiting for an organ. “The organ of a 60 plus person can go to another 60 plus person. For heart, donors are preferred up to the age of 50. Otherwise there is no age cut off. The main condition is the wish to donate and as per law family consent is a must,” she reiterates.
According to the National Organ and Tissue Transplant Organization Website, a deceased donor can generally donate organs and tissues within the following age limit:
* Kidneys & liver: upto 70 years
* Heart, lungs: upto 50 years
* Pancreas, Intestine: upto 60-65 years
* Corneas, skin: upto 100 years
* Heart valves: up-to 50 years
Bone: up-to 70 years
Despite the limit, there have been instances of Cadaver Donation to medical colleges by older people, Dr Navin points out.
How to Go about it
Organs and tissues can be donated at the time of brain death. Organs should be removed from the body before a stipulated time. E.g., six hours for the eye and up to 12 hours for skin, according to Dr Navin. To be an organ donor, it is important to register yourself by signing up for Organ Donation. You could visit the following websites to know more about the process:
Various states also have deceased organ donation and transplantation programmes. Andhra Pradesh has the Jeevandan programme (www.jeevandan.gov.in), Karnataka has the Zonal Coordination Committee of Karnataka for Transplantation (www.zcck.in), and Maharashtra has the Zonal Transplant Coordination Center in Mumbai (www.ztccmumbai.org) and Nagpur. The Kerala government has the Kerala Network for Organ Sharing (www.knos.org.in), while Rajasthan has http://www.rnos.org/.
Once you register with any of these organisations, you will be given a Donor Card, which will state your consent to having your organs and tissue made available for transplantation upon your death.
The Best Way to Decide
Organ Donation can be a tough call for many, despite the noble gesture associated with it. With the taboo surrounding any discussion related to death, it can often lead to lack of action, despite willingness. However, family support could go a long way in helping a senior citizen decide on organ donation. When 73 year old J Sumitha passed away in Chennai after a prolonged illness, her family was quick to honour her wish to donate her organs. Sumitha had been suffering from a prolonged illness and had pledged her organs online while bedridden. When she passed away, the family chose to honour the pledge. Dr Navin suggests that speaking to ones family about one’s wish to donate is the most important.
In cases where the decision may cause dilemma to some elders, it may also help to speak to one’s pastor or spiritual guru in case of doubt. Talking to a trained counsellor (most organ donation organisations work with them) also helps.
Some of the common questions senior citizens have are on their age and whether it would effect their ability to donate. There are also questions about disfigurement and rebirth in some cases, while some are worried if the organs would be used for illegal purposes.
To answer such doubts and set minds at rest, several senior citizens groups across the country are talking to their members and creating awareness about Organ Donation. At Jnanajyothi, each new member is given a form for eye donation. Shanta Laxman, vice president Jnanajyothi, mentions that their members were informed about the process by a doctor team from MS Ramaiah Hospital Bangalore. So far, apart from eye donations, three of their members, all women, have donated their bodies for medical research, with the oldest donor being Dr Padma Rao at 80. Mohan Foundation regularly conducts awareness sessions among senior citizen groups. Some of their recent initiatives have been with embers of Senior Citizens Welfare Association, Vijayawada and the Senior Citizen’s Forum, Secundrabad.
Vaishnavi feels lack of awareness is why many people do not go for organ donation and mentions that the process is done with extreme care and sensitivity. “The doctors from Prabha Eye Clinic who came for the process when amma passed away were very well trained and courteous,” she mentions. She suggests that the Donor Card is kept in a place where it is visible to all, as it would help to inform the family that the deceased person had chosen to donate.
Thoughts of death are not among the most pleasant. But the thought of carrying on the light of life, through one last selfless gesture may be. All it would take is some information, a talk with your family and filling a form. So go ahead, give the gift of life to somebody today.
Caring for a family member with dementia is an experience that is challenging and in many ways, life altering. Safety becomes of utmost importance during this time. Here’s a quick guide for caregivers on safety measures for dementia patients.
There are more than 3.7 million Indians living with various forms of dementia and the numbers are expected to double by 2030, says the The Dementia India Report 2010. A report by Alzheimer’s and Related Disorders Society of India (ARDSI) describes Dementia as, ‘a syndrome usually chronic, characterized by a progressive, global deterioration in intellect including memory, learning, orientation, language, comprehension and judgement due to disease of the brain. It mainly affects older people; only 2% of cases start before the age of 65 years. After this, the prevalence doubles with every five year increment in age. Dementia is one of the major causes of disability in late-life.’ While a diagnosis of dementia can change not just the patient’s life, it can also change everything for the patient’s family, often the primary caregivers. It can be a challenging road to navigate but with the right support and information, the task could become marginally easier. In this feature we bring you one important aspect, every caregiver of a dementia patient should take note of: SAFETY MEASURES.
As dementia progresses a person’s physical and mental faculties deteriorate and can impact their judgement, behaviour as well as sense of time and place. Hence it becomes imperative to adapt the house to these changes and make it safe to live in and safeguard the person from potential falls and injuries.
A four step process can help you prevent any accidents and worries.
Here is a quick guide to what to look out for –
Remove/ hide potentially dangerous substances across the house
Due to the disease, the patient may not understand that swallowing foreign substances could cause choking or poisoning. Hence, take following precautions –
Fool proof the house for slips and falls
Bathroom safety tips –
Kitchen safety tips –
A person with Alzheimer’s may lose sensitivity to temperature extremes hence it is imperative to make your kitchen safe. Potential hazards include toaster ovens, stoves, coffee makers, power tools etc.
Home safety against wandering
While following the above may prevent any accidents, mishaps are inevitable. In the wake of an emergency it is quite important to maintain calm and not get overwhelmed. Having a regularly updated emergency plan in place can help deal with the situation quickly.
Safety first should be the mantra when caring for a Dementia & Alzheimer’s Disease patient. Follow these safety measures for dementia patients. Be alert and be safe!
With inputs from Dr. Anil Kumar Chawla
Fatigue, silence, hypochondriac behaviour could all be signs of Geriatric Depression. Sangeeta John writes about the symptoms to watch out for and how you can help your elderly parent or relative battle depression.
Mornings used to be hectic for Arvind Desai. An accountant in a small private firm, there was a time when this 58 year old began his day by dropping his kids to school before catching the local train to work each morning. Evenings had him rushing to take the same local train back home, reaching just in time to eat his dinner and sit around with his family before calling it a day. Years went by. His two children grew up. His daughter got married and his son moved to Australia for good. Gradually he developed symptoms of depression, something even his wife could not ascertain till they decided to meet their general practitioner, who then directed them to Dr. Anjali Chhabria, a Mumbai based psychiatrist and psychotherapist.
“He was suffering from fatigue, hopelessness and loss of motivation when he came to me,” she says. After having spent an entire life between work and family, Desai was overwhelmed with a deep feeling of worthlessness. “I don’t know for whom I should continue working or earning money now,” he told Dr Chhabria. She counselled him for months before she could restore his sense of purpose and help him to look forward to other things in life.
“Like Desai, depression may go undiagnosed because the symptoms are generally undermined and attributed to old age,” says Dr Chhabria. “The disturbance in sleep, appetite, mood, and interest and motivation level is generally associated with the age and sedentary lifestyle.”
And Desai is not alone in this. Depression is significantly present among the ageing population or senior citizens. Due to lack of statistics in India, it is difficult to give a number or percentage. “However,” Dr Chhabria points out, “it is suggested one in every four geriatric patients who visit GPs may be suffering from depression.” In a study by Sheikh et al (2014), about 25 per cent of people above 65 years of age with a chronic medical illness suffer from depressive symptoms and 15 per cent suffer from Major Depressive Disorder. Along with the regular symptoms, those with depression are more likely to be anxious about their physical health triggered mostly by any recent physical illness or changes in physical abilities. Old age is associated with a pre-occupation of bodily functions and disorders and is more often linked to hypochondriacal ideas. This is said to be a pre-dominant symptom of Geriatric Depression.
Geriatric Depression is a Real Thing
“While you were all laughing over the Deepika Puadukone- Amitabh Bachchan starrer film Piku, I was living it,” says Sushma Subramanium from Chennai. The film explores a young daughter’s predicament over her father’s obsession with his bowel movements. “What made matters worse was the fact that I had two small kids to raise, and an aging father to look after, who was more often delusional about his health till one day I decided enough was enough and took him to a psychiatrist.” After being in a prolonged state of denial, resistance and resentment, Subramanium’s father finally agreed for treatment and medication. Things have begun to improve ever since but it will be some time before it will be back to normal for the family.
“These hypochondriacal ideas may be so firm that it could almost be delusional,” says UK based psychiatrist Dr Manoj Therayil Kumar. “Depression in old age may also be present with noticeable decline in memory. This may lead to false diagnosis of dementia. Those with depression may have poor cognitive functions that can be misdiagnosed as dementia.” In most cases however, these memory problems are more likely to go away once depression is tackled. Depression is not a natural part of aging. It is often reversible with prompt recognition and appropriate treatment, says Sherry A. Greenberg of the Hartford Institute of Geriatric Nursing, New York University College of Nursing. He cautions that if left untreated, Geriatric Depression may result in the onset of physical, cognitive, functional and social impairment, as well as a decreased quality of life, delayed recovery from medical illnesses and surgery, increased health care utilization and even, suicide in some cases.
Incidentally, depression is the most common disorder found among the elderly as compared to other disorders in India. While there is no specific type of depression which can be attributed to old age, dysthymic depression and situational depression are common. “There is no such depression which is found only in the elderly,” says Dr Chhabria. “It is important to note that medical problems can cause depression in older adults, either directly or as a psychological reaction to the illness.” Geriatric Depression occurs due to common changes that often come later in life, like retirement, medical problems, and the death of loved ones. Cognitive decline, loneliness and isolation, lack of proper support system, reduced sense of purpose, fear of death, anxiety over financial problems or health issues are some of the main causes of depression. “The empty nest syndrome is another main culprit,” points out Dr Chhabria.
Lifting the Black Veil
The good news is that every case can be treated. However, the level and speed of recovery depends upon various factors such as biological response to medication, presence or absence of a support system, affordability and hence continuity of the treatment. “The elderly patients, mostly in their 60s or above, rely more on medication as a form of treatment than counselling,” says Dr Chhabria. In some chronic cases, the patient needs to be on a maintenance dose throughout their lives. Apart from medication and counselling, Dr Chhabria uses an advanced technology called repetitive transcranial magnetic stimulation (rTMS). “It has no side effects and is especially suitable for patients of this age group.” Since most cases are treated effectively for depression, there is minimal rate of relapse. “We use a combination of medication, counselling and or rTMS depending on individual case.” However, “While most people completely recover from depression with assistance, those accompanying brain changes or those with significant decline in brain functions may have difficulty in achieving full recovery,” warns Dr Kumar.
How can Geriatric Depression be avoided? According to AgeWatch Index 2015 complied by HelpAge International,India is among the worst places to grow old. The enabling environment is especially non-conducive when it comes to supporting our senior citizen population. “What we can do as individuals is to build a support system for geriatric patients,” recommends Dr Chhabria. “We organise senior citizen’s group meetings every month, keep recreational activities such as one day picnics, all which helps give them a sense of belonging, purpose and a social support system.”
Fortunately now, individuals have become more aware of psychiatric illnesses and are co-operative and willing to support. The families are made to understand the nature of the problem and how they must deal with the patient. They need to be supportive towards the patient and realign their expectations from them.
Robert D’souza, 71, is blessed with a family who not only cooperated but also ensured timely intake of medicines etc. D’souza was diagnosed with depression and anxiety and his two children took turns to get him to the clinic, and sometimes even adjusted their work timings to ensure he never missed an appointment. “By adopting a positive approach in their communication with them, they encouraged him and also kept him from having negative thoughts,” says Dr Chhabria. Today D’souza spends a large part of the day helping out at his son’s hardware shop and makes it a point to go for his daily walks in the park every evening.
Unfortunately there are also family members who are not completely aware of or even sensitive to psychiatric illnesses, its diagnosis and treatment. They believe it’s all due to the age and there is nothing more to it. Thus, they do not seek professional help and reject clinical options of treatment.
Look at the elders around you. Do not dismiss their silence or inaction to old age. A little care and understanding is all they need. Everybody has the right to live and live it to the fullest.
* Some names have been changed to protect identities*
Sangeeta John spoke to Dr Anjali Chhabria extensively for this article. You can contact Dr Chhabria on:
MINDTEMPLE
Telephone: +91-022-26289792/ +91-022-26288928
Skype Id: mindtemple.dranjalichhabria
Website: http://anjalichhabria.com
The loss of a spouse of loved one can have a devastating effect on an elder’s state of mind. We speak to experts and those who have gone through loss to find how you can cope with grief.
When Suchitra Karnik’s husband passed away at the age of 68, she felt her life had suddenly come to a halt. Karnik, a former lecturer in a Mumbai college, had retired recently and she and her husband had planned what they would do over the next two years – travel, volunteer, repair their house – when a massive heart attack took his life.
“I felt unable to do anything. My son flew down from US and handled everything and my daughter kept visiting from Delhi until everything was sorted out. Without them, I would have gone too,” muses Karnik, who found it tough to cope with grief and who still cannot control the catch in her throat after two years. What worried Karnik’s children was the change in their outgoing and lively mother. Even months after their father passed, she had stopped meeting people and doing the things she usually loved, like going for a walk or gardening. Her daughter Tanuja was worried. “We felt she was just giving up and decided to move her to Delhi to live with me for a while. Once there, I gradually cajoled her to do things she enjoyed, got her involved in the children’s activities and when we felt the need, even forced her to see a counsellor. The change was gradual and slow but after two years, we feel we are getting our mother back. She still stays with me but has made friends here and recently joined a ladies kitty group. She also travels to Mumbai often to meet her sister and keep a check on her house which has been rented out.”
Bereavement of a spouse can leave a huge impact at any stage, especially at a later stage in life, when spouses are often dependent upon each other, having spent so many years together. In fact, research done by the University of Birmingham, UK, has found that bereavement can impact the immune systems of older people. According to the study, a key element of the immune system that protect the body against infections is weakened when someone is grieving and the impact is greater in people over 65 years.
Why Grief Needs Help
Then again, we don’t need research to tell us that grief can be all consuming, like in the case of Karnik. “You can be overwhelmed with emotions, feel very angry about what has happened and often let go of yourself in the first weeks,” says Dr Soumya Hegde, consultant geriatric psychiatrist, Nightingales Centre for Ageing & Alzheimer’s, Bangalore. She advises that it is healthy to let the person cry and give them time to realise what has happened. “It is extremely normal to go through emotions that range from being upset at the person not being able to complete their responsibilities and questioning why this has happened in the first few weeks,” she says, adding, “Sometimes, it may even take up to 6 months for the bereavement to start settling and that too is very normal.”
Tasneem Sheikh of Pune lost her husband after an illness that lasted almost four years. During this time, she slowly accepted the fact that he was not going to recover. “I thought I was prepared, which I was in terms of paperwork, legal things like power of attorney, etc. But the sadness never goes away,” she says, adding that even now, the sight of something her late husband loved can move her. “The sadness is a part of you but you cannot let it rule you,” is what Sheikh lives by and advises others too.
Get Help with Grief
Everyone grieves in their own way and it is hard to put a timeframe to how long the process of grieving would take. However, as Dr Hegde says, families do need to keep an eye out for some reg flags. In some cases, the grief after the loss of a spouse or dear one can be so overwhelming that the person is unable to emerge from it. “E.g., beyond six months, if a person has not overcome the grief and is not able to think of anything else beyond what they have lost, that’s when families should worry as it may become a pathological issue.”
Some of the warning signs could be if even after some months, the person is not getting on with their usual routine, hygiene needs or not being able to sleep well. “That’s when the family should approach a bereavement counsellor or psychiatrist to help their parent or relative get back on track,” Dr Hegde adds. The need for help can take many forms. She cites an instance where an elderly gentleman felt so guilty about not listening to his late wife that after she passed away that the guilt reached the point of needing help.
Find a Support System
Dr Hegde mentions the “culture of support” in Indian societies, which can also be therapeutic for the bereaved person. Having family around always helps.
When Madhu Mehra’s husband passed away after a brief but unexpected illness, her two daughters rallied around their mother. While her younger daughter and her husband shifted base to their mother’s home, her elder daughter took a break from her job in US to support her mother through the crisis. In some cases, friends can become family. When Delhi based Surinder Singh lost his wife to cancer, his son, who had just started a new job and was constantly travelling, wasn’t as much a support as his family friends were. “After all the rituals and ceremonies were over, my son had to leave and I was alone at home, three of my friends and their wives made sure I never ate dinner alone. They would either invite me over to eat with them by rotation for many days, until I got used to the emptiness at home and found a 24 hour househelp,” says Singh, adding that his son is grateful for this too.
Finding a support system can be a huge help in alleviating the loneliness many elders feel after the loss of a spouse. It could be moving in with your children if circumstances are favourable towards it or connecting with your circle of friends. In some cases, this may not be a long lasting solution. Singh employed a house help not just to help him with the daily chores but also because he did not want to return to an empty home.
Sheikh has decided to move into a retirement home facility as her children live in other cities and she feels the need for company of others in her age group.
Ways to Cope
Madhu Mehra lost both her husband and mother in law soon after one another. She had recently retired and most of her time had been spent in being a caregiver during their illness.
“There was suddenly a huge vacuum in my life and I went back to my old love knitting. I slowly started taking orders and getting in touch with people,” says Mehra, who runs a successful home business called She Who Knits. She adds that dealing with the paperwork after her husband’s death also took her mind off things. “I also went and spent three months in US with my other daughter, I just wanted to get away.” Even in US, Mehra kept her mind occupied by knitting, posting on her Facebook page and replying to messages from customers and it helped her overcome the grieving process. As she says, “You can never stop missing the person you have spent 40 years with but you can stop being and looking sad.”
Like it did with Mehra, a change of location, if available, may help. Staying connected socially, like she did, would also help to keep your mind away from your loss.
“How somebody copes depends on how mentally prepared they are,” says Dr Hegde. “In cases of chronic or neuro conditions, where the family is actually watching the person die slowly, they feel it is best for the person to go. When death comes out of the blue, it may get difficult to cope.” One’s attitude to life too matters a lot. Karnik admits she went into a “dark area for almost a year” and says that despite her reluctance to go to a counsellor, she listened to her daughter as “my state was affecting her life too.” Today she is glad she went and received help, even if she did it for her “children’s sake.”
Keep your outlook positive and stay brave is how Madhu Mehra puts it. “If you keep crying, you will only make others miserable.” Her advice? Take charge of your life and do something to keep yourself occupied. So if you have a parent or elderly relative who has been bereaved recently; if you are grieving for a loved one yourself, find something that would keep you occupied, It could be a hobby or a vocation you wish to pursue. Give it a go. It may help you value life. Because life, as they say, has to go on.
* Some names were changed to protect identities
Dr Hegde lists down few things families could do to help a bereaved person overcome their process of grief:
* Do not leave the person alone as they may lack the initiative to do things on their own or even take care of themselves. If possible, stay with or around the person.
* Structure their day for them if needed as they may have little inclination to do so. Involve them in outings little by little.
* Let relatives visit but depending upon the situation the person is in, warn them not to touch or dwell upon the topic. While it may help to talk in some cases, in others it may lead to dwelling too much upon the loss.
* Ask the bereaved person to get some physical exercise like walking regularly or doing Yoga.
* Make sure they are getting enough sleep.
* Grief needs to be shared and expressed. Help the bereaved person go through and sort out the cupboard or other things used by their lost loved one.
* Relive the good moments.
* Encourage the person to participate in a group activity like either a senior citizens group or a hobby class.
* Keep an eye out on their health as in the middle of everything, they may have forgotten to take care of themselves.
Dr Hegde may be contacted at http://nightingaleseldercare.com/
Staying active mentally can lead to happy and healthy ageing. We speak to some experts and active senior citizens to get you tips on how to stay mentally fit and young!
Every morning, 70 year old Asit Ghose takes a walk around the park in his South Kolkata neighbourhood. The walk is followed by a cup of tea from the tea stall nearby, followed by a round of carom with his friends in a small room that doubles up as an activity centre at the park. “It’s become such a habit that when I visit my son in US, this walk-carrom routine is what I miss the most,” laughs Ghose. His wife would initially grumble at the hours lost “doing nothing” (Ghose leaves home at 7 am and is back by 10 am) but has changed her mind now. “It makes him happy to play carom, walk and meet with his friends. He can talk about his problems, discuss things of interest and get an excitement from playing with his friends. It sets the mood for his day,” says his wife Mandira. Ghose says he feels good to meet his friends and challenge them to a game. He and two friends are planning to start playing Sudoku also very soon. “To sharpen our brains,” he quips.
As one grows older, an active lifestyle becomes extremely important. Not only does it help to keep you spend your time gainfully but also keeps you mentally agile. Frequent cognitive activity in the older years has been associated with reduced risk of Alzheimer disease, according to a study published by the American Academy of Neurology.
Staying mentally fit comes with its advantages. A study by researchers at Rush University Medical Centre in Chicago in 2012 concluded that ‘keeping mentally fit through board games or reading may be the best way to preserve memory during late life.’ The study focused on 1,076 people of around 80 years, who were free from dementia, over a 5 year period. The people studied were asked to report how often they read the newspaper, wrote letters, visited a library and played board games such as chess. The conclusion was that being mentally active leads to better cognitive health in old age.
It isn’t very difficult to keep yourself mentally fit and active. Develop a hobby, start learning something new or involve yourself with a regular activity. What’s more, many senior citizens have the time for it too. Here are few things senior citizens can do to stay mentally fit and active.
Exercise the Mind & Eat Healthy
Research shows that a good diet and some amount of exercise goes a long way in keeping not just your body fit but also your mind. Walking is one exercise that anybody can do. According to experts, walking is a perfect way to start exercising, even if you haven’t exercised before. Just get yourself a comfortable pair of shoes, find a spot either in your apartment complex or a neighbourhood park and you are all set.
If you find a good instructor and have the inclination for it, you could also take up Yoga, like Delhi based Mahesh Palta did. This active septuagenarian not only practices Yoga regularly but also does it under water! Yoga has been long known for enabling a healthy body and a calm mind. “Research shows that Yoga offers significant benefits to the elderly. This is true for both physical aspects like flexibility and stamina, as well as mental aspects like alertness, memory, and mood,” says S Varambally, Department of Psychiatry, Advanced Centre for Yoga, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore. Ramesh Joshi, a Mumbai based Yoga instructor at 70, adds that “More than 50 percent elderly in India have problems in life and stress and anxiety. Yoga helps in restoring their mental peace and calm the mind, often the reason for various ailments.”
Whichever form of exercise you take up, don’t forget to check with your doctor what would suit you the best. A healthy diet can help all throughout life, especially in the older years. Elders are advised a diet rich in fruits and vegetables and whole grains.
Stimulate your Mind
Keeping your mind challenged and working is a must, especially as you age. Many senior citizens take up activities like solving Crossword or Sudoku Puzzles in the daily newspaper.
Ulfat Rai Jain, 78, feels solving Sudoku puzzles of varying complexities not only keeps his morning occupied but also satiates his lifelong love for problem solving and Math. He also likes playing board games like Monopoly and Scrabble with his grandchildren and teaching Math to his grandson. “It keeps my interest alive and I also feel good that I haven’t forgotten anything that I learnt,” he tells us. Suguna Rangaswamy, 76, plays Scrabble once a week with her friends. It creates a social circle, adds to the fun and keeps their mind active.Not sure where your interest lies? How about trying something new? Read something that is not part of your usual routine, such as a different newspaper or magazine or a genre of book you haven’t tried before.
Learn Something New
Challenge yourself to learn something new, whether it is a new art form like Zentangle or a craft like Origami. There are lots of tutorials on Youtube to choose from at your time and convenience. Just remember that you’re never too old to learn something new. It could be a skill you’ve been meaning to hone or something you’ve been curious about all your life but never had the time to learn. Noida based potter Meena Vohra learnt pottery after the age of 50. “On my 50th birthday, I took the resolution that I’d had enough of syllabus and decided to do something creative,” she says. Art had always been Meena’s forte but the one art form she had never had training in was pottery and she chose to take the challenge up. Today, at 65, she is a successful potter who also teaches others and holds exhibitions.
Sanghamitra Sengupta, 66, has gone back to her first love singing after her husband’s death. As a caregiver for the last 10 years, her interest and love for music had been at the backburner. Today, she is the youngest in her music class and perhaps the most keen student. “I recently performed a group song in a cultural function and felt really good,” she says, adding that she wishes to continue learning and even appear for exams.
You could even learn a new language! Research has shown that learning a new language could help delay the onset of dementia by years. Samvedna Care, an activity centre for elders in Gurgaon, offers Spanish classes for its members as learning a foreign language may slow down the advent of dementia. “Our members are really enjoying it,” says Archana Sharma, founder of Samvedna Care. OP Maheshwari, who moved to Bangalore with his son’s family eight months ago, is learning Kannada, though a Whatsapp group called Kannada Gottila. “Nobody in the family has the time or interest to learn. So I thought, why not try? Will help me in interacting with the local population also!” Asha Philar, cookbook author and grandmom, recently cleared the Sarala Sanskrit Pariksha held by Sanskrita Bharati of Karnataka and secured 100 per cent marks. She had never learnt Sanskrit earlier and decided to challenge herself by mastering a brand new language!
Staying Engaged Socially
Senior citizens at a birdwatching walk
Pic: Silver Talkies
Keeping in touch with family, friends and other groups socially plays a huge role in keeping elders fit and agile mentally. “In silver years, company becomes vital. Cultivate relationships either professionally or with family and friends or by getting involved in activities of interest where you may find like-minded people. This will go long way in ensuring both physical and emotional well-being, advises Dr. Mathew Abraham, Senior Consultant Neurologist, Neurology Clinic, Kochi.
You could look out for a senior citizens club in your neighbourhood, who often organize interesting activities and get togethers. Silver Talkies organizes events for senior citizens on a regular basis. Many seniors who meet at these events, go on to become friends. Similarly, there are other organizations like Mumbai’s Dada Dadi Park, Secundrabad’s Senior Citizen Association, Bangalore’s senior groups like Senior Citizen’s Enrichment Program (SCEP), Jnanajyothi and Senior Citizen’s Bangalore, that meet regularly and conduct activities based on the interests and philosophies of its members. Many apartment complexes also have Laughter Clubs, a happy way for senior citizens to meet.
More than anything, it helps you avoid loneliness. Srikala Bharath, Professor at Dept. of Psychiatry, NIMHANS, says seniors should be prepared for children leaving home. “Widen your social network. Be part of local social activities. Being part of support groups help too. These could be local senior citizen forums, bhajan groups, walking groups, laughter clubs, etc.”
Follow Your Feet
The post retirement years can be the best when it comes to following your interests. There is time in your hand and in many cases, no pressing demands of children and work either. Travel is an interest that could be an eye opener. In 2014, 79 year old Padmanabh Arkalgud decided to follow his heart and complete his long cherished dream of a trip to Antartica. This year, he is planning to travel to Russia and Berlin. “After retirement there’s plenty to do if you want to. In my case, staying active improves my own self worth,” he tells us. Indrajit & Sumana Chatterjee enjoy travelling and have made a list of countries to visit. “Traveling has always been a hobby and more so after my retirement,” Mr Chatterjee tells us. “During my working days, I used to travel to many countries but didn’t have enough time to see the places like a tourist. Me and my wife now made a wish list of places to revisit at leisure with the family.”
Do something Positive
Gunmala Jain, 76 is deeply into spirituality and volunteers at her neighbourhood Jain temple. It not only gives her immense pleasure to devote her time to spiritual pursuits but also keeps her mentally calm and away from negative thoughts. Many seniors also spend their time in a positive way by volunteering with organizations where they can help, be it reading to blind children or teaching a deserving but needy student. Members of Senior Citizens Bangalore, a group of elders in the city, regularly contribute to schools and organizations that need help. From donating scholarship awards to uniforms to government school children, these seniors have spread positivity and goodwill all around.
Get a Hobby
A hobby can help you while away your time, keep you from getting bored and give you something interesting to do. Developing a hobby and staying motivated to pursue it can be very positive for your self esteem and help keep your mind healthy. Select a hobby that you can pursue easily and have a real interest in. I Balasundaram from Bangalore loves painting and tries his hand out at sketching, shading and painting at regular intervals. Suman Prakash of Bangalore loves to knit and cannot be seen without a knitting needle in her hand. She has even turned her hobby profitable by showcasing her work in exhibitions. Jayasree Chakraborty loves to paint and runs a home business of hand painted saris and dupattas. “Even if I did not have this a business, painting is a hobby for me. I cannot fall asleep at night unless I paint. It gives me great pleasure and keeps me creative and thinking,” says the 68 year old. So whether you decide to take up Quilling or revive your long forgotten stamp collection or develop an interest in photography or learn art, find a hobby that will give you both joy and purpose.
Here’s to working your mind in the best ways possible!
What is it like to become a caregiver all of a sudden? And how do you cope with the enormity of it all? Moumita Ganguli shares a very personal and honest account of her on going experience as a caregiver.
Never did I imagine that I’d have to be my parents’ parent, but early in 2014, that’s what I became.
That was when my father had a stroke and my mother was diagnosed with Alzheimer’s, and my whole life changed. I quit my job – just for a while, I thought – and moved from the home I’d carefully created for myself in Bangalore to Delhi where my father was born and where he insisted he would die because he would never leave.
It was the worst year of my life.
As the consequences of my father’s stroke sank in, and as I grew more familiar with the symptoms of Alzheimer’s and understood the disease better, I realised that when I plunged into the role of caregiver, I had made many rather blithe assumptions.
For instance, I had assumed that I wouldn’t be the only one taking care of my parents – certainly I’d do the bulk of it, but I’d have plenty of help because I have four siblings – but I turned out to be wrong. Only one of my siblings flew to Delhi whenever we needed help. Two of the others had caregiving of their own to handle (small children). And the fourth sibling has never been available.
I also assumed that once I got things sorted, I’d be able to work again. After 10 years of marking time in one position, I had just climbed to a level in my career that would actually take me to the top – provided I’d keep hard at it for the next three or four years. And then I had to quit.
Don’t worry, I assured myself. Within six months, you’ll be back at your desk and that’s not a long time to be away.
But within three months, I knew that only a miracle would get me back at work again. Two things worked against me. For one, I needed good caregivers for my parents. But no one, not even doctors and nurses, could recommend a decent nursing agency. Nevertheless, I tried. I interviewed about 60 women, all of whom appeared to have arrived in Delhi straight from the middle of nowhere. Language was a problem. Concepts like hygiene were a problem. Complete unfamiliarity with modern life was a problem – not one of them could use a phone, some couldn’t even light the gas stove. I couldn’t leave my parents with them and go out to work.
Problem two – the clincher – was my mother’s fear of non-family people. There was no way, none at all, that I could abandon her for eight hours a day, plus commuting time.
So I worked freelance from home, earning about an eighth of what had been transferred to my salary account before. My career ambitions? Bye bye. From now on, I was in charge of the household, the household finances, the dispensing of medication, the making of doctors’ appointments, the instigation of wills and powers of attorney (just in case), the cleaning of the consequences of incontinence, the cutting of toe nails, the shampooing of thinning hair, and many other things that weren’t going to get me anywhere in my career.
And then there were parenting issues. I had become my parents’ parent, but my parents didn’t like that at all. Not so much my mother. I think she was actually relieved that she didn’t have to be responsible for a family any more. But my father was 81 years old and thought he was a sprightly 40. How on earth was I supposed to keep him safe and well when he refused to do anything his doctors had ordered? How was I going to be his authority figure, when he had been my authority figure all my life?
I was so stressed by this sudden, all-encompassing change in my life, that I stopped looking after myself. Anxious all the time about my parents, I stopped eating, slept badly, and stopped reading. I got panic attacks every time I had to talk to anyone including my dearest friends, and sank into a clinical depression that even Prozac couldn’t sort.
But that was last year.
This year, I’d still rather not recall last year in sharper detail than a blur, but I acknowledge that I learned a lot about caregiving from it.
I learned that a career isn’t everything. Till last year, I had defined myself by what I did at work. Now, I’m happy to work sincerely for the money I need (and as I build my freelance reputation, I’m actually getting close to my last full time salary) but I will not give my job my whole life.
My life belongs to my parents now, but again, not my whole life. I’m still on Prozac and can’t spare the time for counselling, but I know now that the only way I can take care of my parents is to take care of myself. If that means abandoning them to the television in the evenings while I curl in my bedroom with a book, well, that’s what it means.
I learned that when I need help, I must not wait for it to be offered. I must scream for it, and when I do, it will come. So much help. So much support. So much kindness. It’s unbelievable.
I’ve learned that sharing caregiving problems with other caregivers takes my mind off my own woes and makes me more compassionate than perhaps I’d been before. I’m single and I have no children, the only thing I had to give up was my career. But a fellow caregiver I met has children, a travelling spouse and two incapacitated parents with expensive medical needs. She can’t afford to give up her job and try and work from home. She needs all the money she can get and she is exhausted and worried about her children and the state of her marriage, and just this side of a nervous breakdown. My life is easy-peasy in comparison. If she wants to cry, I listen.
I’m still anxious about my parents’ health, but I learned how to build a support system even with part time domestic help. I visit hospitals close by and check out their emergency rooms and other facilities. I get the hospitals to give me the phone numbers of reliable ambulance services, reliable visiting nurses and reliable chemists. I’ve built a relationship with a local chemist so that now, whatever I need, whenever I need it, it’ll be procured and delivered. I have miraculously found doctors I can trust even though they won’t visit. I have neighbours and friends close by whom I can call in an emergency. I feel more in control.
I’ve learned that when it comes to becoming the authority figure to an authority figure, there’ll be arguments and fights, sulks and disappointments, but really it’s the same as establishing yourself as the boss in your career. If you have to be tough, you be tough. Which is why my father will not die in Delhi where he was born. He will die in Bangalore where I have moved them because in this city I have a support system that will support me so I can support my parents.
Mostly though, I’ve become used to this. So when my helpful sibling offers to visit so I can take a holiday, I say, just now, no. I’ve become a parent to my parents, and it’s frightening, very guilt-inducing because you never think what you’re doing is good enough, and terribly stressful. But somehow, it’s extraordinarily delightful to be with my parents again – in a way that I never had any idea could exist.
About 7 million people in India are said to be afflicted by Parkinson’s Disease, a degenerative disorder of the central nervous system. One of the main hindrance in its treatment is the lack of awareness, something that organizations like the Mumbai-based Parkinson’s Disease and Movement Disorder Society (PDMDS) is trying to combat. We spoke to Dr. Nicole D’souza, Physiotherapist of the PDMDS to know more about Parkinson’s Disease and how to cope with it.
* What exactly is Parkinson’s disease?
Parkinson’s disease (PD) belongs to a group of conditions called movement disorders. It is a neurologic syndrome usually resulting from the deficiency of the neurotransmitter dopamine as a consequence of degenerative, vascular, or inflammatory changes in the basal ganglia (the part of the brain that controls movement). A person with PD has abnormally low levels of dopamine. This is because the Dopamine-generating cells, known as dopaminergic neurons (types of nerve cells) in the substantianigra part of the brain die slowly. Without dopamine, the nerve cells in that part of the brain cannot properly send messages. This leads to the loss of muscle function. The damage gets worse with time. Exactly why these brain cells waste away is unknown.
*At what age is it most likely to occur?
Average age of PD onset is approximately 50 to 60 years. The incidence of this disease increases dramatically with increasing age. However, in the past few years, the incidence of this disease in those younger than 50 has also been increasing. In about four to five percent of cases the sufferer is younger than 40 years. When signs and symptoms develop in an individual aged between 21 and 40 years, it is known as Young-onset Parkinson’s disease.
* What are the symptoms of PD?
PD is a chronic (long term), progressive (gets worse with time) disease of the nervous system characterized primarily by certain cardinal Motor symptoms (related to movement):
* Does it affect only movement or is there a chance of further body and brain disorientation?
While the main symptoms of Parkinson’s disease are movement-related, progressive loss of muscle control and continued damage to the brain can lead to secondary symptoms. These vary in severity, and not every individual will experience all of them. Some of the secondary symptoms include:
* Could it lead to dementia?
Parkinson’s disease dementia (PDD) is a type of dementia that occurs when a patient with Parkinson’s disease develops a progressive dementia at least two years after a diagnosis of Parkinson’s disease has been made, and other causes of dementia have been ruled out. Approximately 25-30% of all patients with Parkinson’s disease also have dementia, but after having Parkinson’s disease for 15 years, the prevalence of PDD increases to 68%. PDD is usually different in how it presents itself from Alzheimer’s disease.
* How much awareness is there about PD in India? Do people take it as seriously at least in the initial stages?
Awareness about PD in India is low both in urban and rural areas with many people living undiagnosed. With a limited number of neurologists and a large population in the country even diagnosed patients lack an understanding of their disease.
Most people do not take the disease seriously until it starts affecting their work and daily activities. However, we have seen through experience that patients who are provided information about the disease and have been counseled, tend to take the disease seriously right from the initial stages.
* Is there a taboo associated with it? Do some people want to keep it a secret?
As such PD is not a taboo word. However, like any disease in India, the sufferers are subjected to accusations of wrong or evil doing based on superstitious beliefs. A large part of which is due to the lack of awareness.
Most patients especially the younger, working adults try to keep their disease a secret out of fear and embarrassment. Fear of losing their job, of not being able to support their family and live independently and fear of dying. Embarrassment stems from the fact that PD symptoms are difficult to conceal even in the initial stages and for some may even be socially inappropriate. The lack of awareness among the general population further worsens the situation.
* What are the available treatments for PD? Does the person need to go through extensive therapy?
There is no known cure for Parkinson’s disease. The goal of treatment is to control symptoms. Medications control symptoms, mostly by increasing the levels of dopamine in the brain. Doctors usually prescribe levodopa (L-dopa), which helps replace the brain’s dopamine. Other drugs may be prescribed which affect dopamine levels in the brain. At certain points during the day, the helpful effects of the medication often wear off, and symptoms can return.
Surgery may be an option for some patients with Parkinson’s disease. These surgeries do not cure Parkinson’s, but may help ease symptoms.
PD is a progressive disorder and thus requires extensive lifelong therapy. Although medications are the mainstay of treatment, patients with PD require interventions from a multidisciplinary team (Physiotherapist, speech therapist, occupational therapist,psychologist, dietician etc.,) to enable them to live independently and to their fullest capabilities.
* How should a person with PD be taken care of by the family? For instance, should the family involve him/her in activities and exercise and a regular life as much as they can?
It is very important for the family members to understand the disease and its many disabling manifestations. It is usually a lack of awareness that leads to constant misunderstandings and frustration between the patient and caregiver.
The patient should be allowed to carry out all the activities that he performed prior to the disease provided he has the capacity to do so and can do it without causing harm to himself. The more active a patient is the better he is able to deal with the disease.
* Do caregivers need any special training?
Caregivers need special training which focuses on education about signs and symptoms, handling and lifting techniques, strategies for helping patients carry out their daily activities (rolling in bed, getting up from a chair), strategies to overcome freezing phenomenon (patient gets stuck in a position and is unable to move unless a cue is given) training in the use of assistive devices and coping strategies for depression, anxiety, impulse control disorders, memory loss and hallucinations.
* How important are support groups for PD?
It has been said that “a group can often do the work that individual therapy cannot do.” We believe that support groups provide the best setting for the PD patient and their caregivers to gather information and understand their disease. Parkinson’s support group members can offer each other emotional and practical support. Getting together with other people who are facing similar challenges makes people more open to sharing feelings and experiences. As well as providing benefits from the exchange of practical information, support groups also provide motivation and inspiration to help a patient deal positively with the changes in their lifestyle. It also gives PD patients a chance to meet new people, which help to break down any feelings of social isolation associated with the disease. Support group meetings range from group discussions, to educational sessions by guest speakers or just social outings.
Photos courtesy: PDMDS, Mumbai
Coming soon: Support Groups and Helplines for Parkinson’s Disease. Watch this space!
There is cataract surgery. And then there is cataract surgery conducted on our reader, birder and prolific writer Deepa Mohan, who describes the process in her unique style with a touch of humour. Read on to have a good laugh…
On March 12, 2015, I had the cataract removed from one eye (with laser surgery) . The other eye was operated upon on Friday, 13th March, 2015. Both are reasonably painless procedures. My vision was manageable, but was already giving enough fuzziness through my spectacles to make me want to go to the eye surgeon.
Here’s how it went:
Everyone told me how simple and painless, the procedure is, these days. Did this stop my worrying about it? Of course. I was very, very calm, cool and collected. On Tuesday night, I even had a pleasant dream. In the dream, the eye doctor unmasked herself in the operation theatre…. she was actually a demon, and proceeded to poke out my eyes with a hot trident. I calmly woke up and calmly did not sleep the rest of the night.At some point, my daughter called me up, asking, “Would you like to see your grandchildren while you are still able to see them?” thus completing my serenity quotient.
I was quite surprised at the counsellor that the ophthalmologist sent me to. This lady, with a bright smile, breezily announced, “Madam, cataract operation, no risk at all! Absolutely no risk!” I told her that no surgery came without a certain risk, however negligible it might be…I expected to go to the optometrist…but I got Ms. Optimist! I had to tell the doctor that he needed to counsel the counsellor not to make such tall claims.
Many friends offered to be with me on both days of the surgery but the fear of being thought a wimp (even though I was one) kept me from accepting. So one friend dropped me at the clinic, and spent a little time with me before she went home to accept a conference call. During this time, I must say, one of the nurses plied us with a lot of attention, even giving us a calendar printed by the clinic, and stood quite close until my friend gave her a hundred-rupee note. She was going off-duty at 9am and would not be around when I came out of the surgery, so I really don’t know what the ‘lubrication’ was for but I hope there was Chicken Biryani in her home that evening, and that she thought of us!
Coming in at 7.30 AM, my friend and I realised that the surgeon would not come in before 9 AM, so we went next door to the Adigas Eatery and had some breakfast and excellent filter coffee and then came back. The clinic was airy, clean and comfortable.
I was soon given the latest Surgery Fashion Clothing to wear. A robe that was, luckily, not open at the back ( and hallelujah, I was not asked to remove my clothes) was draped tastefully around me, touching me at odd points, dropping off me at others, and tied at the back. A cap, exactly like the ones worn by members of catering services at weddings, who served the food on our plantain leaves, was set atop my short-cropped hair. I now had made the transition from DM to Patient no. XYZ.
My friend left after wishing me luck, and I opened the day’s newspapers. The usual…one murder, one scandal, one rape, one protest…the only thing worth going through were the comics and the puzzles!
At about 9.20am, after I had done the day’s newspaper crossword and got all the details about the local starlets’ love lives from the tabloids, the nurse and I walked into the operating theatre (thankfully, I was not wheeled in. I don’t think I could handle the drama of that.) I lay down on the table. The eye that would not be ‘done’ was covered, as was the rest of my face. My hands and feet were bound to the table, and this certainly did disturb me, but I didn’t want to let my craven cowardice show. A clip of some sort was attached to one of the fingers of my right-hand. A band-aid kind of strip was laid flush with my open left eye. When a sheet was pulled up to my chin, I already felt like a dead body. Only the bright lights shining into my one open eye, from above, kept my soul from rising free in the manner described by so many alienists.
It was at this nadir of the morning that the surgeon walked in and bade me a chirpy “hello,” to which I mumbled a response. She was very kind and kept describing, throughout the 20-minute procedure, what she was doing. When the cataract was emulsified, there was a feeling of pressure, and there was some unearthly musical whine (think Close Encounters of the Third Kind!) that the laser machine made while the incisions were being cut into the cornea. But as the surgeon had given me some anaesthetic drops which actually made that bright light above me (a microscope was also being used) go dim and grey, I didn’t mind anything. I kept taking deep breaths, and consciously relaxing, only to start again when I realised I was holding my breath once more! The procedure was finished, expertly, and a thick padded bandage applied to the eye.
I got off the table with just a little feeling of soreness in the eye, and walked back to my room, close by. For some reason (not fear, of course!) my throat was dry, so I drank a lot of water, closed the other eye, too, and meditated (no, not medicated).
After a couple of hours, the nurse came and removed my bandage, and my friend Chandan, who had come to take me home, got a list of ruinously expensive medicines. I was asked to get home and use my eyes normally. The list of eye-drops (sorry, in today’s world I must call these iDrops, and I certainly did have an iPad over the left eye!) also came with a 3K (in Tamil, Karunanidhi Karuppu KannAdi). This was a kind of oversized, wraparound pair of dark glasses which instantly made me look like a canvassing politician, or a B-grade cine artiste. I was supposed to wear this when outdoors, to prevent dust from getting into my eyes. Anyone who can completely exclude dust in a city like ours deserves a medal, and these glasses were more for my psychological satisfaction. I must say, looking like a cheap politician/actor did not add to that! The first day, I thought I’d use my own shades, but realised that something that also covered the side of my face would be better.
The next day, after surgery, I had to buy the same medicines again (“For the right eye, Madam, keep them separate!”) but there were no dark glasses! Why? “But madam, you got one pair yesterday!”. “No, I gave back those glasses, because I had my own dark glasses but now I prefer the wraparound type. Anyway, why did you leave out the glasses without asking me?” I queried the nurse. I got the glasses, nice cheap China-made ones, which further dimmed my already bright-eyed beauty. I refuse to take a selfie of myself with those things on!
I had specifically asked if the ‘normal usage’ of my eyes included laptop work, and yes, it did. So of course, I logged into FB when I reached home and got it in the neck from friends about eyestrain and sleeping and spoiling my eyes. Not ONE person asked me what the doctor had said I could and could not do.They all knew better, and gave me all sorts of instructions (not advice, which I can take or not,but instructions, which I must follow.)
No one seemed to think that I was under the eye doctor’s care, and that I would implicitly and explicitly follow do’s and don’ts; that these were my eyes, and I would not take any risk with them! I had a follow-up on Saturday the 14th (I drove myself to the clinic and back.) I’ve had another on Thursday the 19th. I have the feeling that I will be putting drops into my eyes for the rest of my natural life, having become habituated to it over four weeks!
The best of the responses to my eye surgery:
1. Have they fitted a Hubble telescope?
2. Is laughing a risk now? (It always has been…remember that. Sometimes laughter leaves one in stitches, just like surgery does!)
3. Did the doc fit a 600 mm prime or a 100-400 zoom lens (this from photographer friends…whether I should also get a teleconverter has
not been specified.)
4. You are a person of vision.
5. Why are you having one surgery done on Friday the 13th? Don’t do it. It will not go well. (It did go well but there were 14 such messages!)
6. Best that you keep sleeping until you get your glasses (this is going to be after three weeks, so I am supposed to do a Kumbhakarna or Rip Van Winkle)
Well, I realized that all the commandments were out of concern and affection, so I just listened and did not react too much. Putting in drops of one sort or another pretty much kept me housebound, and I napped when I felt like it. It felt very good to slothify for some days!
The Aftermath
The surgeon who carried out the procedure on my right eye the next differed in minor procedural details from the lady who did it the day before. So it was quite interesting to realize that even in a simple procedure like this, each surgeon has a slightly different approach. I asked Friday’s surgeon to describe what he was doing; it would, I said, give me information and allay my anxiety. Because of this, I got quite an interesting talk on the history of cataract surgery!
The insurance was taken care of rather easily and being a typical insurance plan, covered only 80 per cent of the surgery costs, and a small percentage of the medications I had to buy. It was not only my cataracts but some of my bank balance as well, that were extracted! I came home on Friday with two white-hazed eyes instead of one, and when there was some clearing of that haze, I found that I had pretty good vision out of both eyes and that the colours were now so vivid.
I had not realized how the cataracts must have dimmed my sight over the past two years or so! However, I had to instil various drops in my eye, for the next few weeks and one of the i-drops dilates the pupil. So every time I begin to have clear vision, I know it’s time to fuzz it up again!
Earlier, I used to wear glasses (for myopia or short sight) all the time, and remove them for close-up work. Now, it’s the reverse; I need no glasses for distance vision and have to put on a pair of reading glasses to do close-up work. Getting into the habit is still not a very successful effort! I keep trying to take my glasses off when I lie down (I’ve worn glasses for myopia from age 12); when I can’t find my glasses, I feel I should take off my contact lenses (after all, I wore them from age 16 to 54!) and then I feel foolish when I realize that I’d better not touch my eyes!
The funniest part is sitting at home because every hour on the hour I must put in 1, 2, 3, or 4 different types of drops, one or more of them. I call it having dropsy…or drops-eye!
OK…time for the next set of drops in both eyes…truly I am singing, ‘Eyes, eyes, baby!’ these days!
Deepa Mohan is deeply concerned about the rapid evolution of her city, Bangalore, but is also interested in theatre, quizzing, music, wildlife, photography, heritage, history and writing, all of which she does with enthusiasm.
Falls among elderly are a common cause of injuries and fatalities. We profile a Chennai based centre that provides risk assessment & rehabilitation therapy for seniors at risk for falls.
Falls are a common cause of injuries and fatalities among the elderly. Many elders need to be hospitalized or are bedridden for the rest of their lives due to a debilitating fall that could have been easily avoided. In the US, 30 percent of individuals aged 65 years and older fall at least once a year.
In India, the prevalence of falls among the 60+ is between 14 percent to 53 percent.
Falls can lead to hip fractures, brain and upper limb injuries, according to a report in the Asian Journal of Gerontology & Geriatrics June 2014. With advancing age, fall- related injuries can become severe and even fatal. This is where a Fall Prevention or Risk Assessment Clinic helps.
According to Dr. David Vijay Kumar, MPT (Geriatrics) and the person behind the Elderly Physio Care Clinic in Chennai, “More people rush to hospitals for injuries related to falling than from any other cause, and they are the primary cause of accidental death in people over the age of 65.” In fact, falls are the cause of 70 percent of accidental deaths in people aged 75 years and older.
However, fall prevention programs like those offered by Dr Vijay Kumar’s clinic in Nungambakkam, Chennai, can effectively help elders to reduce the risk of falls. The centre offers a Fall Risk Assessment and Conditioning program for senior citizens, who can also take these sessions from their home.
How it’s Done
The program gets to the bottom of what is causing the fall, taking into account specific risk factors known to contribute to falling and decreased mobility. The patient’s scores are then compared to the norms of healthy and active people to determine their fall risk. If the patient is at risk, they are given a personalized program to target their deficiencies. The treatments, which occur in the clinic and at home, focus on strength and flexibility, balance, walking speed, step length and endurance.
Therapy is provided in the form of exercises such strengthening, stretching, walking, weightlifting, aquatic therapy and balancing, says Dr Vijay Kumar, adding that the centre comes equipped with the latest technology and machines to help with this.
Many a times, the underlying causes behind a fall could be due to a different ailment, says Dr Vijay Kumar. M Srinivasan, an elderly patient who is a regular at the centre found out he had Parkinson’s Disease only after a fall.
“I was a fast walker and when I fell down, I escaped with bruises but later, could not lift my leg,” he remembers. After five years of Parkinson’s medication and physiotherapy with the centre, he feels much steadier and active throughout the day, despite the fact that Parkinson’s Disease is a progressive, degenerative disease and results in stiffness of muscles and movement related problems. Srinivasan is now able to sit at his desk and work and flex his toes, small changes that have given him a much needed energy boost in the last five years. He attributes this to rehabilitation therapy. He also feels that the stretching and relaxing of muscles during exercise provides him relief.
Dr Vijay Kumar feels that it is important to educate elders and their families about fall risk assessment and rehabilitation therapies and there need to be more centres like this across the country. “While the concept is a common in the Western countries, in India it is still new,” he says. He however adds that while therapy and exercises can help an elder back to his or her feet, their self motivation is equally important as well.
The Elderly Physio Care Centre is located in Chennai and can be contacted on 9884130430 & 9940234934
You can also visit them on http://www.elderlyphysiocare.in
Noted geriatrician Dr VS Natarajan is considered the Father of Indian Geriatrics and was instrumental in pioneering many initiatives for elders in Chennai. He tells us of some of these could benefit elders in living a healthy and active life.
Dr Natarajan (right) with a patient for an immunisation drive
Pic courtesy: Dr VS Natarajan
The simple unassuming Adiparashakthi Clinic in Kilpauk, Chennai, does not give away the importance it holds for many senior citizens in the city. Until you spot the neatly framed Padmashri on the wall, the country’s third highest civilian honour that was conferred on geriatrician Dr VS Natarajan in 2012.
A tireless advocate of active ageing and a good example of it himself, Dr Natarajan is considered the Father of Indian Geriatrics.and in the late 70s, set up India’s first geriatric outpatient wing at the Madras Medical College and Hospital. He firmly believes that if managed well, old age can be a good period in a person’s life. We asked him when should a person visit a geriatrician. “When there are multiple disorders an elderly person is suffering from,” comes the answer. More than anything, Dr Natarajan believes that people should try to stay active and healthy and take preventive measures about issues that may have a solution. To highlight this, this senior geriatrician has been actively involved with several projects to benefit the elderly in Chennai. We take a look at some of his initiatives:
Immunisation Centre
Launched in 2013, the Immunisation Centre aims at keeping seniors healthy by taking preventive measures. According to Dr Natarajan, in old age, the immunity becomes low due to several factors. The elderly need immunisation for protection against serious infectious diseases, just as children do. Common infection in older adults include viral infections like influenza and bacterial infections like pneumonia. While Dr Natarajan’s Immunisation Centre provides vaccines for Influenza, Pneumonia, Hepatitis B, Tetanus and Typhoid, he points out that the Pneumonia vaccine is most important when it comes to elders. “Pneumonia is a bacterial disease and with age immunity is low or people have multiple issues like diabetes, asthma, hypertension or chronic bronchitis; this is when the infection can flare up, leading to further complications. It can create breathing problem and the bacteria can enter the bloodstream, leading to septicaemia and even death.”
Dr Natarajan says Pneumonia is a preventable disease and one shot, costing approximately Rs 3,800 can give a person lifelong immunity (if necessary, revaccination can be done 5 years after first vaccination), which is why it is highly recommended by him to elders.
Memory Clinic
Memory loss is a common problem faced by many with advancing age. Memory impairment may be the early sign of dementia in elderly. “As longevity increases, it is accompanied by memory disturbances,” says Dr Natarajan, speaking of why he started the memory clinic. He feels only five per cent of patients suffer from Alzheimer’s Disease and around 30 per cent of patients who visit the clinic exhibit minimal cognitive impairment. “Persons above the age of 70 should get examined by a psychiatrist, including people who have suffered a head injury at a young age or with a family history of dementia. He attributes anxiety and depression as possible causes of memory loss and says that if dementia is identified in its early stages, it is treatable. “I advise all seniors aged 70 and above to undergo a memory assessment test, which assesses any abnormality,” comes his advice. The Memory Clinic is open to all above the age of 60 years with a memory disorder. Patients are reviewed for a minimum period of three months.
Geriatric Housecall Program
Started during Dr Natarajan’s stint as President of the Senior Citizen’s Bureau, Chennai, The Geriatric Housecall Program is a helpline to bring doctors to the doorstep of the elderly. The team includes doctors, physiotherapists, psychologists, dietician and nurses. It was launched mainly to help the elders in Chennai, aged 60-70 years and above, with restricted mobility and acute medical problems. The program has a network of doctors who attend to the patients residing in their area or nearby. So far the program has benefited several elderly in Chennai, though Dr Natarajan wishes that more doctors signed up for the program. The aim is to revive the old tradition of house visits by the family physician which often enabled the patient to get promote medical aid or the right reference for further tests or checkups.
To know more about these programs or avail of one, please contact:
Adhiparasakth Clinic / Memory Clinic,
Old No.18 A, New No. 50, Flowers Road,
Kilpauk, Chennai – 600 010.
044-26412030/26267282
— Dr VS Natarajan spoke to Reshmi Chakraborty
Laughter Yoga sessions are an increasingly common sight around neighbourhood parks and apartment complexes across India. We spoke to some its practitioners to find out how it can help seniors.
Seniors laugh away to the record books in Mumbai’s Dada Dadi Park Pic courtesy: Ramgopal Cancherla
Can laughing help you stay healthy? Can forced laughter enhance your mood, clear up your respiratory system and strengthen your lungs?
Professor P Sadashiva, President, Karnataka Laughter Yoga International, certainly seems to think so. In the several years that he has been practising Laughter Yoga, Prof. Sadashiva says that he has seen an improvement in his blood pressure and feels something is missing from his day if he hasn’t had his daily dose of laughter. Like the professor, Mumbai’s Ramgopal Cancherla, 66, feels that Laughter Yoga has given him several personal benefits. A lifelong career in sales meant that Mr Cancherla often had to travel on two-wheelers, which took a toll on his back. “I was constantly on Combiflam (a pain reliever) and can say with guarantee that ever since I started practising Laughter Yoga, my usage of pain relievers have gone down,” he says. Mr. Cancherla is a longtime member of the MRRWA Laughter Club, Andheri East, Mumbai and credits Laughter Yoga for the positivity it brought to his life while dealing with complicated office situations when he was close to retirement. “It kept me cheerful and happy and did not allow things (his company was going through a merger) to disturb me much.
Pic courtesy: Nauravainenanu , Wikimedia Commons
Laughter Yoga benefits
Founded by Mumbai physician Dr. Madan Kataria in 1995, Laughter Yoga has been described as a complete workout for wellbeing and usually combines Pranayama techniques (breathing exercises) along with guided laughter techniques. The logic, as Mr Cancherla, a Laughter Yoga teacher trained by Dr Kataria, explains, is that the body cannot differentiate between fake and real laughter and therefore one gets the same physical and psychological benefits from it.
Various educational and medical institutions, including hospitals like Kidwai Hospital and NIMHANS in Bangalore have used it to benefit their patients.
According to research published in the New England Journal of medicine, laughter releases Endorphins and Enkephalins, which are natural opiates and pain suppressing agents. Laughter can also release muscle tension, soothe the nervous system and control pain. Forced laughter in a rhythmic manner brings pressure on the lungs, which throw out all residual carbon oxide and fills up the body with good oxygen, resulting in better lung expansion and contraction. Mr Cancherla in fact says that 80 per cent of people in laughter yoga clubs do not suffer from backache and arthritis.
In a study conducted in Japan, researchers found that laughter can be beneficial for people with diabetes as it can help in lowering blood sugar levels. Prof. Sadashiva, who cites his own example and that of others he knows, believes that Laughter Yoga can help control your asthma, blood pressure and even migraine. He adds that for each and every kind of laughter, there is a purpose. “Some can help your heart, some can benefit eyes,” he claims.
The People’s Exercise
What started with merely a handful people in 1995, has now grown to a movement with over 6000 laughter clubs in 60 countries. Bangalore itself has 220 laughter clubs. Whether
Mr Cancherla laughs away the blues Pic courtesy: Ramgopal Cancherla
the science works or not, often, Laughter Yoga clubs are the harbinger of new friendships, groups and bonds. Most people we spoke to say that while starting out may be a bit awkward (forcing yourself to laugh can be), they soon get into the mood of the moment and find themselves laughing contagiously. Delhi’s Parvati Mishra doesn’t miss the laughter routine in her local park a single day, unless bad health or weather prevent her from joining in. “I feel good to meet friends, laugh, do mild exercises, chat with everybody and go back home,” says the 68 year old. The highlight for her is the laughter part and Mrs Mishra says it doesn’t feel forced. “When I first started I was little hesitant to laugh openly but now there is such a camaraderie that we just look at each other and start laughing.” Mrs Mishra lives in a joint family and her day goes by in a blur of kitchen, home and grandchildren duties. “Morning laughter makes me feel nice for the rest of the day. Nahi to aajkal khulke haasne ka mauka kahan milta hai? (how else do you get a chance to laugh wholeheartedly nowadays?)”
Most Laughter Clubs are conducted in local parks early mornings and in some cases in the evening too. Prof. Sadashiva says 80 per cent of the participants are senior citizens. Whether you believe in the scientific benefits of Laughter Yoga or not, there is no doubt that the act of unrestrained laughter has found many takers. It isn’t an unusual sight to find a bunch of people (mostly seniors) standing in a corner of your neighbourhood park, laughing their hearts out. For many like Mrs Mishra, it is also the joy of interacting with others. “My laughter club group ladies have become my friends. When one of them was hospitalized recently, we all kept visiting to boost her morale, arranged in turns to send food home to her son and husband and helped them out with small chores like grocery shopping and maid issues,” she says. It is also, her Me Time. “Earlier I used to walk and it was lonely. You have to walk alone. This way, I do something and meet people also.”
Has she felt any major health benefits? Mrs Mishra says she doesn’t have any major ailments so cannot speak on that but doing this has made her feel lighthearted and happy.
The MRRWA laughter club; Pic courtesy: Ramgopal Cancherla
According to Mr Cancherla, one of the reasons Laughter Yoga is finding more takers, especially among seniors, is that it is easy to learn. “It is basically a combination of Breathing, clapping, which simulates acupressure; dancing which results in movement of entire body), laughing and singing,” he points out. The other benefit, as Prof. Sadashiv mentions, is that anyone can join a Laughter Yoga Club, as it is free. Mr Cancherla, whose club has members from upper middle class to lower middle class families, agrees. What he also adds is that being part of Laughter Yoga sessions helps to boost confidence. Every year, he and a small group comprising mostly of women from his club, participate in Umaang, a talent contest for senior citizens held in Mumbai. The women, many of whom were hesitant and extremely shy earlier, now go up on stage and have the ability to perform in front of others. Mr Cancherla credits this to their participation and involvement with the Laughter Yoga Club. “It has helped them interact with others, experience things..”
The Spirit of Fun
The benefits may be more psychological than physical and their scientific reasons may still be cause for debate but there is no doubt that Laughter Yoga Club members across the country know how to have fun. The clubs in Bangalore organise a sports day on World Laughter Day, celebrated every first Sunday of May. In 2014, the Laughter Club in Dada Dadi Park, Borivili, Mumbai created a record in the Limca Book of Records by gathering 1950 senior citizens and laughing for 45 whole minutes, under the guidance of trained Laughter Yoga teachers. No mean feat that and we can only imagine the endorphin rush!
As the saying goes, laugh and the world laughs with you. Cry and you cry alone.
Wish to join a Laughter Club? Find out one near you through http://www.laughteryoga.org/english/club/find_club
These clubs are run by volunteers trained as Laughter Yoga teachers and welcome all irrespective or caste, language, community or social status.
Have you experienced Laughter Yoga? Do share your thoughts with us here.
Homeopathy for the elderly can be useful as it fulfils all the parameters required for being an ideal system of medicine for Geriatric care, says Dr Nikunj Jani, consultant homeopathic physician from Mumbai. Read on to know more…
Old fashioned homeopathy medicine chest.
Pic courtesy: http://wellcomeimages.org/Wikimedia Commons
I will never be an old man.
To me, old age is 15 years older than I am.
– Francis Bacon
This century’s biggest achievement is longevity. All over the world life expectancy has risen, leading to a sharp rise in the number of older persons. As per the UN projections, globally the percentage of people over 60 is rapidly increasing and will reach 29 percent (of the total population) by the year 2025.
For a developing country like India, this may pose mounting pressures on various socio economic fronts including pension outlays, health care expenditures, fiscal discipline, savings levels etc. The economic burden of caring of the aged population will be enormous. Changes in the family and social structure will make care of the elderly problematic. Again this segment of population faces multiple medical and psychological problems. Geriatric population explosion is rapidly engulfing developing countries and India is no exception. In India, elderly population is estimated to be 300.96 million by 2051 (12% of total population), as compared to 75.93 millions in 2001 census
What is Geriatrics?
Geriatrics is the branch of medicine that focuses on health of aged patients. The prime aim of geriatrics care is to treat and prevent disease, disability or illness of old people as well as promote general health of senior citizens. A geriatrician is a doctor who is specialized in providing clinical cares for adults.
What is Homoeopathy?
Homeopathy is one of the most frequently used forms of Complementary and Alternative Medicine across the world. Homeopathy for the elderly can be useful as it fulfils all the parameters required for being an ideal system of medicine for Geriatric care. Homoeopathy has been established for about 200 years by a German Physician named Dr. Samuel Hahnemann. It is based on the ‘principle of similars’. Highly diluted preparations of substances that cause symptoms in healthy individuals are used to stimulate healing reactions in patients who display similar symptoms when ill. Homoeopathy believes in treating patients holistically, medications are specific to the individual, rather than diseases. Homoeopathy is a safe effective and scientific system of Medicine accepted in over five continents of the world and today is one of the leading alternative medicine systems of the world.
What is Geriatric Medicine & How it differs from Homeopathy
Pic courtesy: Wikimedia Commons
Geriatrics differs from adult medicine in many respects. The body of an elderly person is substantially different physiologically from that of an adult. Old age is the period of manifestation of decline of the various organ systems in the body. This varies according to various reserves in the organs. Many people cannot differentiate between disease and ageing effects (e.g. renal impairment may be a part of ageing but renal failure is not and urinary incontinence is not a part of normal ageing). Geriatricians aim at treating the disease and decreasing the effect of ageing on the elderly. The decline in physiological reserve in organs make the elderly vulnerable to disease and liable to have complications from mild problems
Functional ability, dependence and quality of life issues are of greater concern to geriatricians perhaps than to adult physicians. Treating an elderly person is not like treating an adult. A major difference between geriatrics and adult medicine is that the elderly sometimes cannot make decisions for themselves. The issues of privacy, legal responsibility, informed consent, etc must always be considered. Elder’s abuse is also a major concern in this age group. In a sense, geriatricians also, often have to “treat” the caregivers and sometimes, the family, rather than just the elders.
Elderly people are highly prone to mental morbidities due to ageing of the brain, problems associated with physical health, cerebral pathology, socio-economic factors such as breakdown of the family support systems, and decrease in economic independence. The mental disorders that are frequently encountered include dementia and mood disorders.
The elderly have specific issues as regard medications. They are particularly subjected to multiple medicines due to multiple diseases and with the advent of Super- speciality in medicine; the Specialists just prescribe medications to their specific specialty not reviewing other medications used by the elder. Multiple diseases mean multiple prescriptions. This leads to more drug-related side effects, interactions and omissions. Sometimes side effects of the drugs may be more than its beneficial effects.
Atypical presentation of illness in the elderly is very common. Presentation may be obscure, misleading or silent. Elders may suffer from heart attack without pain in the chest. They may have stomach ulcers, gall bladder complaints or appendicitis without any abdominal pain. Hence, only a specialised physician like a geriatrician can make an accurate and early diagnosis.
The most important issues of Geriatric practice are immobility, instability, incontinence and impaired intellect/memory. Health issues in older adults may also include decrease in the activities of daily living, use of multiple medications, impaired vision and hearing and depression.
How Can Homeopathy Help & When
Themedicines are safe and non toxic, they have no danger of overdose; Medicines are not addictive, easy to preserve, less expensive in comparison to conventional regimes. In acute and chronic disease, whether the symptoms are physical, mental, or emotional, Homeopathy produces subtle, yet often dramatic, healing. From newborns to elder peoples, most people can benefit from homeopathy. Homoeopathy is not a cure-all system of medicine and it does not reject the great discoveries of modern medical science; but only its commercial abuse. Homoeopath is more concerned with the sick individual and his sickness rather than the mere names of diseases. Thus, great success and curative actions have been possible in patients suffering from allergies, cancers and various auto-immune disorders.
People suffering from common infections tend to get rid of their recurrence when treated Homoeopathically because their immune system is strengthened. In other diseases Homoeopathy can prevent unnecessary surgery (e.g. In cases of Piles, Fissure, Tonsillitis, Calculi, etc) provided these have not grown beyond the capability of the patient’s immune system or have created undesirable mechanical pressure or very gross pathology, which needs surgical intervention. Even in frank surgical cases, homoeopathic medicines can help lessen post-operative shock and hasten healing & recovery. Homoeopathy’s relevance in this day and age is far greater, as man is tampering with the body’s capacity to fight disease by leading an unhealthy lifestyle, abusing the body with stress, unhealthy food and drinks, feeding heavy doses of drug substances indiscriminately, which lead to immuno-suppression. It can be taken by all , right from infants to old people.
Homoeopathy is effective in treating a wide range of diseases from acute inflammations to raging epidemics, from chronic degenerative illness to deep-seated mental and emotional disturbances and, it is safe, non-toxic, gentle, and cost-effective.
Is Homoeopathy Useful in Geriatric Conditions?
A recent study conducted on 3981 elderly patients treated by homoeopathic physicians in primary care practices in Germany and Switzerland found that the severity of the complaints consistently demonstrated substantial improvements following homeopathic treatment, which were maintained through 24 months of follow up. Homeopathic medical therapy may play a beneficial role in the long-term care of older adults with chronic diseases. Of all the specialities of medicine, geriatrics is a branch which needs a holistic approach; it is also a branch where modern medicine has openly accepted its limitations. Here diagnosis and investigations constitute a small part of the therapeutic process. The need is to understand the person and his/ her surroundings and their socio-cultural background. Along with medication, auxiliary and ancillary measures like diet, exercise, physiotherapy, group activities, support also are the mainstays of treatment.
Homoeopathy fulfils all the parameters required for being the most ideal system of medicine for Geriatric care. Also the cost effectiveness of homoeopathy is much more compared to all other systems of medicine. This can be a great help to the elderly, who already have depleted source of income. Homoeopathy can play a great role in addressing a major healthcare concern of our country effectively.
(The views expressed in this feature are solely of the author)
There’s a hard to miss calm around Padmini Menon, 59, the only certified resident Alexander Technique (AT) teacher in India (to her best knowledge and ours). A former English teacher in Rishi Valley School and The Valley School, Bangalore, Menon did a three year full time Teacher Training course at the Alexander Technique College in Brighton, UK, and has been practicing the technique since 2008. Menon runs the only certified Indian Centre for the Alexander Technique in Bangalore. She learnt AT not because of any health issues but due to sheer interest.
Training herself in it helped her discover few things about her body. “For example, I hadn’t realised until then that I had stiff hips,” says Menon, talking about how the course affected her life and wellbeing. “As I realised it, the way I walked changed.” Menon also feels she is calmer and less liable to panic due to AT practice. “I’m able to handle things much better after learning the Alexander Technique and there is a general sense of calm and comfort.”
What is the Alexander Technique?
The Alexander Technique is a gentle non-invasive way of releasing tensions in your body that can interfere with the way your muscles function. According to Menon, the technique helps you go right into the deepest layer and let that tension go. “The result is that our muscles have a chance to function the way they are supposed to, how they worked originally when we were children.” She adds that over the years, as we grow up and submit to a hectic pace of life, we take the underlying tension in our body as normal. She calls AT not a form of treatment but “retraining yourself to function differently.”
Can it help seniors?
It is said that the AT can help seniors with balance and mobility issues. Menon agrees that it is true, and adds that AT teaches you to use yourself. well. “Once you learn, you can take that basic discipline into every area of your life.” She believes one of the reasons people lose balance as they grow older is because they move much lesser, especially given our cultural conditioning. She believes that AT could help seniors get steady but also says that it is associated with the person’s outlook towards life and mind. Having an open mind is a pre-requisite to learn this unique technique. According to Menon, it can teach you to deal effectively with issues of discomfort, stiffness or pain, sit, stand and move with ease. She feels many older people could use this to tackle their mobility issues and gain more freedom. Learning the Alexander Technique can make many elders with mobility issues like inability to climb stairs, sit or stand with ease, more independent.
How it’s done
A description in Menon’s website puts it clearly: In an Alexander Technique lesson the teacher helps you to become aware of the tensions you are holding in your neck, or back, or shoulders. She works with you to release them, in simple everyday actions, as well as in the specialised movements of your work.
Menon calls AT a hands on discipline and it truly is. When working with a client, she places her hands on the problem area in their neck, shoulder or back and teaches them to use their thoughts to release the tension. It may sound easy but it of course, isn’t. “I teach them to do it systematically and consistently.” She also clarifies that AT is “not exercise.” As she puts it: “It targets muscles usually not accessed by exercise.” For instance, one of the lessons include ‘sitting up and sitting down’ and targets the postural muscles. Menon mentions that for many older people sitting up and sitting down are problematic. “When you learn how to get up and sit down the right way it won’t hurt,” she says. Before she begins training, Menon always asks people with health issues to get themselves checked by a doctor.
Menon herself got into learning AT in her 50s and believes that as you grow older, some way of looking after yourself is crucial.”AT is valuable because it helps to change the quality of your life. You gain more control.”
Most people visit Menon with back issues, while some wish to learn the technique and improve the general quality of their lives. As Menon never tires of pointing out, AT helps to improve basic muscle habits. These are used in our daily actions and sometimes extended into stronger form when we do kitchen worker use the computer. “When you learn to improve them with AT, the effect is felt across the range of your actions,” she adds.
Padmini Menon offers group lessons and limited one on one training. She can offer an introductory course on Alexander Technique for a group of 6 to 8 seniors, which would include 12 lessons and cost approximately Rs. 3000. She also has several other learning modules.
If interested in learning or knowing more, reach out to Padmini Menon through her website http://www.alexandertechnique-india.com/
Rahul Upadhyay decided to launch Senior Shelf, a website that stocks daily living aids for seniors when he found how hard they were to come by. Reshmi Chakraborty listens in.
A harrowing three hour hunt through heavy Patna traffic for a Blood Pressure Monitoring machine made Rahul Upadhyay launch a service like Senior Shelf. www.seniorshelf.com is an e-commerce portal that stocks daily living aids and products that could help seniors. Today the BP Monitor Upadhyay was searching for his ailing mother is available on Senior Shelf at the click of the mouse but as he says and many of us have experienced, the exhausting search wasn’t a one-off case.
Daily living or assistive aids like Elevated Toilet Seats, Grab bars, Hearing aids, Wheelchairs or even commonly required products like Walkers are hard to come by unless you trek down to the nearest hospital or a surgical store and pray that they have the product in stock. “Retail in India is not developed for elders,” says Upadhyay, a former marketing professional, who saw both need and business opportunity for these products in a society that is changing radically. “The three hour search in Patna made me realise that it’s not money but the accessibility of the product that is important. Lots of kids are online, even if their parents, the elders, aren’t. If there was a medium through which the kids could buy and send, most of them would want to do it as it would make both their and their parents life easier.”
Seniorshelf, which started operations in January 2014 and is run by a skeletal team, stocks a wide variety of products categorised under Bathroom Accessories, Senior Home Products, Easy Living Accessories, Orthopedic, Walker and Walking sticks, among others. Some of the products, like the Glow in the Dark Tape that ensures elders who get up often at night do not bump into furniture or the Talking Clock that speaks out the time or the Bent spoons for arthritic patients are quite unique.
Upadhyay gets calls from all over the country and so far has delivered everywhere from Gangtok to Silchar to Dimapur. Many of his customers are Non Resident Indians sending products to parents who live alone in various parts of India. “Some of our most popular products are in the domain of toilet safety , such as grab bars, raised toilet seats, commode chairs or the Indian toilet converter.” Incidentally, the latter is a product that converts an Indian toilet into a Western toilet, thereby eliminating the need for renovation and making it easy for the elderly with knee and back problems.
Upadhyay’s target customers are children living away from parents as most elders find it difficult to transact online, even if they are aware of these products. He has kept in mind the comfort point of his customers (including changing the spelling of Orthopaedic to Orthopedic on his site as Indians usually search using that) and in some cases has even sent products on credit as the seniors to whom he sold these found it difficult to transact the money online immediately. “Till date I’ve always got the money,” he says, adding that he prefers to handle the customer care himself at the moment. “It gives me an understanding of the customers, and has led to lot of changes and modifications.” He seems to have the patience required to explain and interact with elderly customers and also the understanding of difficulties faced by elders living alone.
Raised Toilet Seat
Assistive devices can sometimes be complicated to figure out for those using these for the first time and to make it easier for the customers, Upadhyay has videos on his website that can explain the product. E.g., wheelchairs sell fairly well on Senior Shelf and there are videos of various types of wheelchairs available on the site for people to take a look and decide before they buy. They are also particular about specialist products. For instance, Upadhyay says they do not sell a hearing aid unless they see an audiogram done by the doctor.
Senior Shelf also gives out information on travel, pharmacies, retirement homes, etc. as a service to elders and is looking to expand their services as they move ahead.
To check out the products available with Senior Shelf, log on to www.seniorshelf.com
Arun Kumar Singh started running after 50. By 62, he was winning gold medals. He tells Reshmi Chakraborty the story of his run and what keeps him going.
At 65, when many seniors are planning their retirement, Arun Kumar Singh is planning a run. The 65 year old Kolkata based businessman is planning to participate in the 18th Asia Masters Athletic Championship to be held in Japan in September 2014 and trying to raise funds for the same.
A heavy smoker once upon a time, Singh is an example of discovering his true passion in the later years of his life and giving it all he has. He started running at the age of 52, when he gave up smoking and decided to do something to stay healthy. “I used to go to Victoria Memorial (a celebrated monument in Kolkata) for morning walk and gradually started jogging. “In 1992, I participated in a 10 KM run organised by HSBC Bank in Kolkata and to my surprise, was not only able to complete it but also ranked as the second runner up in my age category!” he says. Having rediscovered his love for running (Singh used to love athletics in school, he says) and also the considerable talent he had for it, he decided to take it up seriously, even getting interested in hurdling. The medals and records followed. Singh ran his first hurdle at the age of 55 at the National Master Athletic Meet in 2008 and got a bronze medal in the 100 m category both that year and the next. He even established a State Meet record in the same event in 2010. But what he considers his greatest achievement is his first gold medal in a 100 m hurdle in February 2012, at the 33rd National Master Athletic Meet at Bangalore in 60+ age category.
What is admirable is that in 2012, Singh had fractured his right leg fibula bone and was incapacitated for 42 days, putting him out of practice and giving him merely 8 months to get back in shape. Despite the injury, he managed to win a silver medal at the 34th National Master Athletic Meet, held in June 2013 at Bangalore. He was also selected to represent India in the 17th Asian Master Athletic Championship, held in Taiwan in November 2012 where he ranked 4th in both the 100 m and 300 m hurdles in 60+ category. Singh has represented India in various other events in his age category, including the World Master Athletic Meet at Porto Alegre in Brazil in October, 2013.
Training for the Asian Masters meet in Japan at the moment, Singh says he hopes to do well in the 64 plus age category. He is trying to raise funds to meet the expenses he will incur to participate in the event and credits his friends and nephew with helping him out. His previous international outings were sponsored by PC Chandra jewellers.
In a country where sports is considered just a hobby and even talented young sportsmen and women are sometimes encouraged to give it up and pursue education, Singh’s story is different one. He says completing that 10 KM run way back in Kolkata was what instilled confidence in him to run and hurdle at a competitive level. “Once you get success confidence comes and you gradually think of doing better.,” he says, adding that he loves hurdles.
He follows a simple protein rich diet as advised by his sports medicine doctor and coach Kalyan Chowdhry. “I exercise regularly and do hurdles two says in the week and a 10 KM run every Sunday,” he mentions adding that seniors should try to stay as fit as they can. “Go for a morning walk and try to start the day with exercise. Do things as your health permits and as advised by your doctor. Singh stays alone and says that he is estranged from his wife but counts on the support of his friends and relatives. “Without support, you cannot move ahead,” is his simple statement.
Singh is raising funds for participating in the 18th Asia Masters Athletic Championship to be held at Kitakami City, Japan in September 2014. If you wish to support him in his endeavour, here’s how the money will be utilised, according to information from Catapooolt, the
Arun Kumar Singh has been selected to represent India at the 18th Asia Masters Athletic Championship to be held in September 2014. However, coming from a humble economic background, funds is only one challenge which may stop him in his tracks. The fund is to be paid to our National body, i.e., Masters Athletic Federation of India, Bangalore. The fund will be utilised for airfare, boarding and accommodation, insurance, visa charges and other expenses for the trip to Japan.
To find out more or contribute, please visit https://catapooolt.com
Yoga at 60 plus can be a welcome addition to your health routine as it helps to achieve not just balance, mobility and a peaceful mind but can also help in controlling certain ailments. By Reshmi Chakraborty.
Stay healthy and active with Yoga
Pic: Wikimedia Commons
For 30 years, Mumbaikar Ramesh Joshi was the busy marketing head of a pharmaceutical firm travelling around the country. He had several ailments and a lifestyle that wasn’t the most disciplined. Ten years ago, an introduction to yoga during a visit to North India became a life changing experience for him. Today, at 69, Mr Joshi is an advocate of yoga for everyone, including people over the age of 60. He is also the proprietor of a fitness firm ‘Healththruyoga’ and a practitioner who teaches all over Mumbai.
“Yoga is great for mobility when it comes to seniors,” he says, adding that yoga has helped him overcome various ailments like blood pressure and hypertension. “When I started the first time at an ashram near Haridwar, I did four hours of yoga and gradually found all my ailments disappearing, including kidney problems,” says Mr Joshi. He also remembers losing weight by 18 kgs though he cautions that post 55-60 years, one should not take up Yoga without consulting their doctor and doing a thorough check up. One also needs a Yoga teacher who understands the different requirements that come with advanced age. “For example, for those with backache, we would recommend back relaxing and not back strengthening exercises,” he notes.
Active Body, Active Mind
Yoga has been long known for enabling a healthy body and calm mind. Studies also suggest that Yoga can be beneficial for seniors too. Yoga asanas can tone up the body, keep our internal system in balance and refresh the mind and body.
“Research shows that Yoga offers significant benefits to the elderly. This is true for both physical aspects like flexibility and stamina, as well as mental aspects like alertness, memory, and mood. Specific studies have also shown that yoga can reduce pain in chronic diseases like arthritis and reduce stress and anxiety in patients with cancer,” says S Varambally, Department of Psychiatry, Advanced Centre for Yoga, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore. In fact, to test this theory, a specific yoga module for improving cognitive function in the elderly was developed by NIMHANS.
According to a study published in Indian Journal of Psychiatry, NIMHANS doctors tested a yoga module on 120 elderly living in residential care homes in and around Bangalore. “We found that Yoga based-intervention appears beneficial to improve several domains of cognitive function in this population. This yoga module also leads to improvement in sleep and Quality of Life among the elderly. A separate small study, also found that elderly who practiced yoga for six months had increases in the volume of a brain area (hippocampus), which is important for memory,” the study mentions.
“More than 50 percent elderly in India have problems in life, stress and anxiety,” says Mr. Joshi, adding that their ailments are often psychosomatic. He mentions that yoga helps in restoring their mental peace and calm the mind, often the reason for various ailments. According to Mr Varambally, There is good evidence of different yoga modules helping to control diabetes, hypertension, arthritis, cardiac problems, anxiety and depression, sleep problems, and improving cognitive function. “At NIMHANS, we have done specific research in elderly with Mild Cognitive Impairment (a precursor of dementia), and we have found that yoga helps improve memory and other cognitive functions in these elderly,” he adds.
Stay healthy and happy with yoga
Pic: Silver Talkies
Asanas That Suit Elders
Stretching, bending or even sitting on the floor becomes a difficult physical activity for many elders, while most asanas in Yoga practice tend to involve these postures. Does that prove a hindrance to practising yoga for those with physical ailments like back or knee problems? “There are specific modules (developed at NIMHANS for patients and caregivers), available which combine different asanas, pranayama, and chanting, which are designed for ease of performance and improving specific abilities,” says Mr Varambally.
Singapore based senior yoga teacher Sujata Cowlagi suggests that before teaching, instructors “check the physical and medical conditions” of the seniors. She also points out that instructors can offer a chair for difficult poses like tree balance pose and be close in case they fall or get dizzy. “Depending on conditions such as weak knees , the instructor may need to change the asana sequence to be more therapeutic,” says Ms Cowlagi and cautions that it’s important not to overdo anything and steadily increase the pace and repetitions.”
Mayuri who runs the Yogatree Studio in Bangalore, says that basic asanas like Tarasana and Vrikshasana can be done by taking the support of a wall. “Asanas like Bhujangasana and Suryanamashkara can be modified for the elderly, while Pranayam can be done by sitting on a chair with a straight back and practising breathing. Elderly can also practice alternate nostril breathing.” says Mayuri, mentioning that there is no need for the elderly to sit on the floor. “If the instructor knows how to guide them, they can easily do several asanas,” she says, citing the example of Yoga Guru BKS Iyengar, who is now 94 and is a living legend when it comes to Yoga. Mayuri adds that standing and sitting poses are ideal for the elderly, who can also take the help of props.
Ramesh Joshi is a supporter of Pranayama for the elderly. “It helps to regulate the internal organs if various pranayams are done in the right order.” Once again, health requirements need to be kept in mind. “Many seniors do Kapal Bhati Pranayam (breathing exercises) but it has to be done properly with care as can otherwise have side effects. Ideally, people with respiratory disorders should not do Pranayams where they have to hold their breath.”
Doing it Right
One of the first rules of yoga, or for that matter any exercise is to find a certified instructor. There are several yoga schools mushrooming all over the country and before seniors enrol, they must check the background of the instructor and certifications.
Mr Varambally says that, “As a general rule, we would emphasize that yoga should be taught by a trained teacher only. This is especially important in the elderly, keeping in mind that the elderly may have several medical ailments and limitation in movement. The yoga teacher should be informed of these issues beforehand, so that they may take them into account and suitably modify the module.” Nirmala Machado, a Mumbai senior who practises yoga at her doctor’s advise since the last three years suggests going very slow, stopping to rest and doing what you can do the best of your ability. “If you experience any unusual aches and pains, please ask your instructor and doctor immediately,” she cautions.
Has Yoga helped her achieve a better level of fitness? Mrs Machado isn’t sure if her Blood Pressure has been controlled by Yoga or medications but says that regular practice has certainly helped her to achieve a calmer state of mind than earlier. “It makes me feel relaxed,” she says.
Yoga is an exercise of the state of mind, Mr Joshi says, adding that anxiety, tension , depression, all need to be exercised. Mayuri cautions that if the elderly are starting Yoga for the first time in life, how they take to it it depends on their mental and emotional health. “In the beginning there may be some physical resistance and mental as well,” she says, adding that the need to find a suitable instructor who can understand a senior’s medical condition and modify the asanas is a must. She suggests that in certain cases people need to exercise caution. “E.g., people with BP should not bend forward.” Talking about the workability of Yoga, Mayuri mentions working with an elderly person who was paralysed on one side. Yoga therapy was able to bring back movement to his hand, shoulder and leg and for the first time after his partial paralysis and stroke and according to her, he felt confident and happy. Her last word: Find a good instructor who knows that most asanas can be modified like back bends, forward stretches and supine asanas.
It’s something Mr Joshi agrees with. “I would advocate Yoga but only with proper guidance. There’s no benefit if it is not done right. But once it is done properly, the benefits are immense.”
So check with your doctor and try out Yoga to see if it works its magic on you.
If you wish to find a Yoga class or teacher in your area, please write to us at silvertalkies@gmail.com
As we age, breathing correctly may become a problem for some of us as the rib cage and surrounding muscles get stiffer, making deep breaths difficult to take. However there are breathing exercises that can help you improve your breathing, says Dr Nidhi Kumar.
Breathing deeply may become a problem with age
The cardiovascular and pulmonary systems in our body are inherently linked as they interface with all other body systems. The focus of this article is on improving and managing your cardio-pulmonary health. To do that, let’s first have a brief revision of the respiratory system. The respiratory system primarily comprises of rib cage, lungs, trachea (wind pipe), pharynx (throat), nose, etc. While you breathe, air enters and exits the lungs. As we inhale, the airways get filled with air, made up of stretchy tissues. These are small sacs called alveoli. Blood circulates around these sacs and an exchange of oxygen and carbon dioxide is carried out. As you grow older, there are several anatomical, physiological & immunological changes in all the systems in our body. Ageing leaves a significant effect of on the respiratory system too.
We are listing down some of these:
* Bones become thinner as one grows older, changing the shape of rib cage. The result is reduced expansion of chest during breathing limiting the respiratory volume. This further reduces the respiratory reserve required during acute illness such as heart failure, obstructive disorder, infection, etc.
* Alveoli lose their shape and become baggy.
* The muscles that support breathing are weakened with age and prevent complete inhalation and exhalation of air. Weakened chest muscles also hinder coughing, a natural way of removing phlegm from the lungs.
* The surroundings of lungs stiffen, leading to shrunken airways.
Hence, elderly person are at higher risk of shortness of breath and lung infections like bronchitis and pneumonia, abnormal breathing patterns like sleep apnoea (shortness of breath during sleep).
Remedy
Breathing exercises and ventilator training are fundamental interventions for the prevention or comprehensive management of acute/chronic cardio-pulmonary disorders. The effects of breathing exercises & ventilator training can:
The precautions
Pulmonary training
Perform all the exercises for two to three minutes each, twice daily.
A leading name in the in-home healthcare space, Portea Medical offers geriatric and post-operative care at home. Nidhi Chawla interviews Portea Co-founder and CEO, Meena Ganesh.
Shitij Singh, a patient of Brain Stroke, needed speech therapy and physiotherapy as part of his rehabilitation program after spending a fortnight in hospital. He is now home and has a speech therapist and physiotherapist visiting him twice daily, working on his speech and paralysed right side.
Home healthcare is an emerging segment in India. Apart from healthcare devices to measure your blood sugar or heart rate, today even blood tests can be done sitting at home as diagnostic labs will collect the blood samples. Post-operative care and geriatric care at home were considered challenges for lack of trained and professional help. However that is passé as there are companies as well as hospitals that provide you with trained nurses, physiotherapists and even doctors to take care of you or your loved ones inside the comfort of your homes. Portea Medical is one of the leading names in the in-home healthcare space, a segment considered to be worth USD 3 billion, in the wake of rising life expectancy, growing ageing population, rising incidence of lifestyle-related diseases and increasing disposable incomes.
We spoke to Meena Ganesh, Co-founder and CEO of Portea Medical to get you more insights. The company’s mission is to provide affordable and quality medical care at a patient’s doorstep by making qualified doctors, physiotherapists, nurses and trained attendants available at their home.
The idea for Portea germinated as a result of Meena and K Ganesh’s deeply personal experiences while caring first hand for family members diagnosed with cancer. “My husband, Ganesh and I, realised the many challenges involved and the dearth of options for quality and affordable medical care at home in India. This was also the time when we had just exited our previous venture TutorVista, and were exploring various opportunities. Home healthcare provided a large ‘whitespace’ opportunity that we felt we could address and were confident of building a category leader in the sector.” So Meena and K Ganesh established Portea along with Dr. Manjusha Anumolu, a MD (US Board Certified) in Internal Medicine with 20 years of practice in US and India.
Meena and Ganesh’s foray into India’s healthcare sector via Portea is their fifth venture, preceded by four successful green field ventures and exits. Their last venture TutorVista was sold to Pearson for $213 MM (around INR 1329 crore at current exchange rates).
Portea Medical currently serves patients in 12 cities across India: Delhi/NCR, Bangalore, Chennai, Mumbai, Hyderabad, Pune, Kolkata, Jaipur, Lucknow, Chandigarh, Coimbatore and Ahmedabad. The company’s gamut of services include home visits from doctors, nurses, physiotherapists, nutritionists, counsellors and trained attendants. The company also provides medical equipment like oxygen concentrators, pulse oximeters, suction machines, hospital beds, wheel chairs and walkers among other devices on rent and can make arrangements for home delivery of medicines as well.
Portea caters to patients with diverse needs – patients new to a city looking for medical help, elderly and/or immobile patients, palliative care patients, patients in need of simple yet repetitive treatments like dressings, physiotherapy, daily injections, catheter and tube care, colostomy and tracheostomy care and even patients who would like to be treated in the comfort of their homes and dislike travelling long distances to reach their hospital or doctor. “We bring the entire gamut of healthcare to their doorstep – doctors, nurses, physiotherapy, diagnostics and medicines,” says Meena.
She further adds, “Right now, we are focusing on general primary health care, post-hospitalisation care and chronic disease management. We have care plans addressing various aspects in all of these areas.” The company offers various plans to meet diverse medical needs.
The company does not offer emergency care; however the attendants can provide support for registered patients during hospital visits if required.
The elderly may find the company’s services especially useful as it is delivered by professionals at their doorstep and at their convenience. “Many of our aged patients find the annual elder care plan (Managed care) of great importance,” adds Meena. Sharing couple of examples, she adds that, “We recently attended to a 65-year old gentleman who had fever and upper respiratory infection. He was also a diabetic. The Portea doctor visited the patient, conducted a thorough examination, and prescribed medications at home. Post-treatment, the patient was relieved of his infection, and was greatly appreciative of the accurate diagnosis and care he received within his home environment.”
“There’s also the case of an elderly couple in Delhi with co morbidities. Their children are in Bangalore. Our doctors in Delhi visit the couple regularly to check on them and gauge when intervention is needed. We update the couple’s daughter staying in Bangalore (who happens to be a physician herself). This has greatly reassured both the patients under our care, and their family members located in another city.”
The Portea team is 600 plus employees strong, comprising of senior and junior doctors, senior physiotherapists overseeing the physiotherapy programmes, SMEs (Subject Matter Experts), MSc and BSc-level physiotherapists, a nursing in-charge for the country, nursing instructors with teaching experience, MSc and BSc-qualified nurses and GNMs (General Nurse and Midwife) and nursing attendants.
The patient centric model has the specialists, at a central location, responsible for designing care plans, actively monitoring the delivery of services, applying corrective action when needed and ensuring quality and adherence to proper medical procedures. The junior doctor is briefed prior to a patient visit, treatment plans are constituted centrally, verified offsite and onsite and remedial plans are prepared as needed. When there are cases that are especially challenging or in an escalated mode, the specialists themselves visit patients.
Citing the challenges Meena says, “The biggest challenge is in ensuring adequate oversight of healthcare delivery model since it is outside the confines of a medical facility.” To overcome this challenge, robust system and quality processes have been put in place to meticulously and efficiently manage the delivery model. Technology is also used as a key enabler whereby every clinician carries a proprietary GPS enabled hand held device that not only helps track the clinician closest to you when making appointments but also helps the Portea clinician access the patient’s medical history, check instructions from the patient’s specialist and provide real-time update of data from the patient. Plans are also in place to implement a system where data like blood pressure, temperature and sugar levels are automatically captured.
Continuous training is also a part of the process. A weekly CME (continued medical education) via video conferencing across all Portea centres is held for learning and discussion, where past cases are reviewed as well to enhance learning. The doctors are constantly in touch with their seniors during and after a home visit to fine-tune treatment protocol in each of the three spheres: Medicine, Physiotherapy and Nursing.
Talking about future plans Meena says, “We plan to expand to around 50 cities in the next 2 years. We are also looking at designing specialised programs for chronic ailments such as diabetes and hypertension. We will continue to refine and enhance our offerings to include a mother and baby care program, fall prevention and elderization of the living environment.”
To know more about Portea Medical and to avail their services you can visit their website www.portea.com or call 080-33554554
All images courtesy Portea Medical
With advanced age comes reduced stamina and an increased risk of ailments. A nutritious diet becomes extremely important to maintain a happy and healthy life. Here’s an expert guide on the most important elements to include in your diet post 60, many of which can be sufficed just through a spoonful or handful. By Nidhi Chawla.
Post fifty, the body undergoes many physiological and metabolic changes that impact its nutritional needs. The metabolic rate slows down and the body composition changes with a decrease in lean tissue mass and an increase in body fat. Hence, modifying eating habits becomes imperative to keep in sync with these bodily changes. Your calorie intake needs to be adequate keeping in mind a less active lifestyle and has to be mostly limited if one has a tendency to be obese.
Keep your diet rich in fruit and fibre
Nutritionist Sakshi Chawla says most of what you eat should be in breads (which includes pasta and rice but does not include sweets like cake and cookies), fruits, and vegetables. The recommended fibre amount is especially important in people who are 60 years old and up. Taking more fibre than recommended can be unhealthy for your gastrointestinal tract, so follow the recommended amounts. Inconsistency in your daily nutrient and calorie ratio leads to muscle loss and this loss makes skin look aged and sagging.
Dr.PriyankaRohtagi, Chief Clinical Nutritionist, Apollo Hospitals, Bangalore had this to say:
Keeping the above guidelines in mind, we asked experts which of the above requirements can be met through a spoonful/ handful addition to your diet and here is they had to say.
Ritika Samaddar, Chief Dietician at Max Hospital, Saket, Delhi, mentions that five important food items one must include in diet daily:
1. Oats for fibre and carbohydrates
2. Nuts for good fats
3. Milk and its products/ yogurt for calcium
4. Fluids like buttermilk, coconut water, freshlime, green tea etc.
5. Fruits and vegetables to add fibre
6. Banana (if not a diabetic)
Sheela Krishnaswamy, Diet, Nutrition and Wellness consultant, Bangalore, highlighted three essential nutrients.
Not too difficult, right? Here’s to healthy and hearty living!
Pics courtesy: Silver Talkies
A major illness or disorder may require the need of support from experts and others facing a similar situation. Support groups can be of great help in such cases, for both the patient and the caregiver. Meghana Srinivasan, clinical psychologist, PDMDS Mumbai, on how support groups can help those with Parkinson’s Disease.
Q: How do Parkinson’s Disease support groups work? Apart from creating a common bond between people suffering from the same problem, does it also help in coping with the challenges the disease presents? Could you share some examples or instances please.
A: In most support groups, counseling and education is the main focus with limited focus on a multidisciplinary perspective. However, a multidisciplinary approach is most important in the management of Parkinson’s disease and at a support group like PDMDS, we provide all the rehabilitation options in a community-based setup.
In our group therapy sessions, people with Parkinson’s get to connect with the right professionals, with other patients who have the same disease and with other families. We offer services like physiotherapy, speech therapy, psychological counseling and cognitive stimulation, occupational therapy, simple home modifications, nutrition advice, medications to the needy and assistive devices if patients need them. These are provided on a long-term basis and free of cost. This makes rehabilitation easily accessible, cost effective and provides a home-like environment to people with Parkinson’s (unlike in hospitals). Our group therapy sessions are interactive and lively; patients become more self-aware as they learn from other’s experiences and become more open about their experiences. The dynamic nature of the group enables people from all strata, all stages of the disease and all languages to participate and overcome barriers. As professionals, it enables us to serve more than one person at a time while remaining cost effective.
How do support groups help the caregiver? What kind of issues do caregivers usually go through?
Caregiving is a difficult process because most caregivers are not formally trained to take care of patients. The caregiver’s role is often ignored and undervalued by professionals. By being directly related to the patient, it is often implicit that they will be involved in disease management process. The diagnosis of PD can lead to feelings of shock, denial, guilt, shame, anger, helplessness and sadness in caregivers also. Moreover, they spend all their time with the patient while simultaneously juggling household responsibilities, financial problems, other family members, etc. Emotionally, they often worry about the future, what others would think of them and about their negative feelings related to caregiving. In our sessions, we teach them to accept negative feelings as normal and communicate them, encourage them to take care of their own health, make personal time for themselves and remain positive.
We also educate caregivers about the progressive nature of PD and counsel them that the patient will increasingly become dependent on them because their symptoms will be difficult to manage as PD progresses over time. On the other hand, some people with Parkinson’s become psychologically dependent on their caregivers from the outset even though they can be independent. We make caregivers aware that a patient with PD, initially at least, can still be independent. Many a time, caregivers don’t feel fulfilled despite spending hours with patients and feel they should do more. We teach them how to be aware of their limitations and to delegate responsibilities within the family. Thus, education, counseling and interaction with caregivers of other patients are beneficial to them.
Do support groups make people more aware about medication and therapy?
Yes, group sessions make patients more aware about medications and therapy. We educate them about the medications available for PD, their side effects, the interaction with their diet, surgical options and its advantages and disadvantages. We educate them about the various symptoms of PD so that they can report any new symptoms to their doctor. We also teach them to keep a record of their medication regime and help them plan their visit to the doctor so they can address their queries. People with Parkinson’s are often overwhelmed about how they will incorporate so many changes in their daily life and we help them plan their schedule.
Patients also need to understand that there are individual differences in the ways the disease progresses. What works for one patient does not work for another in terms of medication and therapy. As professionals, we emphasize this all the time because people in the group are at various stages of the disease and many misconceptions need to be clarified. Also, often patients use the internet for information about PD which overwhelms them and sometimes, even misleads them. When we educate patients face to face, we give them an opportunity to ask questions and in turn, we address their individual concerns.
A dance therapy session
Pic: Devika Mehta
Does being in a support group help people to try out various ways of treatment or rehabilitation that they may have been reluctant to earlier?
Yes. We make our group sessions interesting by adopting different forms of therapy. In our physiotherapy sessions and support groups, we have observed that often people with Parkinson’s who are reluctant to participate, start doing so when they watch others. When they see the positive effects on others, they are motivated to try it out as well. We have also introduced patients to dance therapy, music therapy, art therapy and yoga. Since these sessions are based on stimulating creativity, we encounter more resistance from patients. However, with a good facilitator and with a motivated group, even these tasks seem effortless. Treatment includes medication and surgery. Patients who have tried different types of medications or alternative forms and those who have undergone surgery narrate their experiences to others. However, we often encourage patients to clarify these aspects with their doctor and advise caution before they put them into practice.
A physiotherapy session
Pic: PDMDS, Mumbai
Silver Talkies also spoke to Mayura Prahlad of Parkinson’s Disease Society of Karnataka on how a support group can help:
The Parkinson’s Disease Society of Karnataka came together is 1996. A few of us came together to form it, which included patients, caregivers, neurologists and doctors. Initially the idea was to increase awareness about Parkinson’s disease. For instance, most people go to general neurologists, whereas through the society we refer them to specialists to take a second opinion. Why is a Society like ours important? Because it also works as a support group. A disease like Parkinson’s cannot be treated with just medication. It needs assistive therapies as well. The Society can offer patients and caregivers information about these and also conduct these therapy sessions. In fact, we conduct such sessions at least once in three to four months. We offer various therapy sessions on balance, simple movements like getting up from the bed, speech therapy, etc. We also conduct sessions with Yoga experts, physiotherapists, among others. Once a year on World Parkinson’s Day, we do a family get together and lunch and also host a Diwali Mela. These events help bring the patients and caregivers together, know each other, share thoughts, information, etc.
The membership to the group is open to all and costs Rs. 1000 for life membership. We currently have 180 members. We also offer counselling services. Many of us have first hand experience and can share that with the caregivers or patients. E.g., I lost my husband to Parkinson’s and he had it for almost 14 years. We see a lot of positive changes in the patients after they become part of this group. First of all, many are hesitant to try out new therapies or assisted therapies and it helps to speak to others and get encouraged if they have had a positive experience. It is a progressive disorder and different for everybody but patients and caregivers share concerns and doubts, notes on medication and other available alternative sources of treatment. It helps to be part of a group like this.
— Mayura Prahlad is Assistant Secretary, Parkinson’s Disease Society of Karnataka. To contact them, call 080-23332668 or visit their website http://www.parkinsonssocietykarnataka.com
LIST OF PARKINSON’S DISEASE SUPPORT GROUPS ACROSS INDIA
Mumbai (12 Support Centres)
Email: pdmds.india@gmail.com; Website: www.parkinsonssocietyindia.com
Tel.: 022-24977477; 9987216057
Goa
Panjim: YMCA International
Behind Parade Ground, Next to Home Science College, Campal
Mapusa: Emmaus Counseling Centre
Run by Carmelite Fathers, Reis Da Costa House, Feira Alta, Mapusa
Tel.: 0832-2268304; 9867259279; Email: pdmds.sg.goa@gmail.com
Nasik
Tel: 9225127770
Bhavnagar
PNR Society Hospital, Bhavnagar
C/o K.D. Padia
Tel: 09374865307
Bangalore
Jayamahal Extension
Tel: 080-23332668
Pune
Parkinson’s Mitra Mandal
C/o R H Karmarkar,1119 Sadashiv Peth,Chintamani Apts, Pune 411030
Tel: o20-24475718/09423338164
— By Reshmi Chakraborty
What’s the right amount of fat to have in your diet and how to balance the good fats. Dr Priyanka Rohatgi, Chief Clinical Nutritionist, Apollo Hospitals, debunks some myths for us.
For ages, health care professionals ,nutritionists and doctors have advocated that a low-fat diet is the key to losing weight, managing cholesterol and preventing health problems. We need to understand that it’s important to know that more than the amount of fat, it’s the types of fat you eat that really matter. Unhealthy fats increase cholesterol and your risk of certain diseases while good fats protect your heart and support overall health. The good fats—such as omega-3 fats—are essential to our physical and emotional health. A recent research shows that 90 per cent of us do not eat enough good fats. It has been proven as a medical fact that dietary fat can have a deleterious impact on the health and body composition, hence it’s essential to understand the fat quality in detail. We need to comprehend that when it comes to fats, they are not all created equal! And not all fats are bad either.
Olive oil is good for you. Pic: Silvertalkies
The Good, the bad and the ugly
The Good Fats are monounsaturated and polyunsaturated fats, which have a beneficial effect on your health and heart. The Bad Fat is Saturated Fat (Animal fat from meat and dairy) and The Really Bad Fats are Trans fats.
Though all fats are high in calories, the best choices for heart health are the monounsaturated, omega 3 fats and the polyunsaturated fats.
There are three different types of omega-3 fatty acids. Docosahexaenoic acid (DHA) and Eicosapentaenoic acid (EPA) are found in fish oil and Alpha-linolenic acid (ALA) is found in plant foods such as nuts, seeds and vegetable oils (especially flaxseed oil). Omega-3 fatty acids are not one single nutrient but a collection of EPA, ALA and DHA. Omega-3 fatty acids are proved to lower blood pressure, combat LDL (bad) cholesterol, fight inflammation and protect the brain and nervous system.
Omega 6 fats stimulate the inflammatory pathways and promote blood clotting. Omega 3 fatty acids on the other hand are anti-inflammatory in nature and thin the blood.
The Take Home Message
Healthy or good fats/oils come from unrefined vegetable sources or oily fish. Here are some basic guidelines for how to choose the best type of fat.
– For cooking, pomace olive oil, canola oil, soy oil or alternate between the blend of MUFA with PUFA.
– For salads -extra virgin olive oil. Olive-Pomace oil is made from the residue left after producing extra virgin olive oil (EVOO). It is the lowest grade of oil. If looking for the most health benefits, extra virgin wins out but EVOO is very sensitive to heat so is ideal for salads. For cooking specially in the Indian context where temperatures go beyond 180 C, Pomace Olive Oil is very suitable.
– Eat regular helpings of oily fish like salmon, mackerel, sardines and tuna if you are a non-vegetarian. Mackerel, salmon and sardines are commonly available in India and tuna is usually there in canned form. Sardines are priced as Rs 50 per kg. Indian Salmon is called Rawas, which is expensive but sold piece or slice wise as well and the advised intake is two pieces twice per week.
– Add pumpkin seeds, walnuts, and flax seed to your diet frequently, eat more greens and squash, use olive oil and some cold-pressed canola or walnut oil when cooking.
Note: Flax seed oil, hemp seed oil, canola oil and oily fish are great sources of one of the key essential fatty acids.
Flaxseeds are good for diabetics . Pic: Silvertalkies
Recommended Intake of Omega-3 Fatty Acids
Increasing the intake of omega-3 fatty acids will naturally bring the ratio of omega-3 and omega-6 fatty acids back into a healthier, 2:1 or (optimally) a 1:1 balance. Omega-6 oils are derived from Safflower, Sunflower, Corn, Soya, Pumpkin seeds and Wheatgerm. These are the oils that we generally need less of. Remember, however, that some Omega-6 oils are essential for optimum health. For the therapeutic supplementation, 2000 mg. of EPA and 1000 mg. of DHA per day is a common recommendation.
Dietary tips which can help to boost your EFA intake.
Precaution –Avoid eating excess of omega-6 and too little omega-3 as it causes clots and constricts arteries to increase risk for heart attacks, increases swelling to worsen arthritis, and aggravates a skin disease called psoriasis. It may also pose a resistance to the functioning of insulin, causing high insulin and blood sugar levels and obesity. It increases hormone levels of insulin like growth factor-1 that causes certain cancers.
To get your ratio on omega-6s to omega-3s back to a more healthful 2:1, eat seafood, whole grains, beans and other seeds and reduce your intake of foods made with or cooked in vegetable oils.
To get a list of oils that are good for you, click on the link below
Parkinson’s Disease is a a degenerative disorder of the central nervous system that often impairs a person’s balance and regular way of life. About 7 million people in India are said to be afflicted by it. Interestingly enough, researchers have found dance to be as effective as other forms of therapy for people with Parkinson’s Disease. To know more, Silvertalkies spoke to Devika Mehta, Dance Movement Psychotherapist and Clinical Psychologist. She conducts Dance and Movement Therapy sessions at Parkinsons Disease and Movement Disorder Society, Mumbai.
Dance can create new energy and enthusiasm
For people living with PD, exercise is vital in giving them a sense of balance and mobility. How does dance help in that regard?
Movements that I have employed in these past four years from initial exposure to dance to the current improvisational creative movement approach, all have in some way incorporated movements that are beneficial to their mobility as a primary objective. I have used rhythm to help with start hesitation and freezing, employing different body parts in isolated as well as synchronized body warm-ups and cool down activities. With the help of physiotherapists, some of the general basic movement patterns have been integrated with structured movements. This helps them to have a sense of routine with flexibility to move as much as their body allows.
Where are these classes held? Is there any special training you’ve taken on Dance and Movement Therapy (DMT) for Parkinsons?
The Dance and Movement Therapy sessions are held at all the support groups at the different venues which are hosted by Parkinson’s Disease and Movement Disorder Society (PDMDS) in Mumbai. We try and provide as much therapeutic benefit as we can in a community setting with both patients and their caregivers. I have a M.Sc in Dance Movement Psychotherapy from UK and am a registered professional member of the Association of Dance Movement Psychotherapy, UK.
Dance is seen as a joyful activity. For many people, exercise is a chore, something that has to be done because there’s no choice. Does dance help in creating a more positive mindset in them?
Dancing was seen initially as something that this generation (i.e., the elderly learners) would have enjoyed only at festive occasions. Seeing it as a potential treatment option was met with interest but hesitation at the same time. I initially started with very structured movements based on the research done by Madeleine E. Hackney in the United States of America, which employed the use of Tango to improve motility in Parkinson’s. I adapted it to the Indian cultural setting using Indian music and making use of my training in both Indian classical dance and MA Indian folk dance. This was met with enthusiasm by patients as well as caregivers attending the support groups and enjoying the ability to move and was evident in the full attendance that we had in the three months of intense movement therapy program offered. Patients are now able to feel confident in moving creatively and in a group setting.
What are the reasons that make you think people suffering from PD could benefit from dance therapy?
Since Parkinson’s is primarily a movement disorder, it is natural for the patients to see dance as a form to regain their movement. Apart from the physical motility aspect, which includes all the motor symptoms, like freezing, movement co-ordination and automaticity, Dance and Movement Therapy addresses co-morbid psychological issues as well. It helps with depression, social isolation, cognitive functioning, self esteem and self confidence. Research has supported all of the above. Parkinson’s Disease and Movement Disorder Society (PDMDS) did a pilot study within the organization to study the effect of dance on Parkinson’s. There was significant difference found in four out of the eight domains on the PDQ-39, a questionnaire used to assess different areas that are affected by Parkinson’s. These four were mobility, emotional well- being, activities of daily living and stigma. These clearly indicate that the dance program was successful if used effectively, keeping not only the physical but also psychological areas.
Dance therapy pictures courtesy: PDMDS & Devika Mehta
I have been involved in the use of dance with Parkinson’s with the support of PDMDS from the very beginning. My experience with it has inspired me to keep working with PD creatively and offer and develop different techniques that can benefit them psychologically and physically. The techniques which I have learnt in my training have got an encouraging response at home and are inductive to our cultural setting. After the intensive program, we received letters and positive feedback from both patients and their caregivers citing how dancing has changed their outlook, and movement. This program has given the patients a new lease of life and confidence to not shy away from social stigma. The caregivers have observed positive changes in their moods, and their motivation to come to the sessions. I have been a witness to see how every person has bloomed in the various sessions conducted, from tapping of the foot to music to encouraging each other to move and dance. It has been a positive change to accept dance therapy as a valid, complementary treatment option. It was fulfilling to see their faces lit up with joy and indulge in movements that were an effort for them before.
Is it difficult to convince the elderly PD patients to dance?
It is difficult to make anyone move whether it is elderly patients with PD or not. When we move in a group setting, we make ourselves vulnerable to the judgement of others and ourselves. Creating a safe space for the patients and caregivers, where they feel comfortable to move and are motivated, is crucial to the practice of Dance Movement Therapy. The idea of safe space is not just physical, where I make sure that they don’t fall or that they have the support of chairs and walls. Safe space also means making it safe for them to share emotions, to share memories that certain movements remind them of, to make sure that they don’t leave the space without feeling contained. Moving and Dancing taps into emotions and memories which the patients may not be ready to deal with or maybe find difficult. As a Dance therapist, my aim is to keep the space safe and contained. Once they feel accepted, comfortable and see others move, they attempt to move and many a times rediscover the love for movement.
What are the places where dance therapy for PD are held in India?
Dance Therapy is offered as part of the multidisciplinary model of (PDMDS) at the various support groups across Mumbai. For those patients who find it very difficult to move out of their house, Dance therapy can also be used to work within their home setting with creative means, which include art work, breathing and gestural movements.
For dance therapy and information about other cities contact:
Parkinson’s Disease and Movement Disorder Society
c/o Dr. B.S. Singhal
Room 131, Bombay Hospital
12 Marine Lines, Mumbai – 400 020
Email: pdmds.india@gmail.com; Website: www.parkinsonssocietyindia.com;
Tel.: 022-24977477; 9987216057
— Reshmi Chakraborty
Getting in and out of the bed is often a task for many elderly, especially those who have conditions that limit their mobility. There are also chances of falls that may worsen the situation further. However, bedroom aids can come to your rescue, says Dr Nidhi Kumar.
Aids or assistive devices help in performing activities of daily living for many elders. These can be categorized into sub groups depending upon their usage, e.g. mobility aids, bathroom aids, toileting aids, household aids, dressing aids, etc. In a continuing series on aids for elders, consultant physiotherapist Dr Nidhi Kumar focuses on bedroom aids.
Here are some mobility and disability aids for the bedroom:
Knee support: The knee support provides optimum comfort and pressure relief for the lower back and hips. It helps keep the back in the natural ‘S’ shape during sleep. It is secured in place with a ‘touch close’ fastening and covered with a soft polyester fleece.
Bed rails: Bed rails and bars help people to get in and out of bed easily. These supports can be an important means for people to retain their independence in the bedroom. A bed rail can either be fixed to the bed itself, or slid beneath the mattress, depending on the model.
Water proof bedding: This is used for people with incontinence. It is easy to care, wipe or wash with a disinfectant solution. The fabric contains bacteriostat/fungistat to prevent the growth of germs. It is flame retardant for added safety.
Reacher: It is used to pick up small items securely with minimal finger flexion. It features a lightweight shaft and an easy-to-close hand grip.
Mattress tilt: The Mattress Tilt is used under the mattress at the bottom of the bed to relieve the symptoms of swollen ankles, varicose veins or lower back pain. Alternatively, it can be used under the mattress at the top of the bed to relieve respiratory problems.
Cot sides: The correct use of a cot side is to create a solid barrier to prevent the sleeper from falling out of bed. The falls and their fatal effects have been discussed in an earlier article here.
Glide sheets: Glide sheets ensure a smooth glide between two surfaces, thus reducing skin friction for the patient and strain on the carer. The smart sheet has handles along the sides and on both ends to aid the carer’s grip.
Bed sitter: This is an ingenious armchair shaped comfort support that helps maintain an upright comfortable position when sitting up in bed.
Incontinence pads: For medium to heavy incontinence, these pads are widely used by patients. The shape is anatomic and ensures comfort and leakage prevention.
Tap turner: The innovative design of the tap turner makes operating taps easier. These are durable and multi-functional devices to help users with weak hand strength to operate taps. The handle has a rubber moulding to give a firm and controllable grip. They are made of plastic, and are therefore rust proof and always warm to the touch. They have colour coded handles to clearly identify hot and cold taps and are an economical alternative to replacing taps.
Key turner: Keys are usually thin and slender and require fine motor movements. Thus these are ideal for persons with arthritis or a weak/ unstable grip.
Plug pull: These make electrical sockets much easier to use. Plug pulls or pullers make use of loops in the handles to increase leverage for those with poor grip. These are self-adhesive plastic pieces attached at the back of a three pin plug.
Where to buy: Here are a few links that you can check out to source assistive aid devices in India. Kindly note that we aren’t affiliated with any of these websites offering assistive aid devices. Please do your own research about them before you proceed.
http://kosmochem.com/index.aspx
http://www.thirdlegmobility.com/
All images courtesy: Dr Nidhi Kumar. To read about more assistive aids, click here and here
Not knowing about the ailment one is suffering from can be daunting. Silvertalkies strives to speak to experts to bring you answers to myriad questions that you may have about an ailment. This month we cover Prostate Cancer.
Nidhi Chawla Manoj interviewed Dr. Ali Poonavala, Urologist and Co-Director, Alfa Clinic and Dr. Anoop Amarnath, Director and Consultant, Geriatric Medicine, Apollo Hospitals.
1. What is prostate cancer?
Lets first understand what is Prostate gland. Prostate is a walnut sized solid structure below the urinary bladder, surrounding the urethra, the tube through which urine is discharged outside (Fig. 1). Prostate is made up of microscopic balloons (prostatic acini) which make the prostatic fluid. Structured like a tree, Acini are connected by channels (ducts) which finally empty in the urethra.
(Fig. 1 – Anatomy of the Prostate Gland. Source – Wikipedia)
In the lining of tiny balloons, there is continuous turnover of the cells making the fluid, old ones near surface die, being replaced by new cells from bottom. This well controlled process in some acini gets rebellious, new cells forming faster than required and not forming fluid. This is beginning of prostate cancer.
2. How prevalent is prostate cancer in men? Is any age group more susceptible?
Prostate cancer prevalence is a very interesting topic. There are wide variations between countries and different races within a country. USA reports highest incidence of 272 patients /100,000 in African descendants, falling to 170/100,000 in whites while Tianjin province in China has only 1.9 cases per 100,000 per year! 1 Indian Cancer Registries have recorded incidence of 6-10 per 100,000 and trend seems to be on the rise.2
Regarding age, it is rare before age 50 (< 0.1% of all patients) but peaks between 70-74 years of age. 85% patients are diagnosed after the age of 65 years. 1 However, a word of caution: some may have prostate cancer but will not come to any harm due to it, as it is so called dormant disease.
Fig 3. Variation in various cancers’ incidence between USA and India3
3. What causes prostate cancer? Can it be hereditary? Does lifestyle have a bearing?
We do not know. However, both genetic and life style contribute. Apart from race related variations as mentioned above, there is familial propensity too. For example, risk of having prostate cancer doubles if father or brother had been diagnosed with prostate cancer but quadruples, if both have /had it.
4. What are prostate cancer symptoms and signs?
It is very important to realise that all prostate cancer do not progress. Early curable prostate cancer, unfortunately, produces no symptoms. It is picked up either by screening test or incidentally, when a physician feels the prostate by DRE (Digital Rectal Examination).
Once cancer grows, urinary symptoms like difficulty in passing urine, frequency of urine, blood in urine and even retention (inability to pass urine) may occur. Untreated retention can cause kidney failure too. Rectum may be involved, causing constipation. Symptoms may occur only due to spread of the disease. Pain in the bladder area due to pelvic spread, back ache and even fractures can occur. If a vertebra is affected, even paraplegia can occur.
5. How critical can it be? Is it largely confined to the gland or can it spread?
It is a serious disease and if not detected and treated early, it can spread. Commonest area of spread is to lymph nodes (infection check posts) and axial bones, like spine and pelvic girdle.
6. How is prostate cancer diagnosed?
Prostate cancer is diagnosed by examining prostate tissue under a microscope by a pathologist. This tissue is generally obtained by taking biopsies with a needle or during surgery for retention.
7. Are there any screening tests available to keep a regular tab on it?
The most common screening test is a blood test called serum PSA (Prostate Specific Antigen).
8. What is the recommended norm for these screening tests and how reliable are they?
PSA is a very useful test for follow up of a patient who has been treated for prostate cancer. However, for diagnosis of prostate cancer, it is not reliable. It is increased in any disease affecting the prostate including infections, benign diseases, retention, even DRE.
Recommendations for PSA as a screening test are in a flux due to its inherent limitations as mentioned above and our inability to differentiate between biologically inert and aggressive cancers. However, if a family member is diagnosed to have prostate cancer, PSA testing in male members is recommended early. Advantages and disadvantages of screening must be discussed before embarking on it. There is no blanket approval for indiscriminate use of screening.
9. Can prostate cancer be prevented?
Trials are in progress to see if compounds like Finasteride, Selenium, Vitamin E, Soy, Lycopene and Green tea can be used to prevent cancer prostate.
10. What are different stages of this cancer?
Generally, it starts as a focus in outer part of the gland. In first stage it is entirely confined to the gland. Next, it spreads to seminal vesicles (semen warehouse). Lymph nodes and bone or liver spread are further progression avenues. Serum PSA value, Histological grade, CT or MRI scan as well as bone scan are the tests to define the stage.
11. What are the treatment options available?
Treatment options have to take into account age of the patient, Serum PSA at diagnosis, Histological grading and staging test results.
Early disease, which is organ confined, is curable. In general, the disease runs less aggressive, indolent course in elderly patients (80+) compared to younger (50-65) individuals. Active surveillance, which means observation till it is clear that this is biologically aggressive, is good option for some patients. Other methods to cure include surgery and radiotherapy. Advanced disease cannot be cured and only treated to contain it. Initially Hormone therapy and later, chemotherapy are used for limiting advanced disease.
12. Could you please elaborate on benefits and risks of each treatment?
Surgery: Benefit is the immediate removal of cancer with lymph nodes (check posts) which helps in final staging. Risks include those of a major operation, i.e. bleeding, infection, lung and heart complications etc. Peculiar and distressing problem include losing control over urination (incontinence) and impotence. Generally, these are temporary but for about 10%, may be lifelong.
Radiotherapy: Obvious advantage is avoiding a major surgery with risks as mentioned. However, there is no confirmation of cure and no final staging since no tissue is available. Apart from early irritating urinary frequency and diarrhoea which improves, incontinence and impotence sometimes is seen later on. There is also small risk of developing other type of cancer due to radiotherapy itself.
13. Is surgical removal of the gland beneficial?
In younger patients with aggressive disease, surgery offers better cure rates than radiotherapy does.
14. Are there any alternate forms of treatment available?
Cryotherapy (using liquid Argon gas to freeze tissue), RF (Radio Frequency) ablation, and HIFU (High Intensity Focussed Ultrasound) are being used in some selected cases.
15. How long is the recovery period?
Since patient may have different forms of treatment depending on the extent and age, it is difficult to give approximate time frame here. Surgery, especially keyhole type, is associated with excellent recovery in experienced hands. Within 2-3 weeks of catheter removal, urinary control becomes acceptable in upto 95% patients.
16. Are there any chances of relapse and in what form?
Relapse is rare in early stages and common as the disease stage is higher on initial presentation. If surgery was the initial therapy, distant relapse (metastasis) is seen, generally in bones of spine or in lungs or liver. After radiotherapy, both, local and distance failure occurs.
17. Once treated does one requires regular check-ups to look out for relapse?
Absolutely necessary to have a good follow up with the treating team of Physician, Urologist and Oncologist. Depending on the progress, initially 3 monthly and later 6-12 monthly assessments are done to detect relapses early. Further treatment can be given while disease volume is low and patient is fitter.
If Hormone treatment has to be given, there can be significant loss of bone and that can lead to fracture of hip or spine. So these patients need regular Blood Calcium and Bone Density tests and treatment and exercises to prevent bone loss.
18. How does prostate cancer affect a patient?
Though so intimately associated with the urinary system, Prostate is a sexual organ and has no role, except being a nuisance, for the urinary tract!
Prostatic fluid is part of semen. This fluid has substances (proteases) which liquefy coagulated semen and help to sustain the sperm’s journey, from vagina, through the uterus, towards the ovum. Prostate gland function is regulated by the male hormone testosterone.
Since the disease affects a very critical area of bodily function and involves sexual health too, self-image of the patient may take a beating especially if he suffers from complications like impotence or incontinence. One may need to wear diapers on a day to day basis and may find simple activities, like morning walks restrictive as it makes leak worse.
Prostate cancer being a disease of elderly, there are medical financial and social issues which may have considerable impact on the choice of treatment apart from the disease related factors.
19. Any advice for patients of prostate cancer?
They must make friends with this enemy within. Seek expert advice as well as help from support groups. Define priorities. Do your home-work. Do not hesitate to question treatment plans.
Above all, be optimist. Be positive. Remember, most (75%) prostate cancer patients live long enough with their cancer.
Acknowledgement:
1.Campbell and Walsh Text book of Urology 9th Edition 2008 Ed in Chief Alan Wein vol.3 chapters 90-105.2854-3117
2.Trends in the Prostate Cancer Incidence in India. Balkrishna B YeoleAsian Pacific J Cancer Prev, 9, 141-144
3.Cancer Scenario in India with Future Perspectives Imran Ali*, Waseem A. Wani and Kishwar Saleem Cancer Therapy Vol 8, 56-70, 2011.
About the expert: Dr. Ali Poonawala is co-Director of Alfa Clinic, (www.alfaclinic.net ) Fertility, Maternity and Urology Centre in Bangalore and is a visiting consultant since 1993 and Head of Department of Urology at St. Martha’s Hospital since 1995. Being a General Urologist, Prostate and Kidney Stones are his primary work areas; Laparoscopic Urological work and Male Infertility are closer to his heart. He is also President elect of Karnataka Urologists Association (KUA) for 2014-15. He loves cycling and uses it for daily commuting to work, come rain or shine!
About the expert: Dr. Anoop Amarnath is Director and Consultant, Geriatric Medicine, Apollo Hospitals, Bangalore. He has a specialisation in Geriatric Medicine from the Royal College London with certification in Geriatric Nephrology from the American Society of Nephrology and has been practicing since 2004.
Travel is fun, eye-opening but also strenuous at times. A little pre-planning and research however goes a long way in making it comfortable. We bring you senior-friendly travel tips, culled from industry experts and much travelled seniors.
Bangaram Island, Lakshadweep. Pic: Silvertalkies
Travel is fun but it can also be strenuous for most of us, especially if it involves packed itineraries, lengthy rides or long hours of flying. These days, travel isn’t restricted to the younger lot. Seniors are not just traveling to visit children and relatives living in other states or countries but also exploring India and the world on their own. We spoke to some travel savvy seniors and professionals from the travel industry to bring you some tips.
Deciding an itinerary
Choose a terrain that suits your health too. Pic: Silvertalkies
If you are travelling for leisure, whether in India or abroad, choose an itinerary that takes into account factors like the destination’s climate, terrain, accessibility, safety factors and most importantly, your own mobility and health, say industry experts and senior travelers. E.g., if you have respiratory issues or breathlessness, perhaps places like Ladakh or Kailash-Mansarovar are best left out of the plan, advises Jiwan Prakash, 68, an ardent mountain lover from Lucknow, adding that there are several other places that could fit in.
Pallavi Shah, 70, of the travel service called Our Personal Guest, advises getting yourself the services of a good travel agent, who is savvy enough to figure out your needs and requirements or doing thorough research, especially if you are travelling for leisure. Ms Shah herself has travelled all over despite severe health issues. “If mobility is an issue or you are on a wheelchair, cruises make a great option,” she suggests. “There’s enough action going on within the ship to keep you engaged even if you avoid the shore excursions, although, while sightseeing, you can be wheeled off the cruise ship. Also in case of mobility issues, all good cruise lines are mandated to have handicap cabins,” she adds. Ms Shah recommends that while designing an itinerary, you need to take into account the extent of mobility requirement, whether you choose to do your own planning or outsource it. “Look for resorts or hotels that are largely on flat land. It’s important to know the terrain and your capacity, the kind of help you have and your expectations,” she mentions.
Do your own research to get the best out of your holiday. Pic: Silvertalkies
Research, research, research. Says seasoned traveler Indrajit Chatterjee, 64, says you need to take your health into account when deciding whether your itinerary should include group travel as a slower pace can slow down the entire group. Bhavna Mehta, 66, prefers destinations that have ample scope for Indian food due to her food preferences. “I’m a Jain and though most of my relatives prefer group tours, me and my husband like to travel on our own, whether in India or abroad. One of the first things I research is the kind of food available and vegetarian restaurants.” If food is an issue, Mrs. Mehta packs some dry edible items and goes on a largely fruit based diet while on the move. “It’s best to be prepared while travelling at our age,” is the motto she follows.
In other words, keep personal preferences, health and your physical capacity in mind when chalking out your travel plan. One great tip from industry experts is to ask for special offers and assistance for seniors from airlines, hotels and cruise lines. “Indians often hesitate before asking but in my experience assistance is often provided in genuine cases. In some cases you may need to pay a fee while some are free. I’d suggest seniors to ask,” says Mala S, who works for a travel agency.
Mrs Mehta seconds this. “I had food specially prepared for us without onion-garlic in a small restaurant in Arunachal Pradesh, where the cuisine is largely non vegetarian. Not just airlines, usually regular people also comply to requests if asked nicely,” she feels.
Packing
Pack light, comes the unanimous reply from travel savvy seniors. Kolkata’s Jaya Mukherji, 69, regularly visits her three children spread across Mumbai, Manipal and Singapore and says not packing double of everything saves a lot of trouble. “Plus most things are available now everywhere, so you can buy if needed.” However medicines are what everyone advises to pack in copious quantities. “Take emergency and as well essential medicines, especially those special branded drugs which you may not get easily,” suggests Hyderabad’s Dr Padmanabha Vyasamoorthy, who does a fair bit of domestic travel. Mr Chatterjee suggests that you start packing at least seven days earlier, especially if it’s an international trip and buy a weighing scale/luggage scale, available online at stores like http://stores.ebay.in
Here are some packing tips we collated from all our senior experts.
Things to remember
Even if you have you have travelled to the same destination several times, there is still a chance of forgetting things behind. Here are some useful guidelines that people we spoke to shared with us:
International travel
Many seniors across India cross the oceans to visit their children living overseas. Several seniors are now also going on overseas tours, whether as part of a tour group or on their own. Unless your family is based in Asia, international travel to Europe, Australia, UK or US involves long haul flights and could be stressful for those who aren’t prepared. One of the first things our travel savvy seniors and industry experts recommend is to ask for wheelchair assistance at the airport as it gets you help at immigration and several other check points that could be daunting for first time travellers. Also remember that most international airports have quite some distance from the security check to the boarding gate, making it difficult for those who are not able to walk properly. If you are uncomfortable with the wheelchair idea, most airports also have an electric cart to ferry passengers from gate to gate and you could avail that service. Follow Ms Mala’s ask and you shall receive tip above. “There’s no shame in asking. The first time I travelled abroad was Singapore seven years ago and though I was jittery inside, I managed everything simply because I asked around constantly,” says Mrs Mukherji. “Many people our age find it difficult to read signage at airports, so I think it’s best to ask.”
Laminated card with all your details. Pic courtesy: Indrajit Chatterjee
Mr Chatterjee prefers local hotels and travel operators when he is travelling overseas as he feels they offer a more relaxed pace of travel. He also advises picking up a local guide in countries with a language problem. Also recommended is writing down all your details (from passport number to destination address, flight number, telephone numbers, etc.,) in a piece of paper. Mr Chatterjee and Ms Shah advise getting it laminated and keeping it on your person. It saves you time while filling in forms and the hassle of taking out your passport or boarding pass every time. “You only need to produce the actual passport during check in and immigration, so if you have a document with all the info handy, it takes less time to fill up your form,” says Ms Shah. It also minimizes the chances of losing your passport. Mr Chatterjee advises that you research baggage and transit rules and whether you need to transfer from one terminal to another in case of different connections. Recommendations also come for making several copies of your passport, keeping few with yourself and also leaving some with your loved ones.
Ms Shah suggests keeping documents in a sling bag across the body as they are easily accessible.
Ramma Basappa of Marco Polo Travels Bangalore, recommends asking for the aisle seat. “Exit rows typically have more legroom. I would also suggest choosing seating close to the washroom; ask elders to carry one piece of hand luggage, drink lots of water in the flight, etc.” All experts suggest walking up and down the aisle a few times if you are on a long haul flight. When it comes to travel insurance for elders, Ms Basappa mentions that pre-existing ailments are not covered and people post 60 need to get a medical checkup done to certify good health. There are different kinds of insurance, like Gold Plan, Silver Plan, etc, depending on the amount of coverage you want. Mr Chatterjee goes in for cashless comprehensive insurance covering actuals from a US based company as he feels it is more efficient.
Industry professionals feel that it is easier for many seniors, especially those travelling overseas for the first time to outsource travel planning to a professional travel agent as Visa and documentation and even searching for the best airfare is often cumbersome and children are not always free to help. Mr. Chatterjee suggests keeping currency of different countries if you are travelling to several places. “Keep phone number of any contacts in those countries and currency. If you need to call, have loose change handy,” he says, adding further, “carry enough dollars in case you get stranded by flight delays or cancellations. See if the country of transit needs a temporary visa from beforehand.”
The Last Word
“Old age is meant for activity because I don’t have to worry about holidays or work,” says the super-active Jaya Mukherji, who is planning her Mumbai trip. She plans to visit the Ajanta Caves in Aurangabad this year. Would it prove to be a tough task considering she has knee pain often? “I’ll give it a try, if I can’t climb up or walk that much, the others will go ahead and I’ll wait or hire a doli (a chair carried by four men). I wouldn’t know unless I go, would I?” she retorts, proving that it’s the spirit that matters the most when it comes to travel. The rest of the details can be arranged later.
Here’s a list of travel websites to check out
E-Ticketing: http://www.makemytrip.com/ http://www.cleartrip.com/ http://www.expedia.co.in/
Hotels: http://www.hotels.com/ http://www.booking.com/
Travel info and reviews: http://www.tripadvisor.in/ http://www.lonelyplanet.com/
Silvertalkies spoke to several seniors and industry experts for this article, all of whom provided useful information and guidance that went into the article. While we’ve been able to quote some of them, here are the people whom we’d like to thank:
Ms Pallavi Shah, Our Personal Guest
Ms Ramma Basappa www.marcopolotravelsindia.com
Mr Indrajit Chatterjee
Mr Padmanabha Vyasamoorthy
Mrs Bhavna Mehta
Mrs Jaya Mukherji
Mr Jiwan Prakash
— By Reshmi Chakraborty
Dr Anjali Agarwal is a consultant physiotherapist and lifestyle counselor who works with several elderly patients suffering from Parkinson’s Disease. Here she writes a first person account of her rehabilitation work with a patient aged 75 years.
This is a story of my patient, let’s call her Mrs X. She is 75 years old, lives with her husband and is completely dependent on her family that includes son and daughter in law. She has been suffering from Parkinson’s Disease since the year 2010. As her physiotherapist, I have been observing her situation improve over the past two months. This article is a chronicle of the efforts involved to bring about that improvement.
Being financially dependent on the son made Mrs X quite aware of the fact that she would have to spend a lot on her rehabilitation process. According to my study, the elderly lady had been postponing her rehabilitation for almost three years. In fact, I was surprised by her unwillingness to do any exercise.
Since she liked having visitors, left on her own she would be depressed, feel rejected by the family and would have suicidal thoughts, which made her feel quite isolated and worthless.
Given her age, she had multiple ailments and one of the things that troubled her was an extremely painful and swollen knee. Parkinson’s Disease would freeze her knees during the early hours in the morning and her entire schedule, starting from having her breakfast to going to the washroom and having her medications would become a daunting task to complete.
Her husband, himself a post bypass patient, tried his level best to become her carer. There was also a female help who would feed her, assist her to the washroom and help with other basic requirements.
However, being totally bedridden made Mrs X lose confidence to bear any weight on her legs and she would shout in pain and surrender before completing her exercise routine. Each day was a challenge for both me and her. But her caring husband would inspire her day in and day out to continue with the rehabilitation process.
My plan of rehabilitation for Mrs X involved helping her to get independent and also feel valued and respected by her family members, who often felt that she should be like many of the other elderly people who help around the household.My involvement with her as a health care professional wasn’t just limited to her rehabilitation but also involved ensuring that the situational stress in the house did not leave her psycho-social issues unanswered.
For her physical rehabilitation within the home setting, I started with:
1) Strengthening exercises for her quads and hams, straight leg raises and a bit of stretching. A Parkinson’s patient would require stretching exercises on a daily basis.
2) Sit to stand exercises on a sturdy chair, with commands of up and down.
3) Balance Training and fall prevention exercises: We helped the lady get a walker with a seat and wheels that made her quite confident to walk around the house and helped her painful knee.
4) Balance on an exercise ball: She was hesitant initially to even sit on the ball but day in and day out there was a marked spike in her confidence levels and eventually, she exercised balancing on the 55 cm exercise ball and her worry that she would fall got answered.
5) Pain Management: She had painful knees and had severe osteoarthritis. I used Transcutaneous electrical nerve stimulator (TENS), which would help to block her pain.
6) Bridges, Spinal extensions: Lying on the bed the whole day made her lose a lot of strength with regards to her abdominal and spinal ex tensor muscles, I would make her do spinal bridges and static spinal along with pelvic tilts which helped her get some mobility around the trunk region.
7) Calf stretches: She would drag her feet while walking which resulted in some shortening of the tendoachilles and made her peroneal muscles very weak. We worked on doing calf stretching and and peroneal muscle stretching as well.
8) Gait Training: The simple quick fix solution to her freezing problem was taught to her. The command which I generally verbalized loud to her was, Heel, Strike, Heel, Heel and made her walk with bigger steps on to the square marking on the floor. She was educated to understand that if an occasion arises where she feels she is losing balance because of the freezing, she should stop and try imagining putting her heel on a stair step or a book. The key word would be Lift Up Heel.
9) Cognitive skills: I would give her a shirt to button and unbutton and a zipped bag to open and lock. I also gave her a mixture of rice and dal to separate in different boxes.
10) Facial exercise: I asked her to smile as often as possible and to chew her food slowly.
11) Posture Care: Mrs X would stoop forward and that made her prone to falls. She was advised to stand straight, focusing on squeezing her shoulder blades. Though initially she found this real hard, with practice she showed drastic improvement.
12) Relaxation exercises: Her Breathing exercises included Abdominal breathing, Diaphragmatic breathing and Progressive Muscular Relaxation. I asked her to do them whenever she thought she was getting negative thoughts.
13) Lifestyle Modification: Inclusion of a walking aid like rollator walker, feeding and eating aids with bigger grip and more stable cutlery, plates and glasses helped her feel more independent. Dressing and washing herself after the correct guidelines of having her medications on proper timings helped her a lot.
Mrs X’s real challenge to date has been her inability to go out of the house or just to go to a temple. She feels isolated more so because she feels like nobody would respect her special needs and limitations. Thankfully, her husband plays an important role as a carer and he is considerably focused towards her Rehabilitation.
Her family, especially son and daughter in law were given counseling to understand the situation around Parkinson’s. They have now understood the lady’s predicament and are accepting her situation gradually.
My reason behind writing this article is to tell everyone how getting help from a professional is of paramount importance. It can become too difficult for the family, carer or the patient herself/himself to cope with Parkinson’s Disease symptoms all alone without adequate guidance and support.
Aids or assistive devices help in performing activities of daily living for many elders. These can be categorized into sub groups depending upon their usage, e.g. mobility aids, bathroom aids, toileting aids, household aids, dressing aids, etc. In the first of a series on aids for elders, consultant physiotherapist Dr Nidhi Kumar focuses on bathroom aids.
Disability aids for the bathroom can be important tools for those elders looking forward to retaining independence at home, especially while recovering from a surgery or ailment. These are also useful for elders who have difficulty with walking, sitting or getting up. These aids include toileting aids, bathing aids, grab rails, etc.
Here’s a detailed look at them:
Toileting aids
These are aids used in the toilet. They aid the user in providing support, stability, etc. Here’s a short list:
A) Toilet frames: Robust and versatile frames which can be used as toilet surround, toilet frame or a shower seat. These are designed to give support on all three sides for extra stability, especially for patients who suffer from postural hypotension, balance dysfunction, etc. These are adjustable in height and width.
B) Raised toilet seat- these are used by subjects whose spinal movements are compromised or those with hip or knee arthritic conditions. These are extremely comfortable and ideal for those requiring pressure relief. These are easy to
fit as these do not require screw fixing. These are very hygienic & easy to clean due to the tough plastic skin.
C) Commodes-the commodes come complete with a toilet seat, pan & a lid. These are available in either adjustable or fixed height.
Bathing aids
These aids are used to ease the task of bathing. Here they are:
A) Bath seats and cushions: A tough, moulded plastic stool type seat is used for maximum security in water. The seat may have holes for drainage and a particular cut away for easier personal cleaning. The seat is contoured for comfort and may be adjustable in height, using extension legs. These seats can be fixed to bath using large suckers/vaccums.
B) Bath Boards: These are strong boards that provide a stable platform across the bath tub. These are usually slated to allow drainage of water adding an anti slippage feature to it. These fit securely over the bath and are usually made of high quality plastic that is easy to clean. These add stability and balance to the user when they are moving in and out of the bath. Usually indicated for patients who can’t bend or sit at a low height. Handle is an optional feature.
C) Bath steps: These are used for safe and easy bath access by reducing the danger of falling in the bathroom. These are usually made up of anti-slip material and indicated for patients with hip and knee pathology who cannot raise the leg too high or who cannot maintain balance on a single leg while moving in and out of the bath.
D) Wall mounted shower seats: These shower seats allow users to be seated comfortably while in the shower. These are indicated for patients who cannot stand for long or often have vertigo attacks. These have foldable frames that enable the seat to be easily stored away when not in use.
E) Bath mats: A safety essential for the bathroom since slippery bath tubs and bath surfaces can be extremely hazardous. These are usually made up of soft rubber that provides anti-slip protection. It is securely held in its place by suction cups on the underside of the mat. These can be used in showers too.
F) Bath safety strips- these can be used for all bath shapes and sizes. They are made from soft textured rubber and are adhesive backed for easy installation. These are non-abrasive and prevent any damage to the skin. They have a textured coating to provide an effective non slip surface yet have a comfortable surface for walking barefoot.
These rails and supports help in a variety of tasks around the bathroom, stairs, bedroom, etc. These rails provide better grip for wet hands or damp conditions. These provide stability and support while standing, sitting or walking. These bars can be fitted horizontally, vertically or at any chosen diagonal angle.
Here are a few links that you can check out to source assistive aids
All images courtesy: Dr Nidhi Kumar
Aids or assistive devices help in performing activities of daily living for many elders. These can be categorized into sub groups depending upon their usage, e.g. mobility aids, bathroom aids, toileting aids, household aids, dressing aids, etc. In the first of a series on aids for elders, consultant physiotherapist Dr Nidhi Kumar focuses on mobility aids.
Mobility Aids are devices designed to assist walking or otherwise improve the mobility of people. The phrase mainly applies to low technology mechanical devices.
These can be categorized widely into:
Cane/walking stick: The simplest form of a walking aid. It is held in the hand and can be made up of different materials, e.g., wood, bamboo, metal alloys, etc. The metal ones are more suitable as they are adjustable and come with varied base of support, i.e., a tripod or a quadripod.
A stick is mostly divided into 3 parts: handle, shaft and a base. The handle can be of varies types for gentle palm support. The shaft can be of adjustable height and may also be foldable. The base plays vital role in stabilization, e.g., a tripod (3 legged) or a tetrapod (4 legged) with large or small base provides stability and sturdy support.
Crutches: There are three basic types that are used to reduce weight bearing on one or both legs or to give additional support where balance is impaired and strength is inadequate. The use of crutches requires adequate hand grip and sufficient power in shoulder and elbow muscles. These should be thoroughly assessed to determine the type of crutch to be used. Here are the different types:
Axillary Crutches: Made of wood or metal with an axillary pad and a hand piece. The total length is usually adjustable.
Elbow Crutches: Made of metal and have a plastic/metal forearm band. These are particularly suitable for patients with good balance & strong arms.
Forearm Gutter Crutches: Made of metal with a padded forearm support and strap, an adjustable hand piece and a rubber ferrule. These are mainly used by patients with Rheumatoid disease, who have some form of deformity and/or pain.
The Safety Factor
All the aids must checked by physiotherapist, not only while giving them to the patient but throughout the treatment or on a regular basis later. The user must be taught to inspect his or her walking aids and know where to obtain replacement parts. Ferrules which are made up of rubber or plastic should be rough to give a high co-efficient of friction. Good ferrules have added benefit of circular grooved rings on the base to increase the grip performance especially in wet conditions. Examine these regularly and replace as and when required.
The general structure including screws, metal clips, press buttons, hand grips and axillary pads must all be in good condition.
ADVANTAGES OF MOBILITY AIDS
All images courtesy: Dr Nidhi Kumar
Dr Srikala Bharath is a Professor at Department of Psychiatry, NIMHANS (Bangalore) and Consultant – Adult and Old Age Psychiatric Services, NIMHANS. She is also a Consultant in Life Skills Education, having developed a model of School Mental Health Program to improve psycho social competence in adolescents by training teachers or school counselors. Silver Talkies met her to find out more about the psychological issues facing the elderly.
What are the most common psychological ailments among the elderly that you come across the most?
SB: Depression and dementia; other conditions are old age onset major illness like psychosis and mania. Medical conditions like diabetes or cancer and social events like bereavement are associated with depression and other psychological problems, etc.
Depression and loneliness are said to be two of the main psychological factors affecting the elderly today. What are your views on this?
SB: Yes depression is the most common psychological condition among adults and especially the old. Loneliness is one of the important social factors associated with depressive symptoms. Disability is the other physical factor that is associated with depressive symptoms. Disability can be described as anything that restricts one’s ability to function at full potential.
What are the other factors that usually lead to depression?
SB: There are many other socio-econiomic, medical and biological conditions that can lead to depression. Depression is of different type – it could be mild or severe, long lasting or brief. Factors like economic constraints or loans, death of a spouse, friends, retirement; medical conditions like diabetes, stroke, hypothyroidism, Parkinson’s disease, isolation and restriction of activities due to disability like hearing/visual impairment, osteoarthritis; past history of depression and many family members (siblings and parents) suffering from depression are all associated with it. In short, there could be genetic or medical or social risk factors for depression. A person’s coping strategies, if poor, could also lead to depression. It needs to be remembered that depressive symptoms are more common than Depressive Disorder.
Very often depression goes un-diagnosed as family members are not aware of the signs or do not wish to acknowledge it. What are the typical signs they should be on the lookout for?
SB: To be called Depressive Disorder, a group of symptoms need to be more or less continuously present for more than 15 days to one month and affect the functioning of the person. Loss of sleep, loss of appetite, weight loss, feeling sad continuously despite efforts to change it, negative thoughts, hopeless, death wishes that are predominant over the days would be some. Crying spells, significant slowing of activities and speech, disinterest in daily activities will also be present. Depression is diagnosed by a combination of symptoms and signs and not by the presence of a symptom that lasts for a day or two.
Loneliness is often unavoidable in old age as children move away on jobs and the elderly person may lose his/her spouse. What would your advice be to elders to combat loneliness?
SB: Prepare for children leaving home. Widen social network. Be part of local social activities. Exercise on a regular basis with others. Have active hobbies like learning a new language, games, skill like singing, etc. Be involved in volunteering work. Being part of support groups help too. These could be local senior citizen forums, bhajan groups, walking groups, laughter clubs, etc.
What is a good way to keep the brain active and engaged for the elderly?
SB: Reading, puzzles, learning a new skill like a new language or computer skills. Learning to draw or paint.
Dementia also affects the elderly often. What are the signs the family needs to watch out for?
SB: Forgetting is the most common sign. Poor memory to recent events when compared to old memories is the cardinal sign. Important aspect of forgetting in dementia is that many of them are not even aware that they are forgetting. Some are aware. Forgetting should also interfere in their daily activities to ring alarm bells. This is common in Alzheimer’s Type of dementia. There are other types of dementia too.
Is dementia avoidable by taking certain steps or at least can the process be slowed down?
SB: What is good for your heart is also good for the brain. Have medical checkups on an annual basis. Keep diabetes and hypertension under control. Exercise. Reduce weight if obese. Stop smoking. Eat a healthy high fibre diet. Take care of the lipids/triglycerides, not just cholesterol. Take supplements like vitamins as many elderly vegetarians have Vitamin B12 and Folic Acid deficiency. Keep yourself intellectually active. Learn new skills. Be socially connected. Plan for old age. Volunteer.
In India many people are still wary of visiting a psychiatrist or mental health clinic. Does that become a hindrance in the way of help?
SB: Yes response to a treatment is better when a condition is treated early. Most of the cases of dementia in our clinic come to us in the severe stage when the drugs used for slowing down the process are not that effective. In such cases, working with the patients is not of much help. We can provide emotional support and guidance to the carers predominantly. If the patients are brought in earlier then medication can be started for slowing down the deterioration, prevent behavioral problems, etc.
When it comes to aged parents, are there certain things even very busy children must keep in mind?
SB: Very often children become the advisory panel. They don’t have the time but are ready to advice. I’d suggest that you look at your inventory of time spent with your parents. Are you just doling out medicine, money and driver? Or are also spending time with them, talking, walking, etc.
Tell us a little about the services for the elderly offered by NIMHANS?
SB: The Dept. of Psychiatry runs a Geriatric Clinic every Saturday from 2 pm onwards. This is a clinic meant for the elderly above the age of 55 or 60 years. The issues dealt with include dementia, depression, psychosis, chronic pain, etc. Elderly are advised to contact us on Saturdays after 2 pm at the Psychiatric Outpatient Services for any psychological issue. Depending on the need, after a screening, they are sent for a detailed evaluation or registration. We have about 250-300 registrations a year.
Dr Srikala Bharath spoke to Reshmi Chakraborty
All pics: Wikimedia Commons
India has 61 million diabetics between 20-79 years according to the International Diabetes Federation. By 2030, this figure is estimated to go up to 101.1 million. While extremely common among many elderly, the fact that diabetes can lead to multiple disorders is often ignored. Dr. Anoop Amarnath, Director and Consultant, Geriatric Medicine, Apollo Hospitals, Bangalore decodes diabetes for us in this in-depth interview with Nidhi Chawla.
In layman’s terms what is diabetes and what causes it?
Diabetes is a condition that is characterized by hyperglycemia (raised levels of glucose). It is the manifestation of various dysfunctions that include:
a. Inadequate insulin secretion
b. Resistance to insulin action
c. Excessive or inappropriate secretion of a hormone called glucagon.
To put it in simple terms, Diabetes is a condition wherein the sugar levels in the body are inappropriately high
How and why is insulin important?
Insulin pen, picture courtesy Wikimedia Commons
Insulin is a hormone that is secreted by our pancreas. It is very vital in the regulation of carbohydrate (sugar) and fat metabolism. One of the main functions of insulin is to push excess glucose from the blood stream into the liver, muscles and fat tissues. If this function is impaired, as happens in Diabetes, excess sugar circulates in the blood stream, thereby causing damage to various organs like brain, eyes, heart and the kidneys. Thus, insulin is required to keep sugar levels in the blood within normal limits and prevent organ damage.
Is diabetes a life threatening ailment?
Diabetes, per se, may not be life threatening. However, uncontrolled diabetes, leading to end organ damage as mentioned above is indeed life threatening. This may be in the form of heart attack, strokes or kidney failure. It is also a debilitating condition as uncontrolled levels may lead to blindness and/or limb amputations. The other life threatening conditions in diabetes are those where we see extremes of sugar levels. Very low sugars (hypoglycaemia) and some forms of very high sugars like Diabetic Keto Acidosis (DKA) and Hyper Osmolar Non Ketotic Hyperglycemia (HONK) are conditions which, when not identified or treated immediately, can pose a significant risk to life.
Who can have it and why?
Anybody can have diabetes! Those who are obese, sedentary, have a family history of diabetes, have hypertension (high blood pressure) or dyslipidemia (raised levels of cholesterol) and are of Asian descent, have a higher risk of developing diabetes. It is believed that diabetes tends to develop with age, more so after the fourth decade. However, it is not uncommon to see people getting diagnosed with diabetes far earlier in their lives. (This is not to be confused with a type of diabetes that is seen in young people where there is an absolute deficiency of Insulin.) There is now more evidence linking depression with diabetes. So if you are persistently depressed, you are highly likely to develop diabetes.
Is it preventable?
To a certain extent, yes. Reducing weight, exercising regularly, eating the right diet and monitoring sugar levels can help prevent diabetes in those people who are at a high risk of developing diabetes. There are various tools that are now available that can actually stratify the risk of a person developing diabetes. This risk stratification can be performed by your doctor. This enables one to identify his/her chance of developing diabetes and take appropriate measures to prevent/ prolong the onset of diabetes.
Is diabetes a major concern for elders?
Yes, diabetes is indeed a major concern in the elderly. It hastens the progression of various organ disorders. Heart, kidney, eye and nerve diseases progress rapidly in the presence of diabetes. Apart from that, extremes of sugar levels- very high and very low- are more commonly seen in the elderly.
How does it impact a patient?
Diabetes has a multi-pronged impact on a patient. Physically, it can impact each and every organ in the body leading to its dysfunction. Financially, the diagnosis and management of diabetes or its complications can prove very costly. Emotionally, having to face an illness that sticks with you for life, can be extremely draining. Socially, people with diabetes feel stigmatised and many are reluctant to discuss or accept the condition. Legally, there are professions/positions that one cannot get into if he/she is a diabetic on insulin. Thus diabetes can have a profound impact on one’s life.
What are its symptoms and is there any difference in symptoms for elderly vis-à-vis youngsters?
The classical symptoms of diabetes are fairly well known and include:
However, the symptoms in the elderly are very innocuous and variable. These include:
The list is not exhaustive, but contains the most common ones that we see in elderly diabetics- it goes to prove that symptoms of diabetes in the elderly are very different from those that appear in the young.
How is the diagnosis done? Is it done any differently for elders?
The presence of the symptoms mentioned above should lead to the suspicion of underlying diabetes. The confirmation is done by the usual blood tests- fasting sugars, post meal sugars and a blood test that measures the average of the last three months’ sugar levels- HbA1c. We do tend to keep a slightly higher threshold for the detection of diabetes in the elderly.
Treatment of diabetes, especially for elders?
There are certain basic principles that need to be followed whilst treating elderly diabetics
a)Sulfonylureas: e.g., Glimepiride, Gliclazide, Glibenclamide
Advantages: cheap, have been in use for a long time
Disadvantages: Hypoglycemia (sugar levels can drop to dangerously low levels)
b) Biguanides e.g., Metformin
Advantages: cheap, do not cause hypoglycaemia
Disadvantages: can cause kidney impairments
c)Thiazolidine diones e.g., Pioglitazone, Rosiglitazone
Advantages: cannot think of one!
Disadvantages: many- hence not advisable in the elderly
d) DPP4 Inhibitors e.g. Vildagliptin, Saxaglipin, Sitagliptin, Linagliptin
Advantages: do not cause hypoglycemia, good reduction in sugar levels
Disadvantages: Relatively costly as of today.
3. Insulin: Used when sugar control is not adequate with the other lines of therapy, when levels are too high initially or when other forms are contraindicated. There are various types of insulin. Although it is the best way of treating diabetes, there are many disadvantages in the elderly. Inability of the elderly to administer insulin themselves, difficulty reading the small print while adjusting dosages, risk of drop in blood sugars if sufficient food is not taken- are amongst the many hurdles they face.
There are various other categories of drugs that are used in the treatment of diabetes. But they are not routinely advisable in the elderly.
How regularly should a patient monitor sugar levels and how? What are the danger marks, if any?
Early in the diagnosis whilst medications are being introduced, monitoring should be frequent in order to adjust the dosages. These could go up to six times a day (pre and post meal – 3 meals a day). However, once the sugars are stable and dosages are fixed, the frequency can come down. Long term management should ideally include monitoring of HbA1c levels once in three months. A level less than 70 mg/dl and more than 250 mg/dl in an elderly should be a cause for concern.
What should one do in case of sudden spikes (both high and low) in sugar levels?
It is always advisable to seek the help of a qualified medical practitioner whenever one encounters sudden spikes. As each elderly diabetic is likely to be on different medications, it is difficult to provide a ‘one size fits all’ solution.
What are the signs of low sugar levels and immediate remedy?
Low sugar presents as tiredness, hunger, sweating, palpitations, drowsiness and/ or dizziness. However, it is extremely common in the elderly to have what is known as ‘hypoglycaemic unawareness,’ i.e., not to have the usual signs of low sugar as mentioned above. It may present as a sudden loss of consciousness without any warning. It is important for the family to be aware of this and ensure that sugar levels are checked at the slightest hint. If the patient is conscious and able to swallow, it is advisable to give him/her something sweet to drink like fruit juice or even sugar water. NEVER force a person who is drowsy to eat or drink as this may lead to ‘aspiration’ (solids/liquids going into the lungs).
Similarly signs of high sugar levels and immediate action or step?
High sugar levels may have very non specific symptoms like thirst, tiredness, drowsiness and in most cases have no symptoms at all. High sugar levels are precipitated by either the lack of adequate medications or an underlying medical illness. Experienced diabetics increase their dosages/frequency of tablets/insulin when they encounter high sugar levels, but it is always advisable to seek medical help.
Elderly diabetics should eat small and frequent meals. Pic: Silvertalkies
What special dietary aspects should an elderly diabetic patient keep in mind?
The dictum of dietary management of elderly diabetics is ‘No fasting and No feasting’. Avoid heavy and infrequent meals. Small and frequent meals keep sugar levels under control. It is also advisable to avoid foods with high glycemic index (in simple terms, those foods that immediately increase your sugar levels) like fruit juices, chocolates, etc. For a comprehensive list, please consult your dietitian.
What should family members of a diabetic patient be aware of?
They should be aware of the patient’s medical history, medications and their frequency, any drug allergies and the emergency contact numbers. It is advisable to have the medical file handy. But most importantly, they need to be aware of the signs and symptoms of very high and very low sugars and also the fact that in an elderly, there may be no signs at all!
Dr. Anoop Amarnath is Director and Consultant, Geriatric Medicine, Apollo Hospitals, Bangalore. He has a specialisation in Geriatric Medicine from the Royal College London with certification in Geriatric Nephrology from the American Society of Nephrology and has been practicing since 2004.
Operating in Chennai and Bangalore, India Home Health Care aims at providing quality expert care in the convenience of your home.
It was the need for organized players in the home care sector that motivated the founders of India Home Health Care (IHHC) to start their organization. “We found that there were a lot of agencies operating but it was a completely unorganized sector with a total lack of transparency,” says Dr Anitha Arockiasamy, head of clinical operations at IHHC, one of the first organized providers in bringing people quality care in their homes.
Established in 2009, IHHC operates out of Chennai and Bangalore. The idea grew out of one of its founders, V Thiyagarajan’s difficulty in finding a home care nurse for the parents of a friend. Mr Thiayagarajan is the founder and CEO of Sybrant, while IHHC’s other promoters include Sameer Mehta, who is director of Dr Mehta’s hospitals and German national Frank Goller, who is the director and CEO of IHHC.
What they offer
IHHC offers quality care for patients in their home. There are different care packages available for patients, depending on their physical condition and need. “To ensure quality we have our own proprietary protocol care plan,” says Dr Arockiasamy, adding that on receiving a call, the operations team gathers information on the patient and draws up a care plan. Their home care operations include three levels of staff – Registered nurse, Associate nurse and Patient caretaker. All the homecare staff operates on an 8/10/ 12 hour shift on a daily, weekly or monthly basis. “The charges range from Rs 500 to Rs 1000 per shift depending on the level of care that is required,” says Dr Arockiasamy.
At present all of IHHC’s staff come from a hospital background which is a huge advantage for the patients and adds to the reliability factor. The company started with providing only nursing services in Chennai and later realized that there was a lot of requirement for medical caretakers as well in the market. They then developed this service line and are seeing a great demand for the same.
“Registered nurses are required mainly for patients suffering from chronic diseases or post operative care that requires constant medical care and monitoring,” Dr Arockiasamy adds. Some examples of skilled homecare include administering injections, administration of oxygen or nebulization, insertion and replacement of catheters, etc.
Some of the more basic home care needs include help with bathing, feeding, grooming, positioning, exercise and medication.
IHHC also offers male nurses for male patients and female nurses for female patients, adding to the comfort factor for many.
They launched in Bangalore in 2011 with staff strength of 80, out of which 50 are nurses. “We have at least 15 per cent of staff on the bench who are able to take care when there is a need,” Dr Arockiasamy adds.
How it works
IHHC doesn’t charge a registration fee and is flexible enough to provide even a single day’s service. They also offer a physiotherapy care plan which is based on the doctors’ recommendation and patient’s need. An Elderly Care Plan (NRI care plan) for elders staying away from their families is also in place, which includes doctor visits, regular health assessments and annual health checkups based on an annual subscription.
Dr Arockiasamy mentions that even though supply of trained and reliable staff remains an issue for the healthcare industry as whole, IHHC has identified specific strategies for recruiting and retaining high quality staff. “This helps us assure our patients that quality wise there should be no compromise” she adds. At present, IHHC caters to about 100 patients on a monthly basis in Bangalore and Chennai and hopes to replicate its model in other cities soon. You can connect with them on http://www.indiahomehealthcare.com/ or http://www.facebook.com/Indiahomehealthcare
Or call on 044-43594456 (Chennai) and 96866 69538 (Bangalore)
(Pics courtesy: IHHC)
— Reshmi Chakraborty
Falls are a common cause of injuries and fatalities in the elderly. Physiotherapist Dr Nidhi Kumar explains what are the factors that contribute to it and how to avoid them. Read on…
Falls are preventable health problems that can cause moderate to severe injuries and may become primary cause of deaths in persons above 65 years of age. High risk of falls in the elderly can be attributed to many factors, which are broadly categorised into two groups. These are extrinsic/external factors (environment related) and intrinsic/internal factors (age related).
Why falls happen
Intrinsic/internal factors are:
Extrinsic/external factors are:
Falls may cause moderate to severe injuries. The following are health hazards caused due to falls:
How to prevent
1) Exercise regularly: Ageing process, reduced activity level, morbidity, etc. are few factors which lead to reduced muscle strength, balance & co-ordination. This may pre dispose the elderly to falls. Thus organising camps or group interventions motivates the elderly and also gives them a chance to socialise.
2) Ergonomics: Free active and resistive exercises should be done using thera-tubes, thera-bands, putty, pulleys, balls, etc.10 repetitions each 2-3 times a week throughout range of motion.
3) Regular eye check-up: Regular eye check-up should be done and glass power updated to maximize vision.
4) Reduce fracture risk: Elderly should be regularly screened for osteoporosis through bone density tests, DEXA scan etc. Adequate calcium and vitamin D levels in blood should be maintained through dietary intake and through supplements too. Weight bearing/loading exercises should be regularly followed to strengthen and enhance bone health.
5) Postural hypotension: Regular blood pressure check-up, regular updating of medications. If patient has regular postural hypotension attacks, ask him/her to lie down immediately with foot end of bed elevated. Ask patients to perform ankle pumps.
6) Medication review: Ask the doctor to review medication that may cause dizziness/drowsiness. Few drugs that cause drowsiness thereby increasing the risk of fracture are sedatives, tranquilizers, anti-hypertensive, cardiac medicines, hypo-glycaemic agents, etc.
7) Prepare a home check safety list
In the living room:
a) Remove throw rugs.
b) If you have carpeting, secure carpet edges on floor & stairs.
c) Reduce clutter on the floor and reduce wire clutter.
d) Install handrails on your stair case.
e) Avoid slippery tiles and waxing the floor.
f) Use anti-skid mats.
g) Ensure adequate lighting in lobby/walking areas
In your bathroom:
a) Install hand rails in shower and bath tubs.
b) Use anti-skid mats.
c) Avoid wet surfaces.
d) Avoid detergent/soap spillage on floor.
Safe footwear and walking aids
a) Ensure proper balance of walking aids.
b) Do a regular check of anti-skid rubbers/buffers of walking aids.
c) Ensure proper hand grips.
Foot wear
a) Do a regular check of footwear wear & tear.
b) Do a regular change of footwear grip & comfort.
These are simple steps to follow and maintain. Do remember that regular screening and modifications can prevent falls in elderly, thereby improving upon geriatric health, wellness and lifestyle.
(All pictures courtesy: Wikimedia Commons)
About the author: Dr Nidhi Kumar is a physiotherapist, currently completing a masters in Physiotherapy, with specialization in Orthopedics. She also works as the wellness manger in a hospital set up, with focus on lifestyle disorders, obesity management,ante-natal and post-natal management, nutrition and diet.
A low cholesterol diet is important to keep your heart healthy and active. It’s done easily enough with some simple changes in what you cook with and eat. Here is a guide by nutritionist Sakshi Chawla.
A diagnosis of high cholesterol can increase anxiety levels. Cholesterol is a fat-like substance that can build up in arteries increasing chances for developing heart disease or stroke. High cholesterol is linked to an increased risk of heart disease and heart attack. But there is something you can do today, right now, to help lower your cholesterol: Improve your diet.
Your best option is to select a diet that is low in total fats, especially saturated fat, trans fat, and cholesterol. This is called a low cholesterol diet. This means your daily fat intake should be less than 35 percent of your total calories. When choosing the sources of fat in your diet, it is best to choose fats that are polyunsaturated or monounsaturated. If used moderately, these help protect the heart by increasing the level of ‘good’ HDL cholesterol in your blood.
Why should you follow a low cholesterol diet?
The food we eat has three types of fats. These include saturated fats such as butter, milk and cream, lard or the fat under chicken skin. These fats tend to be solid at room temperature and are considered ‘bad’ fats because they raise LDL cholesterol. Another avoidable substance is Trans fat, which acts like saturated fat and raises the level of LDL cholesterol. Margarine and baked goods available commercially usually contain trans fats so it would be a good idea to check the label before you buy.
Unsaturated fats can be monounsaturated or polyunsaturated. Monounsaturated fats are the ‘good’ fats that help lower cholesterol levels and are among the best of the lot. Olive oil, canola oil, and peanut oil are high in monounsaturated fats. Polyunsaturated fats include corn oil, soybean oil, safflower oil and sunflower oil and though they are not bad, monounsaturated fats really simply better. Also heart healthy is fish oils, high in Omega-3 fatty acids and polyunsaturated.
So how much fat should you consume on a daily basis?
According to the Dietary Guidelines for Americans (2005 data), fats should not exceed more than 30 per cent of your daily calories. Out of these, only 10 per cent of calories should come from saturated fat. Trans fats are avoidable as much as possible.
Heart healthy eating habits.
It’s not as difficult as you think. Once you know what is right to eat and what is not, you’ll be on your way to following a healthy diet.
3.Another good whole grain addition to your diet is ground flaxseed. Called the new miracle food, Flaxseeds are easily available. These are small brown seeds that are high in fiber and contain Omega-3 fatty acids, which can lower your total blood cholesterol. Flaxseed can be roasted and powdered and added to the chapatti flour. Also they could be roasted and eaten as such or added to daliya/ cornflakes. Amount recommended per day is 10 to 15 gms i.e., 2 tsp per day.
4. Control bad fats and cholesterol
It’s important to control and limit the intake of saturated and trans fats in your food. It can reduce your blood cholesterol and lower your risk of coronary artery disease. Limit the solid fats like butter, margarine and shortening in your food, especially baked products.
Opt for monounsaturated fats, such as olive oil or canola oil or polyunsaturated fats, found in nuts and seeds. In fact these may actually help lower your total blood cholesterol. This doesn’t mean you go overboard with the ‘good ‘oils. Moderation is a must as all types of fat are high in calories.
5. Where’s your protein coming from?
Choose low fat protein like lean meat, poultry and fish, low-fat dairy products and egg whites. Go for skim milk rather than whole milk and skinless chicken breasts rather than a fried chicken burger. If you are a non vegetarian, fish is a very good alternative, especially cold water fish like salmon, mackerel and herring, rich in Omega 3 fatty acids. Like we said earlier, flaxseed is great as are walnuts, soybeans and canola oil.
Keep your date with dal. Legumes in every form, be it beans, peas and lentils are good sources of protein and contain less fat and no cholesterol, making them good substitutes for vegetarians and non vegetarians alike. Substituting plant protein for animal protein will reduce your fat and cholesterol intake.
6. Go low on salt
High blood pressure is a risk factor for cardiovascular disease and eating a lot of sodium can contribute to that. Reducing sodium is an important part of a heart-healthy diet. Start by reducing the amount of salt you add to the food cooking or at the table. Instead of store bought ready to eat products like soups and curries or curry paste, make your own as these usually have high sodium content.
Heart picture: Wikimedia Commons
Olive oil & flaxseed picture: Silvertalkies
The high price of essential medicines often make it difficult for senior citizens to afford proper medical care, leading to several other complications. This timely and thought provoking article from Baru explores the problem.
The escalating cost of medicines
Among the several drivers pushing significant drug price rise in India over the last two decades, the following two are fundamentally important:
(a) the drastic changes with regard to bringing the Indian Patents Law in line with the international agreements on the intellectual property rights (the indigenously produced and cheaper generic drugs yielding the market space to branded drugs from the multinational pharmaceutical companies much more expensively priced under patent protection (1))
(b) allowing the big multinational corporations to acquire (2) ever burgeoning market share in the pharmaceutical industry, thereby providing a clout in deciding prices and influence in shaping up government policies on the drug price control.
As a result of these policy changes, the retail prices of most essential medicines required for diseases spanning routine infections, chronic acquired ones like diabetes, hypertension, cardiovascular problems, and especially those for critical illnesses like cancer and Alzheimer’s disease have shot up appreciably over the past decade or so.
Add to this the other major shift in the health policy, wherein the government is consciously abdicating its role as the primary health service provider and allowing the private players and market forces to determine the availability and the price of the health care in this country.(3,4)
In this scenario, it is not difficult to understand why the proportion of medical expenses that the Indians currently incur using largely their own resources is believed to be unusually high.(5) While the escalating healthcare cost affects majority of the Indians, senior citizens are particularly vulnerable. Though people of any age can be afflicted with cancer, there are empirical evidence and some scientific arguments to suggest that an aging body may be predisposed to the disease (accumulation of mutations in cancer genes over a longer duration, exposure to a variety of carcinogens and progressive inability to repair cell damages, etc).
Facing the trauma of cancer detection and diagnostic follow up is devastating at any age, but for a man at 77 to discover a malignant tumor blocking his esophagus or for a happy grandmother of 65 to find one surreptitiously growing in the breast, can appear as an indescribably cruel caprice of nature shaking their grip on life. Surgical intervention (in operable cases), radiation therapy and chemotherapy (if advised given the advanced age) are all fairly expensive and there is always a fractional certainty of a positive outcome. In failed cases, the palliative care at home or at hospices can endlessly prolong the agony of the patient and test the resilience and the resources of the caregiver. Even if the cancer is thwarted or, hopefully eliminated, the afflicted often continues to suffer some kind of debility, loss and morbidity, requiring additional long term medication and supplements to pull on. There is an estimate (3) that more than 80 per cent of cancer-affected Indians end up with private treatment facilities and of them more than 90 per cent meet the expenditure for such treatment out of their own pocket.
Some form of dementia (primarily associated with memory loss and degradation of other cognitive functions) as an adjunct of the old age may be manageable without much medical attention. However, some of the aggressive forms like the Alzheimer’s disease, show clinical symptoms requiring active intervention involving diagnostic prognostication, highly expensive medication and other management methods. The Alzheimer’s and Related Disorders Society of India (ARDSI) estimated (2010) that there were 3.7 million elderly currently living with dementia in India, each spending Rs. 43,000 per annum on medical care. (6)
Even otherwise, lower immunity and susceptibility to many adventitious infections, preponderance of common lifestyle diseases like diabetes, hypertension, poor lipid profile (acquired midlife) characterize large segments of the elderly populace, many of them graduating into kidney ailments and/or cardiovascular problems often as an almost pre-destined follow up to those chronic maladies. All these require lifelong medication, routine pathological and a range of diagnostic tests, some (like angiography) requiring temporary hospital admission and procedures like dialysis. Partly out of genuine urge to look for more effective remedies and partly under careful manipulation by the pharmaceutical companies, more recent, novel and branded drugs (7) are likely to be prescribed by the doctors. Also sharing a more prevalent aggressive worldview, they would often suggest more detailed investigations, using ever more sophisticated and expensive tools obtained with cutting-edge bio-medical research, looking for an elusive diagnosis, as the prognosis worsens. No wonder that the medical bill of the seniors will be pushed upwards relentlessly.
Being on the margin of the society both in urban and rural India, the old denizens cling desperately to the medicines, therapies prescribed by their doctors for continuing their tenuous toehold on life and thereby fighting off their shrinking sense of well being and autonomy. One obvious financial implication of the escalating medical expenses for many senior citizens is inability to afford appropriate medical treatment using their own meager and devaluating resources and to become woefully dependent on their children or other relatives that could potentially lead to strain in the relationships and other hardships. The net result is a loss in the quality of life and dignity and associated anxiety and depression. For poorer households bordering on penury and destitution, this amounts to neglect, denial or forgoing access to medicines and/or treatment.
Notes and citations
1. Gleevec, the Novartis (MNC) branded drug for chronic myeloid leukemia can cost up to Rs 1.4 lakh per patient for a month, an equivalent generic drug in India may cost about Rs 9000 for the same dosage; generic donepezil (a staple drug for Alzheimer’s disease) may cost about Rs 1100-1300 (90 tablet pack) in the Indian market, the international branded version ARICEPT could be equivalent to about $840 for the same pack
2. “Are Takeovers Taking Over Indian Pharma?” (knowledge@wharton Today, 24 August 2011 )
3. Selvaraj and Karan, Economic and Political Weekly, 3 October, 2009
4. Montek Singh Ahluwalia, the deputy chairman of the Planning commission, called for a new health policy framework in which government should vacate its role of primary health care provider and allow for greater privatization of the health sector (Times of India report, 8 August 2012)
5. The regional adviser of WHO, Dr. Kathleen A Holloway sounded alarm on the ballooning out-of-pocket (OOP) health expenses of the average Indians and the direct relation of that fact with the progressive/catastrophic pauperization of the Indian population. The planning commission has apparently acknowledged the scenario. (Times of India report, 2 November, 2011)
6. As quoted by Dr. Ennapadam S. Krishnamoorthy in his article “Dementia: a looming threat” (The Hindu, September 29, 2010)
7. A very commonly prescribed low-end TYPE-2 diabetes medicine as a cheap local brand (bare bone generic version : metformin 500 mg + glimepiride 1mg) may be obtained at Rs 19 for a 10 tablet pack, but a more respectable brand like Amaryl from Aventis may cost Rs 124 for the same pack. There is a published report comparing the effectiveness and safety (side effects) vis-à-vis the prices based on an extensive survey of oral drugs used to treat TYPE-2 diabetes and a case can be made out for the overall benefit in favour of many cheaper generics.
Photograph courtesy: Silvertalkies
Support and information are of utmost importance when it comes to Alzheimer’s Disease. This is where organizations like ARDSI can help. Read on to know how in the concluding article of our Alzheimer’s Disease Awareness Campaign.
A recent report by World Health Organization (WHO) estimates the number of people suffering worldwide from dementia to be around 35.6 million, as of 2010. Alzheimer’s And Related Disorders Society Of India’s (ARDSI) National Dementia report reveals that ten per cent of this population, i.e., 3.7 million dementia patients are from India.
With life expectancy on a rise, this number is expected to double by 2030 and triple by 2050.
Given this alarming growth rate, Alzheimer’s and Related Disorders Society of India (ARDSI), a not-for-profit organization, has been working actively to improve the quality of life and care for dementia patients in the country.
The genesis of ARDSI was due to one man’s inability to find adequate information on Alzheimer’s, a disease that his father was suffering from.
So in 1992, in collaboration with fellow doctors, Dr. Jacob Roy formed ARDSI with a mission to promote early diagnosis of the disease, provide affordable and quality care to dementia patients, create public and professional awareness and also to engage the government agencies to create a supportive environment for people suffering from dementia.
In 1993, ARDSI got accepted as a full member of Alzheimer’s Disease International (ADI), becoming the first Afro-Asian organization to get officially affiliated with ADI, UK, an umbrella organization spanning 76 countries, working at improving the quality of life for dementia sufferers.
Today ARDSI has 18 chapters across India.
ARDSI has been spearheading the cause of dementia and has been working at three different levels – 1) Prevention of dementia 2) management of dementia and 3) public policy advocacy.
The organization has memory clinics that help early detection. It also has day care and 24×7 centres for dementia, where the patients are not only cared for but also engaged in therapeutic activities that helps to improve their cognitive processes. The day care centres are in Delhi, Kolkata and Kerala. Round the clock care homes are available in Kerala and Delhi.
The organization also provides counselling services for caregivers through workshops and peer group meetings and visits at home by volunteers. They also run a helpline to assist people. Training facilities are available for personal and professional caregivers.
ARDSI has also been campaigning for the cause of dementia patients with the government and is a part of the Working Group of Planning Commission. It has been working with the Ministry of Social Justice and Empowerment, and also Ministry of Health and as part of the Working group has made some recommendations such as introducing geriatric wards in hundred civil hospitals across India and setting up regional centres of excellence exclusively for Dementia related ailments These recommendations have been included in the XII Five Year Plan. As a result of these recommendations, the government has been working on setting up the National Alzheimer’s Centre in New Delhi.
With organizations like ARDSI putting in so much of effort at improving the situation of dementia care in India, there is still some hope in tackling a disease that WHO has flagged as an impending epidemic, in the same league as HIV and tuberculosis.
Besides ARDSI, there are few other prominent organizations like Help Age India, Dignity Foundation, and Nightingales Medical Trust that have been contributing to this cause and working assiduously to make the lives of dementia patients and their caregivers little more comfortable and better. To know more about them, please visit their websites. To read our previous feature on Nightingales Medical Trust, click here.
ARDSI – http://ardsi.org/
Helpage India – http://www.helpageindia.org/
Dignity Foundation – http://www.dignityfoundation.com/
Nightingales Medical trust – http://nightingaleseldercare.com/
– Nidhi Chawla spoke to R. Narendhar, Executive Director (National Office), ARDSI.
Caregiving for an Alzheimer’s & dementia patient needs understanding, adaptability and patience. Swapna Kishore, writer, blogger and resource person for dementia care in India gives us a very detailed account.
Dementia is an umbrella term used for a group of symptoms related to loss of brain functioning such as memory loss, language problems, inability to understand or decide, disorientation, inability to coordinate movements, sequence events or take decisions, problems handling daily activities, problems handling emotions, dis-inhibition personality changes, mood changes, etc. Dementia symptoms can be caused by a number of medical problems related to the brain, most of which are irreversible and progressive diseases. Alzheimer’s Disease is the most common cause of dementia, but there are many other causes of dementia also. For example, vascular dementia accounts for 20-30% of dementia cases according to the Dementia India Report 2010. Other types include Dementia with Lewy Bodies, Frontotemporal dementia, Parkinsonian dementia, etc. Various types of dementia differ in which part of the brain is more affected, which symptoms are prominent, and how the dementia progresses.
Since most dementias are irreversible and progressive, these problems keep increasing with time. The patient’s personality changes and some behaviour are difficult to cope with. Over the years, most patients become immobile and fully dependent, especially in their final years. Caregiving for dementia patients requires time, energy, and money. To accommodate this responsibility, immediate family members often make major changes, such as leaving jobs, reducing other responsibilities, and giving up on socializing and other aspects.
When to consult a doc
Because dementia awareness is very poor in India, most people assume that the initial symptoms of dementia (such as mild memory loss, apathy, agitation, inability to learn new things, mood swings, personality changes) are part of ageing. In the initial stages, patients may notice their problems but, because they are scared that they will be considered crazy or stupid, they hide their problems and don’t consult doctors. Early diagnosis is therefore rare in India.
Families typically approach doctors after something goes drastically wrong, like a major episode of agitation or withdrawal, or when the patient wanders off and doesn’t know how to get back home, or forgets something very important.
Why diagnosis is important
Quite often, when people read an article on dementia and the symptoms seem to match those of the person they are concerned about they assume it is dementia and that nothing can be done. Such ‘self-diagnosis’ is wrong and harmful. A dementia diagnosis requires proper investigation and tests by a suitable specialist.
Approaching a General Physician (GP) may be a starting point for some persons. Unfortunately, as awareness of dementia is poor, its symptoms may be mistaken for old age, or for general problems of demoralized elders after retirement and many GPs may be dismissive of the symptoms. I even know of a case when the GP suggested marriage counselling for an elderly man instead of realizing that his changed behavior was because of dementia!
Neurologists, psychiatrists and gerontologists can be consulted by persons who suspect that someone has dementia. A good place to go to is the neurology/psychiatry department of a large hospital, or a gerontology department. These doctors would be able to advise families to appropriate facilities. Even amongst specialists, some doctors are better informed about diseases that cause dementia and have more experience about the range of the ways dementia impacts various patients. It is therefore advisable to look for specialists with experience in dementia. Memory clinics could be a good way to go. The local chapter of Alzheimer’s and Related Disorders Society of India (ARDSI) may also be able to suggest doctors who specialize in dementia.
A diagnosis equips the patient and family to understand what is going on and be prepared for it.
Often, the deterioration caused by dementia worries the patient and family and may cause arguments or despondence. For example, family members may keep scolding the patient for being lazy or uncooperative because they don’t know the person is facing genuine problems. This may distress the patient. Or the patient may get agitated or show personality changes that distress the family, who take it personally. Getting a proper diagnosis removes misunderstandings and hurt.
With a diagnosis on hand, families can plan for dementia care and adjust their other roles and responsibilities to accommodate this caregiver role. If the diagnosis happens at a stage when the patients understand it, they get time to plan what is important for them and to explain to their families the sort of care they want in the later stages.
Cure & Prevention
While in some cases, dementia symptoms are caused by problems that can be treated (like hypothyroidism, vitamin deficiency, infections), most dementias are caused by irreversible and progressive diseases (like Alzheimer’s Disease) for which a complete cure is not yet possible.
Research is going on for finding treatments that could reduce symptoms, reduce or stop progression, prevent, or cure the various types of dementias, with a lot of focus on Alzheimer’s Disease–the main (but not the only) cause of dementia. Updates are best obtained from authoritative sites like Alzheimer’s Association USA and Alzheimer’s Disease International (these sites discuss all forms of dementia, not just Alzheimer’s Disease).
We must distinguish between prevention (doing something whereby someone will *not* get dementia) as against risk-reduction (reducing the probability of getting dementia). So even if we find a way to prevent one disease, there are still other diseases that could cause dementia. The focus, therefore, is on risk-reduction. For example, by keeping our blood pressure under control, we can reduce the risk of vascular dementia. In general, good health and nutrition practices and an active mental and social life are supposed to reduce dementia risk; up-to-date information is available at the authoritative sites mentioned earlier.
What a caregiver needs to understand
For appropriate dementia care, family members must understand the impact of dementia on the patient and accordingly adjust their interactions with the patient. Let me take an example. Our culture teaches us that elders are wise and that we should follow their instructions and advice. But a parent who has dementia is facing problems even with small activities, and will obviously get stressed if expected to take on the burden of the “senior in the family” role atop existing dementia-related challenges. Such patients may take wrong or hurtful decisions, or neglect something important.
I’ve heard of situations where patients were cheated of their properties and bank balances by outsiders who noticed the person’s confusion and knew that the family had left the responsibility on the person.
Another example: out of respect and affection, we often tell the elders every event in detail. For a dementia patient, excessive, unnecessary data is a burden. They may feel diffident because they can’t handle our chatter. Or they may misinterpret it, or get agitated and say something hurtful.
We have to first understand the characteristics of dementia and then apply our love and respect to interact in appropriate ways.
We shouldn’t swing to the other extreme either. Some people treat patients as persons in a “second childhood” and say things like “my mother is my baby now”. This may stem from affection, but if it is accompanied with baby talk, that could be insulting; after all, they are adults facing an extremely tough situation and don’t like being patronized.
To interact with patients, the foundational caregiving skill is effective communication–understanding the patient, and helping them understand us. Tips include using simple, short sentences, speaking clearly and slowly, face-to-face and with eye contact, leaving time for the patient to absorb and respond, and so on. Additionally, caregivers must know effective ways to help patients with various daily activities. They need to know how to reduce/ manage challenging behaviour (like wandering, agitation, and repetition)
Families can also adjust the physical environment so that the patient remains safe and as independent as possible. They need to know about possible adaptations, such as improved lighting, removing things that could hurt or scare the patient (sharp objects, lose wires, dark pictures, etc.), and adding grab rails. (To read more on this click here)
A daily routine
Structuring the daily routine is another aspect of caregiving. A predictable routine gives the patient a sense of certainty and security, but should include pleasurable fun activities to improve the patient’s quality of life. What works best varies from patient to patient.
Understanding the medical aspects is also essential. Family caregivers have to coordinate the patient’s medical support for dementia and other ailments and emergencies. Patients often can’t tell when they are in pain or unwell, so this is a heavy responsibility. For late stage patients, caregivers must understand home nursing well enough to provide care or supervise hired helpers.
Do note that each of these is a topic in itself, and what I’ve said doesn’t even begin to skim what caregivers need to know. I have created online resources on these and other caregiving areas on my website, and interested persons can refer to the section for caregivers: Caring for Dementia patients
And of course, it’s not just learning the skills. They have to be applied all the time. Dementia care is an ongoing work and has been likened to a 36 hour day.
Dealing with caregiver stress
Caregiver stress is common…
Well-wishers and counsellors often advise caregivers to take care of their own health and stress levels, eat nutritious food, exercise, take breaks, remain active mentally and socially, take time out for their hobbies, meditate, and so on. These are essential, but caregivers often find it difficult to squeeze these into an already overwhelming day; they consider caring for themselves as yet another task to do (in addition to all that they are already doing).
Ideally, people around families with dementia can help caregivers take out time out to rest or relax.
One additional problem is that since caregivers are busy in the care-related work, they lose out on their own social circles and support. Many caregivers end up feeling isolated.
Caregiver services and support systems
Unfortunately, not much is available in India. Ideally, we should have services like agencies providing trained attendants, centres for day care and respite care, home health service providers, and so on. We should have training workshops for family caregivers, home visits by doctors and experts, phone helplines, online chats, caregiver support group meetings, and counsellors. We need these across the country. But these services and support are not available even in most state capitals.
So far, service providers have not jumped in to fill the demand. We can help caregivers by being there and accepting the situation without judgment. Many people are so uncomfortable with the way the patients change that they go in denial (pretending nothing is wrong) or blame the patient (she isn’t trying hard enough, she is negative, etc.) or family (they are cruel to her, they suppress her, they must be doing something wrong to her). Often, friends avoid the patient or the family because they find seeing dementia is depressing.
Just remaining available in a non-judgmental way makes sure the patient and family don’t feel isolated and misunderstood. Suggestions should only be offered after understanding the situation and gently so that they don’t sound critical.
Outsiders can also help by doing various required tasks, depending on their personality, time and energy. If they spend time with the patient, that gives caregivers a break. Or they can take the caregiver for an outing. Or do chores. Or help caregivers by locating information on various topics or resources. They can help take the patient for medical check-ups, and indicate availability for emergencies. They can take the kids of the family for outings or tuitions or exams or help them with homework and projects.
Though dementia care is strenuous work without any break, caregivers may not ask for help because they don’t want to impose on others, or they feel that asking for help is like admitting failure in fulfilling their duty. But if friends, colleagues and relatives offer help sincerely without judgment or criticism, caregivers may accept.
My journey with my mother
I saw my late mother through all the phases of dementia–early, middle, and late stage. In the beginning, we didn’t know she had dementia; she would hide her problems or blame me, and I had no idea she was suffering and I’d get hurt or angry. Though we consulted neurologists very early in her dementia because of some other problems, we got a formal diagnosis only after multiple consultations.
Over time, our family found its rhythm and balance, and this required truly understanding her situation and adjusting everything around it. It required making major changes in my life to a point where caregiving became my main identity and role. I count myself fortunate that she seemed at peace and happy in her last few years even though she was totally dependent. I have been sharing my caregiver journey (joys, mistakes, challenges) in detail on my blog http://swapnawrites.wordpress.com.
One tricky but essential aspect is to find a caregiving pace we can sustain. Doing so much that we burn out does not help, because then we will break down and give up, and who will do the caregiving after that? But doing too little can result in problems, hurt, and even tremendous guilt later. So it is a balance, and each of us has to find one’s own level of caregiving and their pace; there is no one-size-fits-all. Then there’s this aspect of role and identity. Caregiving for dementia is a full-fledged role that extends across years. It is tough, high-responsibility work that consumes time and energy akin to a career, and needs the same seriousness. So learning skills, finding resources, connecting to others, planning for time and money, taking enough breaks to recharge, all are important.
Finally I’d say that while caregiving may seem all-consuming for years, it is better if it is not our sole form of identity because then, when it ends (as it must someday), what remains? Some of us may become fulltime caregivers, but we are also persons with other interests and needs, and even in caregiving we are applying creativity and flexibility. If we do not value ourselves, why would others?
© 2012 Swapna Kishore
Stay mentally active and communicate with those around you, says Dr.Anoop Amarnath, Director and Consultant, Geriatric Medicine, Apollo Hospitals, Bangalore. He has a specialisation in Geriatric Medicine from the Royal College London with certification in Geriatric Nephrology from the American Society of Nephrology and has been practicing since 2004. Nidhi Chawla of Silvertalkies met him for an informative Q&A as part of our Alzheimer’s Disease Awareness Week.
What is Alzheimer’s and how is it different from dementia?
Alzheimer’s is a form of dementia and is the most common type of dementia accounting for about 60-70% of all dementias. The other forms of dementias include- vascular dementia (caused due to lack of blood supply to the brain, dementia associated with Parkinson’s and other degenerative dementias like FrontoTemporal (FT) dementia.
What causes it?
Alzheimer’s is caused by the loss of nerve cells in a particular area of the brain called as the Hippocampus. There is an accumulation of a certain type of protein called Amyloid B.
Who can get it? Is it genetic?
As to what causes this abnormal accumulation leading to loss of nerve cells and who are more susceptible to get these changes, it is still not very clear! There may be a genetic element linked to the disease although there are no particular tests, as of now, to identify these.
How long does it take to manifest?
The time between the accumulation of the abnormal proteins (Amyloid B) causing destruction of nerve cells to the actual onset of clinical symptoms like memory loss, can take years.
Can it be predicted?
The National Institute on Ageing- Alzheimer’s Association guidelines recommend certain neuroimaging tests (brain scans) and CSF analysis (a type of fluid present around the brain and spinal cord which can be obtained by inserting a small needle in the back)- to predict Alzheimer’s even before the onset of clinical symptoms. These, though expensive in an Indian setting, can be carried out.
How long can the progression take?
Alzheimer’s progresses very slowly. It may take years for it to reach an advanced stage
Is there any way of preventing or slowing down onset or progression?
Yes. If diagnosed early and if appropriate treatment is started at the earliest, the progression of disease can definitely be slowed down. In terms of prevention, the more mentally active a person is, the better it is in terms of prevention. This includes solving puzzles, reading books, playing interactive games or even simply speaking to your near and dear ones on a regular basis.
What are the warning signs?
It is very important to differentiate simple age related memory loss and Alzheimer’s. Some of the warning signs include loss of short term memory that affects day to day functions. For example not being able to find directions to a place that is very well known, unable to recollect whether one has had their breakfast or lunch. On the other hand it may be common to forget things like where one has kept their house or car keys.
What else may cause similar symptoms?
There are other conditions that can mimic symptoms of Alzheimer’s. These include vitamin B12 and folic acid deficiencies, abnormalities in thyroid function, simple infections such as urinary tract infection, depression, normal pressure hydrocephalus (a condition where there is lot of accumulation of fluid in the brain), brain tumours and incidences of unrecognized head injuries. It is extremely important that all these are ruled out before a diagnosis of Alzheimer’s is made.
Whom should a patient meet to understand the condition?
It is advisable to meet a doctor who specializes in diagnosing and managing these cases- this may be a Geriatrician or even a Neurologist
How is the diagnosis done?
As mentioned above, it is important to rule out other conditions that have a similar symptom profile. These are done by carrying out basic blood tests and scans of the brain. This is followed by a GDS (Geriatric Depression Score) – a questionnaire to rule out depression. Finally a Mini Mental Status Exam (MMSE) – another questionnaire type of test is done to assess the level of dementia. All in all, the diagnosis is done more on clinical grounds rather than one based on laboratory tests.
Once the diagnosis confirms Alzheimer’s what is the first line of treatment?
The first line of treatment is to start on a tablet that would prevent the breakdown of a chemical called Acetyl Choline in the brain. These include tablets like Donepezil or Rivastigmine. Based on the response, the doctor may decide to escalate therapy thereafter.
How does the condition progress?
The condition starts off with an insidious onset of memory impairment- typically short term memory. This is followed by problems in execution of tasks- like inability to plan or perform multiple tasks simultaneously. In the late stages we notice problems with speech, language, behavior and personality.
Is the ailment curable?
Unfortunately, it is not curable as of today. But, like various other lifestyle related disease i.e. diabetes and hypertension- it can be controlled.
What kind of support framework is available in India?
The kind of support framework that is ideally expected is lacking. Having said that, there are a lot of NGOs and Senior Citizen Groups that are doing tremendous work in supporting care givers and people with Alzheimer’s.
Do memory clinics help and how do they work?
Memory clinics do help. They are useful in identifying types of memory losses, their causes and to help track the progression of memory loss. If done in a scientific way, they are extremely beneficial in managing people with memory loss of any type- not just Alzheimer’s.
Any message for the elderly?
Ageing is inevitable. But ‘healthy ageing’ is in your hands. Understanding diseases that are common amongst the elderly, identifying symptoms, regular health checks, being consistent in taking medications that are prescribed and keeping oneself functionally independent will help you achieve ‘healthy ageing’.
Any message for the caregivers?
When people age, they become like children and as age advances, they are as good as infants and newborns. It is that level of care, that was given to you when you were a kid, that is now required for them. Although a lot of people feel that caregiving is difficult, we need to understand that it is our responsibility.
Nightingales Medical Trust in Bangalore is a name synonymous with elder care. We profile their Center for Ageing and Alzheimer’s and their new program, Jobs 60+.
The gazebo at Nightingales Centre for Ageing & Alzheimer’s
Walking around the Nightingale’s Center for Ageing and Alzheimer’s is a humbling experience. Located in Kasturinagar, it is a well designed facility that offers a soothing atmosphere for both patients and caregivers. “At the facility we promote a family based support system,” says Premkumar Raja, the co-founder and Trustee of Nightingales Medical Trust (NMT) which runs the center along with several other services for the elderly. Mr. Raja emphasizes that NMT encourages those suffering from dementia to stay with their families as according to them, the family should be strengthened at such a time. “NMT should provide what the family is not able to do,” Mr Raja adds.
The Center for Ageing and Alzheimer’s offers options for both long term care, short term care and even day care for those going out to work and unable to take care of elders with dementia. There is a memory clinic for screening and assessment as well as a fitness and rehabilitation centre among the facilities offered. An important service offered is training for caregivers, who may often be unaware of the challenges involved in caring for an Alzheimer’s patient.
Memory Corner
At present there are about 70 patients in the center being cared for. As we are taken around, we are informed by the staff that several activities are conducted to improve the condition of the patients and enrich their daily life. Some of these are pet therapy, water therapy, gardening (even for those in wheelchairs) and a memory corner with an array of objects that belong to the past. We are also informed that none of the patients are referred to as uncle and aunty by the staff but by their names. This is to keep their mind active.
Art therapy corner
The center offers four bedded and six bedded rooms. The patients are encouraged in various ways, obvious when an elderly resident graciously treats us to an impromptu Bhajan rendition on his Casio. His memory may not be what it used to be but his talent is still sharp. And the Center for Ageing and Alzheimer’s is helping to ensure that it stays that way.
Set up in 1996, NMT also has various other programs for the elderly. One of their recently launched programs is Jobs 60+, which aims to provide employment for elders above 60. The aim is to provide jobs for those with no pension or financial security. The idea germinated during a job fair in 2006, says Merlin Remedios, centre manager at Jobs 60+. “We got more than 1000 people and realized there was a real need of job support for elders.”
Jobs 60+ was eventually launched on Oct 1, 2011, World Elders Day. “We received 138 registration forms in two months,” says Ms Remedios. The Jobs 60+ team seeks out potential employers and matches their requirements with that of the applicants. So far 22 applicants have been placed and Remedios mentions that the employers are happy as seniors bring experience and are responsible and committed. As of now, the job profiles are for mid level executives, like manager in a hotel or service apartment, accountant or sales manager in a firm. Seniors are also offered training in computer skills if required, to keep up with the times.
Nightingales is striving to keep family bonds intact through various innovative, families and community based support systems for elders of different socio-economic groups. Every day, over 800 elders benefit from the services of Nightingales
Nightingales Medical Trust also has several other initiatives for the elderly, including the Day Care Centres, Elders Helpline, in association with the Police Commissioner’s office, Steady Steps, a fall prevention program, Rural Mobile Medicare Program , senior citizen’s ID cards, authorized by the Government of Karnataka and ,Regional Resource and Training Centre for the four Southern States of India authorized by Government of India
To know more and to get a complete list of their services, check out http://nightingaleseldercare.com/
– Reshmi Chakraborty
A vegetarian diet can meet all your dietary requirements. Just make sure it is a balanced one, says nutritionist Sakshi Chawla.
Vegetarian diets of various descriptions have enjoyed increased popularity in recent years. Those who choose them may be motivated by philosophical, religious, or ecologic concerns or a wish to have a healthier lifestyle. Considerable evidence attests to the health benefits of a vegetarian diet. Epidemiological data, particularly from studies of Seventh-Day Adventists show that the diet results in lower rates of Type 2 diabetes, breast and colon cancer, and cardiovascular and gallbladder disease. However, data are not enough to prove that an omnivorous diet based on the recommended guidelines and combined with a healthy lifestyle is not equally beneficial (National Institute of Nutrition, 1990).
Is it really true that vegetarian diets are healthier? If yes, then why are we humans born with canines? Basically, vegetarian diets of all kinds are low-fat diets as compared to non-vegetarian food. Therefore, doctors and health nutritionists believe that diets rich in fruits and fresh vegetables are healthy. High-fat diets are normally believed to be responsible for obesity, heart disease, coronary heart disease, diabetes mellitus, and some forms of cancer. Eating meat (including red meat) is unhealthy only when certain limits are exceeded. No diet is more or less healthy as the human body requires all forms of nutrition. A balanced diet is therefore the key to a healthy life.
Of the 8 to 10 million people in the United States who profess to be vegetarian, most eliminate ‘red meats’ from their diet but eat fish, poultry, and dairy products (Tufts University, 1988). A lacto-vegetarian does not eat meat, fish, poultry, or eggs but does consume milk, cheese, and other dairy products; a lacto-ovovegetarian also consumes eggs. A true vegetarian, or vegan, does not eat any food of animal origin. The vegan diet is the only vegetarian diet that incorporates any real risk of obtaining inadequate nutrition, but this risk can be avoided by careful planning.
Vegetarian diets tend to be lower in iron than omnivorous diets, although the non-heme iron in fruits, vegetables, and unrefined cereals is usually accompanied either in the food or in the meal by large amounts of ascorbic acid that aids in ion assimilation. Vegetarians do not have a greater risk of iron deficiency than those who are not vegetarian (American Dietetics association,1997). Vegetarians who consume no dairy products may have low calcium intakes, and vitamin D intakes may be inadequate among them. The calcium in some vegetables is inactivated by the presence of oxalates. Phytates in unrefined cereals also can inactivate calcium; however this is not a problem in vegetarians, whose diet tends to be based more on the fruits and vegetable.
Long term vegans may develop megaloblastic anemia because of a deficiency of vitamin B-12, a vitamin found only in foods of animal origin. The high level of folate in vegan diets may mask the neurologic damage of a vitamin B 12 deficiency. Vegans should have a reliable source of vitamin B12 ,such as fortified breakfast cereal or soya beverages, or take a supplements, according to the American Dietetics Association,1997.
Well planned vegetarian diets are safe for infants, children and adolescents and can meet all of their nutritional requirements for growth. They are also adequate for pregnant and lactating women. The key is that the diet be well planned. Vegetarians should pay special attention to ensure they get adequate calcium, iron, zinc, and vitamin B12 and D. Although vegetarians tend to eat less protein than non vegetarians, the total intake is sufficient.
A Good Meal• No matter what kind of a vegetarian you are, a variety of foods should be included in the diet to meet all energy requirements.• This one is essential to all: Keep your diets free of high sugar and high fat foods; these are simply low in nutrient density.• Using unrefined or whole grain products is always the better option. If possible try to use fortified or enriched morning cereal.• Eat a variety of fruits and fresh vegetables, including foods that are good sources of vitamins A and C.• If you fall in the lacto-vegetarian category use skimmed or no-fat milk.• Eggs may be good because of their nutritional value but they are also very high in cholesterol so limiting intake is a good idea for all ovo-lactovegetarians.
ConclusionSo you see it really doesn’t make a difference whether you eat meat or you don’t, as long as you’re eating all that’s good for you and avoiding all that isn’t. What’s important is that you manage to get yourself a complete and balanced meal. Being healthy is the key to being happy, and like I said earlier it’s not about what you eat or how much you eat, it’s about eating the right thing!
Planning to go vegan? There are enough groups in your city to ensure you stay on the right nutritious track. Check out the following links:
http://sharan-india.org/home/try-vegan/
http://veganbengaluru.wordpress.com/
http://vegan-india.blogspot.com/
All photographs courtesy: Silver Talkies
Caregiving for an Alzheimer’s patient at home can be a difficult and daunting task. Dr Chawla concludes his series on Alzheimer’s Disease with a must-read manual for caregivers. You can read Part II and Part I here and here.
SAFETY FIRST
Providing for safety of the patient is an important job for care givers and the most important part of Alzheimer’s management. A safe environment can help prevent falls and injuries, besides keeping the patient relaxed and less overwhelmed. The environment should be studied, hazards discovered and adaptations done from the point of view of the needs and difficulties of the patient.
Here are the safety guidelines:
Home safety room by room
Guarding against choking and poisoning:
Knives, appliances and electrical goods
Be careful about heat, cold and fire
Prevent slips and falls
Bathroom safety
Home safety behaviour to behaviour
One can take care of an Alzheimer’s patient by educating oneself about the disease and its manifestations and by following the above guidelines without getting overwhelmed. For the caregiver, caring for an alzheimer’s patient remains a very demanding task which may be challenging to say the least. The caregiver could also do the following:
SUPPORT GROUPS
Total awareness and involvement is required day in and day out to care for an Alzheimer’s patient. If one has to tackle the above guidelines alone then it can be stress producing for the care-giver. A care-giver must seek help in the form of keeping a domestic help, eliciting the help of relatives and neighbours besides taking the help of professional bodies like Alzheimer’s Associations, Geriatric Physicians and hospitals, Community care nurses and physiotherapists etc. Care giver support groups are there which can be joined. Family members should be regularly involved. Care giver should take care that he or she doesn’t develop anxiety or depression. Someone should relieve the care giver for a few hours or days regularly. A caregiver should be a member of the support group of the Alzheimer’s patient.
Care-givers also face the agony of seeing their loved ones’ minds and personalities disappear and they have to shoulder physical, social and emotional burdens over a long period of time. The effects on the affected families are personally profound and financially devastating. Therefore, care-givers need the support of the whole family and relatives. They need to take help from multiple sources rather than going it all alone which can become very stressful for even a strong person. The care- givers themselves might also need help of Psychotherapists, counsellors and psychiatrists and should not hesitate to seek such help.
Ultimately, the caregiver’s ability to cope depends on many factors like the kind of relationship and the quality of relationship the caregiver shared with the person with Alzheimer’s disease prior to the onset of the disease or the the caregiver’s emotional and physical health. What also matters is the type, frequency and disruptive effects of behavioural and psychological symptoms exhibited by the patient; the caregiver’s response to and tolerance of these symptoms; the availability of support services; the caregiver’s perception of whether he or she receives sufficient emotional support and the caregiver’s ability to make lifestyle adjustments including taking over household responsibilities and decision making within the home.
The second part of Dr Chawla’s series on Alzheimer’s deals with diagnosis and treatment. You can read the first part here.
DIAGNOSIS AND TREATMENT
The diagnosis of Alzheimer’s is made by clinical suspicion based on the patient’s symptoms. It is supported by the Mini mental status assessment by the Mini Cog test which includes three item recall and the clock drawing test. The test shows the presence or absence of dementia.
A suggestive Mini Cog test in the absence of other systemic illness or brain disease which itself could cause these deficits, for example nutritional deficiencies, inflammatory or other brain disorders and also absence of disturbances of consciousness suggests Alzheimer’s disease. A Brain CT scan and other investigations may be required to rule out other causes. The CT or MRI scan may show decrease in the size of the brain or brain atrophy.
Prognosis & treatment
Alzheimer’s disease is a progressive disease which starts in old age, usually after 65 years. The condition gradually worsens and death usually occurs 6-12 years after the onset. Rare patients may survive for twenty or more years of the disease. It is important to understand that at this time there is no treatment which can arrest or cure the disease process. The aim of investigations is to rule out any treatable causes of dementia like vitamin and nutritional deficiencies, infective or vascular disorders and treat them.
There are no drugs which can stop the neuro-degenerative process. There are some groups of drugs which can be tried in early stages to slow the progression of cognitive decline related to thinking and memory loss but none is proven to be highly effective. Basic management often depends on social and support services and involvement of the family members in supporting their elderly as they become more and more dependent on others for their day-to-day activities. Symptomatic relief can be provided by tranquilisers and sedatives to help sleep and calm the patient. If there are delusions and hallucinations then anti psychotic drugs may have to be used.
The drugs which have been used to halt the progression of Alzheimer’s disease are:
a) Cholinergic drugs: Acetyl- choline is a neuro- transmitter which is considered deficient in the patients of Alzheimer’s. To enhance its activity in the brain, drugs like Donepezil (Aricept), Rivastigmaine(Exelon), Tacrine(Cognex) and Galantamine have been used. Another drug Memantine which is approved for use in moderate to severe disease, affects another neuro- transmitter glutamine in the brain. Drugs like anti-oxidants, vitamins A, C and E, anti-inflammatory agents and hormones are shown to be of no value. General management includes nutrition, hydration, skin care, mobility and care and safety of the patient.
There is no way known to prevent Alzheimer’s disease. The progression may be slowed by some of the drugs mentioned above. General measures which are recommended for all ageing individuals like keeping physically and mentally active, regular walk and exercise, learning new things, remaining socially active and involved, taking vitamins and avoiding nutritional deficiencies and active spiritual leanings are some measures which may help.
Around four million people in India suffer from Alzheimer’s disease, which is two to three times more common in older women than in men. In this three part series on Alzheimer’s, Dr Anil Chawla explains its symptoms, treatment and the extremely important role of a caregiver.
ALZHEIMER’S AND ITS SYMPTOMS
Alzheimer’s disease is a type of dementia. It is also called Senile dementia and is characterised by the impairment of memory, intellectual abilities and associated personality and behaviour changes that occur among elders usually after 65 years of age. It is generally slow in onset and is a progressive, primary degenerative cerebral disease of unknown aetiology. Alzheimer’s disease occurs in a small percentage of individuals of advancing age. According to one study in US, Alzheimer prevalence was estimated to be 1.6% in the year 2000, in both overall and in the 65–74 age group, with the rate increasing to 19% in the older 75–84 group and to 42% in the greater than 84 group. According to 2010 estimates, about 5.4 million people in US suffer from Alzheimer’s. In India, the rough estimate is around 4 million. Alzheimer’s disease is two to three times more common in women than in men. The symptoms of Alzheimer’s include:
a) Forgetfulness or memory impairment
b) Functional and behaviour changes which may be noticed by the family members, like poor judgement, difficulty in making calculations and handling money, inability to write cheques or use public transportation, etc.
c) As the disease advances, the person becomes confused, disoriented and incapable of doing activities of daily living like eating, grooming or using the toilet.
d) Some people develop personality changes like becoming aggressive, suspicious, delusional (holding strange beliefs), quarrelsome and agitated while some develop apathy and become socially withdrawn. Anxiety and depression and sleeplessness can also occur.
e) Mis-identification of objects are common, like the washing machine detergent may be mistaken as wheat flour; a round tablet may be picked up as a key to unlock the door. It goes to the extent that the person may fail to recognise himself or herself in the mirror and say there is someone else.
f) Some people with the disease tend to wander away from home as they hear voices (Auditory Hallucinations) and think that someone is calling them outside. Many get lost as they are confused and disoriented and can’t find their way back.
g) With further advancing disease the control over urinary bladder and bowel is lost leading to incontinence.
h) Total dependence on caregivers develops eventually.
Warning Signs
Forgetfulness or memory disturbances which are becoming perpetual, inability to learn something new or recall recent events are the things which should ring a warning bell. It’s all right if you forget whether it is Monday or Wednesday, why you went to the next room or where you left your keys. It’s not all right if you forget that you have already had breakfast and ask for it again or don’t remember how to make a telephone call; how to find your way around your home or the way upstairs; the names of your spouse or children or whether it is summer or winter.
Cause and Risk Factors
Unfortunately , the cause of Alzheimer’s disease is unknown. A small percentage of Alzheimer’s (less than 1%) which begins early, that is before 60 years of age, may have a genetic basis. Alzheimer’s is largely sporadic and not familial. The main cause is advancing age of the individual. The risk factors are advancing age and family history plus genetic factors in some. Some probable risk factors are also lack of education, oestrogen deficiency, viral brain infections, aluminium toxicity and head injuries.
Next: Diagnosis and treatment
Dr Chawla has 37 years of experience in the medical field. His work has ranged from being a full-time senior consultant in Medicine at IBRA, Oman; Royal Hospital, Oman; Salmaniya Medical Center, Bahrain to being a lecturer-professor at reputed institutes like Oman Medical College; AIIMS and Maulana Azad Medical College in India. He is M.B.B.S, M.D (Medicine-PGI, Chandigarh), M.R.C.P (U.K), F.R.C.P(Glasgow)
The years teach much which the days never know.