Treating elderly the way they deserve

CHENNAI: Have you noticed the number of senior citizens who are also patients and caregivers in any hospital? In the waiting room, emergency room, ICU, wards, pharmacies, labs, hallways…the elderly are often found walking gingerly to their destination. Some are unsure about where to go or what to say, and look lost. There are also instances when, in the everyday hustle of a hospital, their needs are dismissed, or worse, ignored.

In a world often characterised by fast-paced modern technologies that bring everything at our fingertips, geriatric care in medicine still requires the indelible human touch – a form of personalised care that cannot be replaced by technology.

That’s where the National Centre of Ageing (NCA) in Guindy plays a very important role, especially for those from the economically weaker section.

Specialised care

Ageing is characterised by a continuous degeneration of molecules and cells that result in the weakening of many body functions, vulnerability to environmental issues and a growing risk of disease and death.

With more than 10,000 out-patients receiving care at the NCA since its inaugural in February this year, the requirement of exclusive medical facilities for elderly cannot be stressed enough. “I cannot run across departments in other government or private hospitals. Also, they are more crowded,” said Shailaja (56), who accompanied her husband to the centre. “I came here for a consultation for my husband’s knee injury, and he also has diabetes. We’re now getting regular check-ups done here, because doctors and nurses listen when my husband or I say something. They’re attentive and patient too.”

Patience and paying attention are two of many qualities often missing with regard to geriatric care in other hospitals, which make the elderly feel they are not a priority for the doctors.

“They have to struggle for everything. Often, accessibility is a serious issue. Here, the Centre is exclusive for them. Doctors, nurses, administrative staff, lab technicians and other support staff are all trained in geriatric care in its myriad forms. When their specialised needs are met, they come to the Centre, even though specialities like neurology, nephrology, cardiology, ENT, radiology, pulmonology, etc., are available other hospitals,” explained Dr S Deepa, director in-charge, National Centre of Ageing.

As many as 300 inpatients have been treated at the Centre since the inaugural till March. The NCA has four modular operation theatres and one minor operation theatre to treat septic cases mainly.

“We receive more than 600 patients in a day and the number of daily cases is slowly increasing. The first surgery was performed at the hospital on April 5 on a patient suffering with hernia,” she added.

Accessibility

The hospital has five wards with 25 beds each. There are around 15 cases in the women’s ward and 20 cases in the men’s ward on a regular basis. The pay wards (at Rs 900) with a separate AC room and bathroom have also received a good response from patients.

Both middle-class and upper middle-class families have also shown interest in bringing their elderly to the NCA, where they get specialised quality care with a private room at a subsidised rate.

A geriatrician at the NCA said that patients can take medical tests and lab tests in the same building. The main challenge for elderly patients is accessibility and convenience. So, the hospital is equipped with grab bars and railings even in the corridor.

“Washrooms have also been designed with grab bars and ramps. The hospital will soon have battery cars to facilitate commuting within the hospital premises. While travel from the nearby Guindy bus stop was a concern for patients, there are mini buses now being run from 7 am-6 pm for the elderly,” said the geriatrician.

Emergent cases, common issues

Most cases brought to the NCA are cardiac ailments. While men suffer from respiratory illnesses such as chronic pulmonary obstructive disease (CPOD), women have anaemia and weak bone density.

“Among women, lumbar spondylitis, anaemia, renal failure, and cardiac complications are common. Lower respiratory tract infection is common in both men and women. A large number of patients come here after cardiac arrest or heart failure,” said a nurse at the NCA.

The hospital authorities say that a large number of patients visit the NCA in the later stages of the illness. “There are a lot of cases of heart failure, COPD, delirium, Parkinson’s and liver failure among men. Most of these illnesses are age-related; and, smoking and drinking have worsened their health over the years. COPD is mostly reported among patients with a history of smoking for 20 years or more. Such patients would require oxygen support too,” explained Dr Dinesh Kumar, junior resident, NCA.

With diabetes and hypertension being the most common comorbidities among the elderly, the hospital sees around 70-80% of patients with either of them.

“Diabetes impacts immunity and thus, they are at a high risk of developing infections and illnesses. With the mercury levels rising, a lot of cases of seizure, electrolyte disturbance and heat burns are becoming common due to dehydration and hyponatremia,” he added.

The emergency triage ward at the NCA gets many cases of myocardial infarction, stroke, falls, sepsis, respiratory failure, pneumonia, cardiovascular problems, and pulmonary issues.

“Often, we don’t see the typical symptoms of a heart attack in the elderly. They might be having a burning sensation, which would be indicative of a cardiac arrest. They do present with typical symptoms in case of acute stroke, and some cases of COPD. There is not just a single ailment and we have to carry out multiple investigations to recognise the multiple comorbid conditions. There can be other underlying causes of a respective illness also, because they are not identified in many cases,” elaborated Dr P Niveditha, resident doctor, NCA. “Patients also come when their blood-sugar levels and BP suddenly shoot up.”

Rehabilitation

The Physical Medicine and Rehabilitation Department at the Centre receives the highest number of patients at the Centre, with about 130-140 patients visiting daily.

As we age, the existing trauma injuries and illnesses increase and the risk of fall is also higher, which is why most people require medication and rehabilitation services.

“Patients who have suffered a stroke, those with Parkinson’s, and even some suffering from old spinal cord injuries – all of them require different forms of physiotherapy exercises and occupational therapy (OT), which we provide. OT aims at making them self-reliant to carry out their daily routine activities on their own. We’ll be having an independent OT centre soon,” stated Dr Bruno, assistant professor of physical medicine and rehabilitation, NCA.

Many patients who visit the NCA live on their own and do not have anyone to assist them. “When they have restricted movement and mobility of certain body parts, they find it difficult to carry out the daily activities. Therefore, we emphasise on OT for such patients. In addition to out-patients, we also provide rehab services to patients admitted here. They would also need physiotherapy for improving mobility and movement. We have treated more than 4,000 patients so far,” added Dr Bruno.

Referral cases

Patients are referred to the NCA, not only from the private hospitals in the city but also from GHs and private hospitals in other districts.

“People from the southern parts of Chennai and suburban areas visit here often, but we also get patients from other districts including Chengalpattu, Kancheepuram, Dindigul, and Thoothukudi. Those living in other countries with their parents in Tamil Nadu have also enquired about our services,” pointed out a nurse at the in-patient block of the NCA.

She added that the advantage of having NCA was that all geriatric specialities are in one place and most elderly patients have multi-morbidities. “They suffer from various age-related illnesses because organs degenerate and bones also weaken. We usually assume underlying illnesses and do multiple investigations to ensure that we know all their health parameters,” said the nurse.

Mental health, social challenges

A large number of patients visit the NCA not just for their physical problems but also for their mental health challenges and other social issues that bother them.

Janaki (62) said that her children could not bring her to the hospital as they had to go to work. She was accompanied to the hospital by her care-taker but she lamented over the discomfort of being dependent on others for lifting her and using the wheelchair.

Most elderly patients are lonely and they need assistance with everything. They don’t have much hope for recovery and given the multiple morbidities, their recovery is also slower.

“A lot of them are lonely, depressed and anxious. When they experience deafness or blurred vision, they get frustrated easily too. It takes a lot of patience to manage an elderly patient, and often, requires a longer period of time than a younger patient,” said a NCA doctor. “Many elderly patients are very sad and most of them don’t have attendants. Even if they do, attendants stay for a day or two and leave them in the hospital. So, patients get very restless when they are alone and it is difficult to manage them in such a scenario.”