The structural and functional changes with advancing years is the ‘ageing process’. The theories for ageing as per Gerontologists are loss of irreplaceable cells, production of unsound cells, limited capacity for division and accumulation of waste products. Due to structural changes most organs tend to become smaller in size but some like prostate may increase in size. In the same individual different organs age at different periods. It depends on how much an organ is insulted. There is decrease in gastric secretions, sluggish colonic movements, reduction in kidney function and decline in hormone functions.

Certain benign changes which can be effectively tackled are cataract, deafness, abnormal taste, dry skin pigmentation and growing of facial hair in women. The old person is prone to develop multiple diseases due to degeneration (arthritis). Infection (pneumonia) neoplasms (cancer) and miscellaneous conditions (obesity, nutritional deficiency, etc.).

The more common ailments, their prevention and treatment is outlined below:

If the blood pressure goes above 160/95 mg. in a person of 60 years or above it is Hypertension, It may be silent or with symptoms like headache, giddiness, breathing difficulty, swollen legs or chest pain. If untreated, it may lead to heart attack, stroke, kidney failure or eye problems. Once diagnosed, mild to moderate hypertension can be treated by regular exercise, nonsmoking, less salt intake and meditation. If not drugs control blood pressure. Homeopathy is also effective in controlling Hypertension. Familial obesity, restricted activity, mental stress and drugs like steroids result in another common disease, 

Diabetes Mellitus with ultimate complications like loss of vision, kidney failure, heart attack, stroke or tingling and numbness in limbs. The diagnosis is confirmed when fasting blood sugar is above 120 mg and post prandial blood sugar(1-1/2 hours after meal) is above 160 mg. When diet restriction and exercises fail, then drugs or insulin keep blood sugar under control with minimal interference to quality of life. 

Obesity is more harmful to men than women and obese people are prone to arthritis, hypertension, diabetes, raised cholesterol, gallstones, falls and fungal infections, etc. Restricting calories intake to 1000 cal per day and regular exercises are the solutions.                                                                

Heart Attack occurs when blood supply to heart is reduced. In 1/3rd of patients, the symptoms are severe excruciating central chest pain spreading to lell side of arm or sides of neck associated with profuse sweating and vomiting. In rest of them, it may be indicated by gastric problem, sudden extreme weakness, breathing difficulty or mental tension. ECG, ECHO, treadmill and coronary angiogram confirm the attack and is managed medically and if not, by coronary angioplasty or bypass surgery. Abstinence from smoking, reduction of overweight, control of diabetes, BP and high cholesterol and avoiding sedentary habits, stress and strain prevent heart attack. An intake of 150 mg Aspirin aller the meal is advisable undermedical supervision.                                               

When the blood supply to the brain reduces, one side of the body fails to function and results in paralysis. A block, clot or bleeding from any artery may reduce blood supply due to hypertension, diabetes mellitus, smoking, high cholesterol etc. And on confirmation by brain CT scan, stroke has to be treated by management of risk factors and physiotherapy.                                                          

Due to too much of acidity or loss of mucousal resistance in stomach or upper part of small intestine, Peptic ulcer is not uncommon in old age with complaints of stomach pain and blood vomiting. It can be diagnosed by endoscopy and treated medically or by surgery.                                Want of fibre diet, disease of stomach and intestine, thyroid deficiency, mental depression, certain drugs, lack of exercises and less fluid intake lead to constipation affecting bowel movement. The complications are chest pain, giddiness during straining for stools, anxiety, hernia, varicose veins in legs and obstruction of intestine. Constipation can be managed by increased fluid intake, exercises, drugs and high fibre diets like Ragi, Wheat, Bran, Greens, Banana Stem, Cabbage, Cauliflower, Bitter gourd, Dates, Mango, Papaya, Peppel; Coriander and Omum.                                                          

Obstructive Jaundice, more common than infective type, in old age is due to the obstruction of flow of bile from gall bladder to intestine due to gall stones, cancer of pancreas or drugs. Tests including ultrasonogram should be done without delay and treated early.                      

Tuberculosis, commonly silent without cough, phlegm or blood in the phlegm, in aged is indicated by loss of weight, weakness or low grade temperature and is more common in diabetics and smokers. On diagnosis by chest X-ray and with modem treatment, cure is possible within a year: 

Lung Cancer should be suspected among chronic smokers when there is change of voice, persistent cough with rapid loss of weight and could be diagnosed by chest X-ray and bronchoscopy. Treatment by chemotherapy, radiotherapy or surgery can be contemplated        

Arthritis are of two types, Degenerative arthritis involving knee, hip back bone and neck bone are more common than Rheumatoid arthritis involving joints of hand and feet. Arthritis is managed by weight reduction. Pain relievers, physiotherapy and surgery.                                            

Urinary problems confronted by elders are frequent urination, scanty and burning urination associated with chills and fever due to enlarged prostate (only in males), infection, diabetes and drugs. Appropriate antibiotics are prescribed as treatment.                                                 

Secretion of less or excess hormone causes Thyroid Disease. When the thyroid gland situated in front of the neck, secretes less hormone, the symptoms are lethargy, excess weight, dry skin and change of voice. When it secretes excess hormone it results in excess of appetite, weight loss, sweating, tremors of hand and prominent eye ball. On confirmation by hormone assay tests, the patient receives treatment.                                                          

Elderly people are more prone to Cancer. Men are prone to develop cancer of the mouth, stomach, lungs, rectum, liver and prostate and women to cancer of uterus, breast, stomach, oesophagus and rectum. Warning signals for cancer are 1. Change in bowel or bladder habits 2. Sore throat which does not heal 3. Bleeding or discharge 4. Lump in breast and elsewhere 5. Difficulty in swallowing 6. Change in mark or mole 7. Nagging cough 8. Progressive weight loss with anaemia.                                               

Hernia, piles, hydrocele, intestinal obstruction/perforation, gall stone, enlarged prostate, uterine mass, lump anywhere, fractures, gangrene, bleeding inside the brain are some of the surgical problems which the elderly face. Age is not a contraindication for surgery but the risk and complications are more in old age.                                                       

Gradual decline of libido or sexual impulse is normal with advancing age but rapid decline may be due to diabetes, cancer; urinary problems, liver disorders and mental depression. Sexuality for the aged is a good thing for those who want it                                                           

Depression is the commonest mental illness in the old age. These persons lose interest in life, eat less, lose weight, suffer from sleeplessness and constipation. They are vulnerable for suicidal attempts and need counselling and antidepressants. With the recent advances in medical therapy they can be cured and those who fail to respond require electro convulsive therapy.                                  

A mental illness of increasing inability to remember; to learn, to think and to reason known as Dementia may be due to Alzheimer’s disease in which lack of communication between brain cells due to damages or small clots affect blood supply to brain. The reason for this condition is not known and is often irreversible and progressive. The management is mainly supportive and symptomatic and the old person merits, consideration, kindness and respect as a human being. For healthy ageing, periodic health check-up, at least once a year is essential. Many old age diseases are either preventable or treatable. Health check-up detects silent diseases, makes early diagnosis and prevents complications, Proper nutrition is vital for promotion of health and prevention of illness. Quality of diet is more important than the quantity. The general guidelines are more fluid intake, inclusion of dietary fibre Iand at least one fruit and two glasses of milk. Aged are advised to have a heavy breakfast, moderate lunch and light dinner: Physical ex:ercise is good for all ages, more so in old age. Regular exercise improves blood circulation in all organs to maintain normal function. It reduces obesity, cholesterol, BP, blood sugar; prevents constipation and promotes sound sleep. Consult your physician before choosing an exercise according to individual physical capacity. Brisk walking 3 to 5 Kms or 40-60 minutes in the morning on empty stomach and if possible in the evening too is advisable. Regular exercise and proper calcium intake in diet prevent loss of bone (osteoporosis) and other minerals from the spine which could lead to low back pain or fracture. Mild exercises performed daily to give full range of movement to all joints keep away arthritis. Periodic eye check to detect cataract or glaucoma, ENT check up to remove wax and defective hearing and dental check-up as tooth decay affects general health are mandatory. Mental health is as important as physical health in old age. Due to progressive loss of neurons the brain of a 70 year old person weighs only 56% when compared to its original weight. This results in mental depression, memory loss and anxiety. Brain atrophies with disuse and sensitivity is six times greater in those who have withdrawn from people and life. Loneliness leads to depression which may lead to death. For this right from middle age itself; one should plan for a hobby to keep onself occupied during old age. Hobbies like gardening, indoor games, meditation, bhajans, religious discourses, reading, interacting with others, etc. help the aged persons maintain a sound mental health and enable to age gracefully.

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