Ageing is not a disease — Geriatrician

By 2050, the world is predicted to have more people aged over 60 years than it will have younger people. But the elder face challenges, including abuse. There is a day — Elder Abuse Day — to talk about it, says Dr Ogugua Osi-Ogbu, consultant geriatrician at National Hospital, Abuja Why do we need an […]

By 2050, the world is predicted to have more people aged over 60 years than it will have younger people. But the elder face challenges, including abuse. There is a day — Elder Abuse Day — to talk about it, says Dr Ogugua Osi-Ogbu, consultant geriatrician at National Hospital, Abuja

Why do we need an Elder Abuse Day?

The changing world demographics with population ageing, has made it imperative to shine light on issues of the elderly as a growing group in the world. It is estimated that by 2050, there will be more elderly people (above 60 years of age) in the world than there will be younger people. 

Abuse has been identified as a common challenge that this group face. The [World Health Organisation] WHO estimates that about 4 to 6 percent of the elderly suffer from some form of abuse and most go unreported. The first world elder abuse day was celebrated in 2012, June 15th and since then this day has been celebrated in communities worldwide to raise awareness on abuse issues in the elderly.

Elder abuse is defined as “a single or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person or violates their human and civil rights.”

Quality of life is of paramount importance in the elderly, and elder abuse contributes to a very poor quality of life, poor state of wellbeing and in some cases increases risk of death.

This is why it’s important to ensure there is adequate awareness on this issue, that the elderly and carers/family members fully understand what constitutes elder abuse, can recognise it and make significant efforts to prevent it.

Elder abuse takes different forms ranging from neglect to physical, psychological, financial, sexual and discriminatory abuses. The elderly are a vulnerable group with increased risk of multiple disease conditions and disability which makes them dependent on others for care.

Those with disability of various kinds, especially those requiring assistance with daily activities, are more likely to be abused. Older adults who have suffered strokes and are bed bound are at risk of been neglected. Their meals could be skipped or not adequate increasing their risk for malnutrition and frequent ill health form reduced immunity. 

Other consequences from the neglect include bed sores which also get infected and be a reason for hospital admission and increased financial expenditure. 

Other conditions in the elderly that make them subjects of abuse include reduced mental capacity like is seen in those with dementia and financial dependency. Studies have shown that close family relatives and paid carers tend to be individuals that abuse older adults. 

Physical abuse will lead to frequent falls, fractures, lacerations/wounds etc. Psychological abuse could result in depression and risk of suicidal attempts.

Where do you place Nigeria in its policies about taking care of the elderly?

According to the Global Age watch index for 2015 Nigeria is ranked 86 out of 96 nations. The Nations listed at the bottom are those that have performed poorly in ensuring good wellbeing for their older adults.

The features measured for the ranking include health status of the elderly, the capability (employment and education status of the elderly), income security and enabling environment.

Nigeria needs to consistently make efforts at implementing existing policies that border on the rights of the elderly while ensuring that new strategies and policies are deployed to improve the wellbeing of our senior citizens by focusing on the thematic areas contained in the global age watch index.  

Making our public places age friendly, subsidizing health care cost and improving access to the elderly with health insurance.  Other areas of intervention, monthly income to the elderly, especially those that were not formally employed to be eligible for pension and making our primary health care centres” age friendly”.

What are the key things to do in taking care of the elderly?

1. Show them respect: as individuals with rights just like other members of the society; see them as assets rather than overused goods to be dispensed with. Tap into their wealth of experience and skills to fill gaps (either on voluntary basis or to be re-engaged formally).

Allow them autonomy over their lives: children should not be overbearing in dictating to their aged parents what is good for them! Be accommodating of any existing physical challenges in approaching and caring for older adults: allow time when tasks are to be done by this group in appreciation of the slowed reaction time in some of them as a consequence of the ageing process

Two, make the environment “elder friendly”: buildings should have facilities that welcome the elderly who use assistive devices for walking such as walking frames or allow wheel chairs for those who are wheelchair bound.

Personnel at establishments and health care facilities should be trained to be age friendly in their approach to continue to allow this group participate and interact with the society freely.

Family members and care givers  should be trained to better address the needs and accommodate the challenges of ageing while providing care to older adults.

Also improve access to good health care at subsidized rates (that’s in providing health insurance. Provide income: monthly allowance to the aged

What should the elderly do to live better and healthy lives?

What happens to us in our old age is contributed to by how we lived as children and younger adults. The ageing process begins from birth so measures should be taken throughout the life course to ensure that people age” actively”: remain healthy, be independent, maintain good network of friends and can still participate and contribute to society meaningfully!

It is recommended that throughout the life-course we all embrace healthy living tenets:  indulge in lots of vegetables and fruits, drink lots of water, reduce calories from carbohydrates and fats, exercise regularly ( at least 150 minutes of quick paced walks per week), ensure routine medical checks and prompt treatment of medical conditions.

Avoid tobacco, excess alcohol, excess sunlight, over the counter medications, herbs and undue stress. Maintain healthy spirituality and commit to standing up for the rights of others as well as yours.

As we age there are changes that occur in the body that increase the risk of disease conditions such as diabetes mellitus, hypertension, stroke, cancers, dementia (memory loss), depression, incontinence particularly of urine but can involve faeces too.

Other conditions include malnutrition and weight loss, dental problems with tooth loss, joint problems, (osteoarthritis) with difficulty with walking and risk of falls, hearing and vision loss.

A number of these conditions that we describe as, “Geriatric syndromes” are caused by a constellation of factors and require multiple disciplines to correct or control.  For those who develop these conditions they can be assisted with devices to still live as functionally and as independently as possible by deploying a multidisciplinary care approach. The multiple disciplines that care for older adults in addition to the geriatrician/physician include, physiotherapists, nutritionists, geriatric nurses, geriatric psychiatrists, pharmacists, occupational therapists and social worker.

As geriatrician, what advice do you have for aged ones?

Ageing is not a disease; you have a right to health care just like every other member of the society, seek medical attention as often as you require it without feeling guilty or shy. Face the ageing process with a positive attitude and continue to engage in physical activities and mentally stimulating ones. Play games, exercise regularly, participate in social events. 

If you have a disability,   do not be shy to go out to public places on a wheelchair or using a walking stick, wearing hearing aids etc. Embrace the world around you, endeavour to make new friends of both the young and the old. Do not give upon yourself! In the words of Mark Twain “Age is an issue of mind over matter, if you don’t mind it does not matter”. Let your quality of life matter and not the age!