Buhari, Tinubu and the Five Geriatric Giants

In what is now stale news, PMB granted Channels TV an interview last week. The discussion sparked series of debates and was followed by mixed reactions across the country. Many of his comments on state policing, insecurity, corruption and the infamous ‘going back to the farm’ were bland, lacklustre and downright insensitive. However, my favourite […]

In what is now stale news, PMB granted Channels TV an interview last week. The discussion sparked series of debates and was followed by mixed reactions across the country. Many of his comments on state policing, insecurity, corruption and the infamous ‘going back to the farm’ were bland, lacklustre and downright insensitive. However, my favourite take-away from the interview was his comment on ageism. 

“Age is telling on me, working now for six to eight hours a day is no joke. Questions of executive council memos from as many states as possible to be considered every week. So, really it is a lot of hard work, but I asked for it and I cannot complain.”- PMB

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The comment was meant to be light hearted, implying that he is tired and cannot wait for retirement, but as a medical person I detected an underlying truth. The fact is that at age 79, absolutely nobody can work at optimal mental, physical and social capacity. Six to eight hours is what children spend at school learning, yet they come back home full of energy. Adolescents and young adults can study and work for more than 10 hours a day; while the poor Nigerian man in his thirties, forties and even fifties has been known to work for more than 10 hours! Do you know the hours truck drivers spend? What about the manual labourers on building sites? They are able to spend these hours everyday because they are young and energetic. Period.

A few days after the interview, Jagaban decided to put the rumours to rest when he publicly announced his intention to run for the office of the president of Nigeria. I marvelled at the irony- while one is lamenting about the stress of office and counting the months to retirement, another person, of the same age group, is rushing the same stress. Different strokes.

Conventionally, “elderly” has been defined as a chronological age of 65 years old or older. The United Nations adopted 60 years as the cut off mark for ‘elderly’ while WHO and other countries have adopted 65yrs and above. However, whether we take 60 years or 65 years, remains immaterial as both PMB and Tinubu have long passed that age. 

The sight of these two old men made be remember the phenomena of the geriatric giants. 

In 1965, Bernard Isaacs coined the term “geriatric giants.” They are a group of symptoms which are largely associated with old age. Professor Isaacs named these ‘giants’ as immobility, instability, incontinence, and impaired intellect/memory. These ‘giants’ have changed over the past 50 years. The understanding of ‘modern geriatric giants’ has evolved to encompass the several new syndromes of frailty, sarcopenia, impotence, the anorexia of ageing, and cognitive impairment. These syndromes are the harbingers of falls, hip fractures, affective disorders and delirium with their associated increase in morbidity and mortality among old people.

Let me stop the ‘dogon turanchi’ here and describe only the five symptoms that apply to us. What Oga does in the other room does not concern us.

The first geriatric giant is immobility. This is not restricted to inability to move alone, as many old people as we know are mobile and can walk for miles and miles. Immobility here includes, but is not restricted to, all those joint pains that creep on you ever so slowly, when you reach the fifth decade of your life. The complaints of knee pain, low back pain and hip pain. I am yet to meet a single person over the age of fifty who has not experienced joint pains. These pains prompt them to go the hospital only for them to be told what we all do not want to hear; that we are growing old. The joints are tired and the bones, frail. Like my mechanic would say ‘this “bow-joint” don pafuka, make we change am.’ Unfortunately, for humans, our ball-joints don’t have spare parts. Even the most sophisticated knee and hip replacement cannot guarantee you a pain free life. 

The second giant, Instability is closely related to Immobility. This refers to the elderly’s preponderance for falling. Falls in the elderly are dangerous and are related to a lot of factors like osteoarthritis (joint and bone pains), declining vision and hearing, dizziness (orthostatic hypotension), hypoglycaemia etc. It is for these reasons that older people are encouraged to have their bedrooms downstairs and not upstairs in duplex houses, to have carpets in their homes instead of tiles and to stop standing up abruptly from sitting or lying position. They are encouraged to eat better because old age causes the cells in our tongue to die therefore eating is not enjoyable anymore. Hence, the weight loss of the elderly. When you factor in the presbyopia (vision loss due to age, why reading glasses are required), and decreased bone density, the risk of falls multiplies 50-fold.

The third one is Incontinence. This is the ugly brother nobody likes to talk about but is very much in our lives and is experienced by both men and women. In women, it is due to weakening of the pelvic floor muscles caused by multiple pregnancies. And as for the men, it is due to the ‘small but mighty’ prostate gland which starts to give men hell after the age of forty. Its symptoms vary but are not limited to: bloody urine, pain on urination, hesitancy while urinating, straining and a feeling of incomplete emptying of the bladder after urinating. A culmination of these symptoms, depending on the pathology may then cause incontinence. When a person is unable to hold urine long enough to reach the bathroom or when the urine starts dripping on its own without control and so has to use medication, urinary catheters and eventually adult diapers when it becomes too bad. Many elderly men battle some form urinary condition or the other. 

The fourth and fifth geriatric giants are usually described together: Impaired memory and   impaired cognition/intellect. These two group of symptoms are perhaps the most important reasons why choosing a president in this age group is a dicey task. Studies have shown repeatedly that no matter your intelligence, once we begin to age, some parts of the brain begin to atrophy. Impaired memory means we begin to forget things: Who is this? Pls remind me. Where are my glasses? Where am I? What happened here? Even after being told just minutes ago. The elderly person may be able to recall things that happened long ago, but have short term memory loss. 

Impaired cognition is much worse, as it affects the part of the brain responsible for reasoning. 2+2 suddenly does not make 4 anymore. The elderly man or woman begins to make blunders which affect daily function. Sometimes, the memory and cognitive decline are symptoms of dementia and may progress. However, in most people they do not.

These collections of symptoms were described because statistically MOST elderly people will have more than one or two of these symptoms. These symptoms occur because of the natural ageing mechanism and therefore as long as we grow old, cannot escape them.

Once upon a time, a 68-year-old patient came to me and said ‘Doctor, I want to live long, perhaps till I am 150’. I only smiled and told him about the geriatric giants. There is no way life would be enjoyable at age 90, when you can’t even enjoy a simple plate of Jollof rice and peppered chicken. Where are the taste buds? How do you perceive the aroma of the food? (the sense of smell being long gone) Where are the teeth? 

Both PMB and Jagaban are old people with established health issues and more than a few geriatric giants in their cupboards. Agreed, the president of this country does not have to be a rocket scientist, BUT (and this is a big BUT) he should be one who can manage six to eight working hours a day without complaining or jetting off to the UK to get much needed rest.

Growing old is a necessity, but do not delude yourselves, all the money and power in the world cannot make it pleasurable. 

I rest my case.