Enteral Feeding – An introduction

Sometimes, a bedridden person may not be able to ingest food through their mouth. This can be due to various reasons, from refusing to eat (in some cases of dementia) to inability to swallow due to being comatose, having neurological problems, having obstructions in the food canal or other similar problems.

Enteral Feeding – An introduction

Under such circumstances Doctors advice enteral feeding. Enteral feeding is defined as delivery of a nutritionally complete feed, containing protein, carbohydrate, fat, water, minerals and vitamins, directly into the stomach, duodenum or jejunum. Basically, what this means is that the doctors will insert a tube into the body and you will have to use that tube as the means to feed the patient. The food, in this case, would be a nutritionally complete meal replacement powder such as Ensure, Fresubin or some other brand.

The feeding tube can be inserted in a couple of different  ways. Given below is a brief layman’s understanding of them.

Nasogastric intubation
In this case, the doctor will insert a narrow bore tube, called a Ryles’ tube or a nasogastric tube, through one of the nostrils into the stomach or duodenum(which is the part of the small intestine just after the stomach). Whenever feeding is required, the desired quantity of the meal replacement solution (freshly prepared) can be injected into the tube slowly. Alternately a bag of the food can be attached to the tube and the food released slowly over an extended period. It is usually recommended that this method is used for no more than six weeks at a time, but if no other option is available, this can be used indefinitely subject to the patient not suffering any major discomfort.

This type of intubation is contra-indicated under some conditions such as

-High risk of aspiration

-Gastric stasis

-Gastro-oesophageal reflux

-Upper gastrointestinal stricture

-Nasal injuries

-Base of skull fractures

Percutaneous Endoscopic Gastrostomy
Percutaneous endoscopic gastrostomy (PEG) is an endoscopic medical procedure in which a tube (PEG tube) is passed into a patient’s stomach through the abdominal wall. In some cases, the tube is extended into the duodenum or the jejunum. This method for enteral feeding is indicated when such feeding is required for extended periods of time measured in years. To install the PEG tube, an invasive operation is required. In one popular method, an endoscope is inserted through the mouth or nostril into the stomach and a light flashed to identify the area where the incision needs to be made. Then an incision is made in the abdominal wall and the stomach and the tube inserted into the stomach. The stomach is then stapled or sutured to the inner abdominal wall at that point so that it does not move and dislodge the tube. The operation is relatively straight-forward and is conducted very often under local anesthesia nowadays.

Since an operation is required, this is not suitable for patients too weak to undergo operations under local or general anesthesia. In addition, this operation becomes difficult if the patient does not have the ability to swallow as that makes it difficult for the endoscope to be inserted.

PEG reduces dramatically the possibility of aspiration (food coming back up from the stomach) and reflux and is ideal in cases where the need for enteral feeding is for a prolonged period.

If your loved elder is unable to eat normally, do consult your doctor regarding enteral feeding.

Right to Vote for Old Age Home Inmates

Right to Vote for Old Age Home InmatesCHENNAI: Confined to an old age home is no handicap for exercising one’s democratic right in the election. Not any more. Senior citizens at the YWCA who were hitherto unable to vote were delighted on Tuesday, thanks to the District Election Officer (DEO), who distributed voters ID for around 35 inmates.

DEO and Chennai Corporation Commissioner B Chandramohan, while distributing voters ID, assured to take steps to make the polling booth senior citizen-friendly, besides ensuring a smooth voting process.

On receiving the ID card, Visa Ravidhran (67) said, “Earlier I knew the candidates in our constituency and their parties. But these days, even the party cadre are ignorant of their supporters. Politicians should be more connected to the people to secure their trust.”

Most of the senior citizens said people should not be swayed by freebies, but rather judge a party’s history before extending support. Rachel Jacobi, General Secretary of YWMA, Madras, said, “So far, I have never missed voting. More than a right, I consider it as my duty. If one is unhappy with the parties, the NOTA option is there,” she added.

DEO Assures Smooth Voting

District Election Officer and Chennai Corporation Commissioner B Chandramohan, while distributing voters ID, assured to take steps to make the polling booth senior citizen-friendly, besides ensuring a smooth voting process.

To read the original article, go here.

(https://www.newindianexpress.com/elections/elections-2016/2016/apr/27/Right-to-Vote-for-Home-Inmates-929607.html )

Understanding and dealing with faecal incontinence

Understanding and dealing with faecal incontinenceAny form of incontinence, though may not be fatal, can surely rob the life of the affected.

Faecal Incontinence (FI) is basically lack of control over defecation leading to involuntary loss of some or all of the bowel contents. This is a symptom and not a diagnosis. There can be several underlying reasons for FI including recent anorectal surgery, damage during childbirth, weakened sphincter, Irritable Bowel Syndrome (IBS), Chrohn’s disease, just diarrhea or neurological conditions such as Alzheimer’s and dementia. Luckily not too many people suffer from this. It is estimated that just over 2% of the adults suffer from faecal incontinence at some point in time and only 0.5 – 1% of adults experience regular FI.

While potential embarrassment is a major worry, there are more serious health concerns associated with FI over and above the underlying causes of the FI in the first place. As the skin around the anal region has prolonged contact with faecal matter, this can lead to maceration, which is the softening and whitening of the skin due to continues exposure to moisture. Additionally, because of the bacteria that flourish in the faecal matter, Urinary Tract Infections(UTI) become more common. Finally, especially in the case of bedridden people, bed sores (also called pressure ulcers) start forming rather frequently.

Use of adult diapers and their regular change can help mitigate some of the problems. Also regular cleansing and strict maintenance of hygiene can go a long way in reducing the chances of bed sore and related issues.
If you or your loved ones suffer from FI, do approach a Doctor at the earliest.

A note for those family members living with their elder parents or relatives: Many people suffering from FI are too embarrassed to discuss this problem and may be trying to quietly deal with the problems themselves. If you notice frequent and hurried visits to the toilet, reluctance to leave home, frequent washing of clothes, especially undergarments, stains on clothes and bed linen and smells associated with fecal matter, broach the subject with sensitivity and gently get them to allow you to take them to the Doctor.

Free bus pass for Senior Citizens in TN

Free bus pass for Senior Citizens in TNApart from availing tokens for free bus travel that will be distributed to senior citizens at 42 bus stands and depots across the city, senior citizens can also download forms at www.mtcbus.org.

The applicants should submit proof of age and two passport size photographs with the applications.

The scheme would be implemented from Wednesday. People over sixty can apply for tokens at designated bus stands and depots. Ten tokens will be issued every month to every senior citizen, an official release said. – Special Correspondent

A parent getting discharged from hospital?

A parent getting discharged from hospitalWhen a loved one gets hospitalized, there are Doctors and nurses to look after them while they are under their care. Despite that, the period of hospitalization can be very taxing, both emotionally and physically for the family members.

However, a bigger challenge awaits when the patient gets discharged and moves back home. Many times, especially in the case of elderly patients, there is a long recuperating period. Looking after them at home, without the guidance and support of Doctors, nurses and hospital equipment can be very difficult. Thankfully, you can turn to Old is Gold Store for guidance, training and information on post-discharge home health care.

In the meantime, here are a few things to learn:
1. Keeping important information handy
Emergencies are common. Keep all important information ready at hand. These could include contact details for Ambulance, the consulting physicians and other Doctors, Doctors who make house calls in your area, the pharmacy, the nursing agency, and immediate relatives apart from all the medical records including the latest prescriptions, and insurance papers.

2, Use of essential devices.
There are many devices that are needed to monitor, maintain and manage the condition of the patient. These include devices such as air beds, pulse oximeters, BP monitors, Glucometers, Nebulizers, Phlegm suction apparatus, hospital cots, wheelchairs, walkers and many other devices. Learning to use them effectively will go a long way in ensuring the patient’s successful and speedy recovery.

3, Maintaining hygiene.
Good hygiene is critical to reducing infection. The hygiene of the people looking after the patient as well as that of the patient themselves are both equally important. Remember to wash hands regularly, limit the number of visitors, and ensure that the visitors wash their hands and feet before entering the patient’s room. Also learn how to use and change diapers and underpads, how to thoroughly clean urine and fecal matter and even how to clean wounds and replace dressing, if required.

Post-discharge home health care can be challenging. Being prepared can mean the difference between life and death.

Old is Gold Store can help guide you with information and training. Call 044-42666684 for an appointment.

Accessibility issues for elders

It is indeed surprising, that despite being a culture that supposedly reveres the elderly, we don’t give the needs of the aged and the disabled in India any thought at all.

To truly appreciate how insensitive we are to the needs of the elderly (and the disabled), do this mental exercise.  Imagine yourself to be wheelchair bound.  Actually, let us not go that far yet. Just imagine you are an old person with slightly diminished reflexes and minor balance issues that necessitate you to carry a walking stick for balance. With that firmly in mind, now take a look at the world around you.

Accessibility issues for eldersOne of the few roads in Chennai with a footpath.  Notice how there is construction debris all over the pavement and the two ladies are being forced to walk on the road, risking the prospect of being run over.

We have all experienced the serious challenges involved in walking on Indian roads. Now imagine you are that old person.  Now think of walking on roads which lack pavements and have heavy and unregulated traffic driven by reckless and insensitive drivers. While you are looking both ways and dodging traffic, don’t forget to bend down and avoid all the wires and cables, thoughtlessly strung from poles, trees and buildings. Finally, remember to jump over the pits and trenches left open by various civic bodies.  All this when you are weak and feeble!

The dangers of walking around on Indian streets today prevent countless elders and disabled from leaving the relative safety of their homes.  Many of them forego their usual walks, their trips to places of worship, or even to banks and post offices to collect their pensions because of their fear of being run over or getting seriously injured.

Now take a look at the public transport available in your city.

Accessibility issues for eldersThe picture on the right shows the true story.  Look at how everyone is running to get into the bus.  Notice the slower ones struggling to reach the bus. Imagine now that you are an old person incapable of running!

Buses come swerving in at breakneck speed and stop somewhere in the vicinity of the bus stop, wait but for a few seconds and speed away before everyone has safely boarded.  With steep steps that only the young can jump onto, riding buses in India is meant only for the young and agile.

Trains are no better. Suburban trains, especially, are a challenge even for the young and nimble unless they are used to them.  If you go to Mumbai for example, unless you are a regular traveller, there is very little chance of making it on to any of the suburban trains during peak hours.  And if you do manage to get on, you may not be able to get off till the train reaches its last station! Long distance trains, though not as crowded, present us with other challenges.  Their steps are practically upright ladders that have to be negotiated to get into them.  If one is wheelchair bound, it is impossible to get on to the train at all, leave alone reach one’s seat, given how narrow the doors and passages are.

Accessibility issues for eldersThis picture with the bent over old lady is a picture of the foot over bridge at the Chennai Central Railway station.  The picture says it all.

Next let us look at the insides public places and buildings.  Many banks, post offices and insurance buildings are in old buildings with no elevators.  Most of their offices are on the first or second floor with only stair access.  Even those that are on the ground floor require navigation of a few steps before the counters can be reached. Barring a few malls and upmarket cinemas, most places have either no toilet facilities (for the visiting patrons) or have extremely dirty ones that no one in their right mind will want to step into.  The lack of a token system  and the consequent need of having to stand in a long queues for several minutes to hours compound the problems faced by the elderly in public offices and buildings.

These are just some of the problems faced by our elders in India.  If you spot more such problems please write to [email protected].

Combating Parkinson’s together

A news report in Hindu talks about a new self-help group that is bringing together people with Parkinson’s.  Here is an extract from the report:

Parkinson’s diseaseAt first, Kannan S. thought there was something wrong with his eyes. He would feel exhausted when out in the sunlight, and found that his handwriting had begun to taper. Later, the resident of Nolambur was diagnosed with Parkinson’s disease, a progressive disorder of the nervous system that affects movement.

“I was put on medication, but I experienced a lot of side effects. And I was depressed. My confidence levels fell,” said the 68-year-old.

What changed this was Parivarthan for Parkinson’s, an Anna Nagar-based community support group for people with Parkinson’s disease and their families. Started about a year ago by Sudha Meiyappan, the group now has about 45 families involved and organises various activities including guest lectures every month, yoga sessions every week and home visits for those who cannot make it to the meetings.

To read the entire article, go here.

(https://www.thehindu.com/news/cities/chennai/combating-parkinsons-together/article7868738.ece )

A short film to create awareness about Parkinson’s Disease

A lot of people are still not aware of Parkinson’s Disease. Especially here in India, many people just think that the old man (or woman) is simply being obtuse and troublesome on purpose.  In this film, however, a doctor describes the condition in a lucid manner and hopefully this will help more people recognize this condition and approach a doctor for treatment.