Senior Care

Don’t give away all to your children, doctor advises parents

A new book called the Generation Gap has been released by Dr. V S Natarajan and Ms. Hema Narasimhan to delve into various aspects of elder abuse.
Here is an excerpt from the Hindu article.

Dr. Natarajan

Make a will to protect your children but keep enough for yourself so you don’t have to depend on them in your old age. Take an active part in their day-to-day routine but never interfere in your children’s issues unless asked for. These are some of the solutions in geriatric expert Dr VS Natarajan’s new book ‘Generation Gap’ that was released on Wednesday .

The two-part English book, by Natarajan and Hema Narasimhan, delves deep into the issue of elder abuse and its various forms rampant in Indian society .

The senior geriatrician, who says he drew inspiration from his many of his patients opening up to him about their children, includes several real stories.

One of them is about a rich elderly woman in Purasaiwalkam, Natarajan’s patient for many years. She sought his advice after her only son threatened to poison her if she did not transfer properties to his name. “The reasons could be that children look at their personal happiness above the welfare of their parents .With real estate boom, children want to sell off their parents’ properties and make money . These are only my hypothesis,” he said.

Dr Natarajan, the author of 30 medical books, had penned a book with the same title in 2015, analysing the abuse of elderly at home.

Natarajan advises senior citizens to lead independent lives and be aware of laws protecting them from mistreatment, while urging at the same time children to spend quality time with their parents. “It not just food and shelter that old people need. They need love and care too,” he said.

“They have to remember that what they do to their parents will be repeated in their old age,” he added.

To read the entire article, go here.

(https://timesofindia.indiatimes.com/life-style/relationships/parenting/Dont-give-away-all-to-your-children-doctor-advises-parents/articleshow/52338625.cms? )

Choosing the right wheelchair

Choosing the right wheelchair for an elderly relative is a non-trivial activity. Wheelchairs come in many shapes and sizes, in many different materials, and designed for different uses.

Here are 15 questions for which you need to know answers in order to decide on the right wheelchair.

Is it for indoor use or outdoor use?
If it is for outdoor use, ensure that the back wheels are big. This will ensure that the wheelchair can take the ups and downs of Indian roads and platforms.

Is it foldable?
Most wheelchairs are foldable. Since wheelchairs are stored away for much of the day and through out the night (in the case of seniors), a foldable wheelchair will occupy less space when not in use.

Will it fit into my car boot?
Sometimes, you may want to take the wheelchair with you. In such cases, it is important that the wheelchair folds into a compact size so that it can be easily stowed away in the boot or back seat of the car. 

Are the armrests removable?
Removable armrests help in sliding from bed to the wheelchair and back. This can help if the user of the wheelchair is capable of moving sideways, and the bed and wheelchair are at almost the same height.

Are the footrests removable?
Removable footrests ensure that the wheelchair folds into a smaller place as well as help in making the wheelchairs less unwieldy while transporting.

How heavy is the wheelchair?
Sometimes, the person helping the user of the wheelchair may also be a senior citizen. In such cases, it is very important that the helper is able to lift and maneuver the chair. where possible, buy a lighter wheelchair.

How much weight can the wheelchair bear?
A typical wheelchair is certified for about 100 kilos. In the case that the user is much heavier, go for a bariatric range wheelchair.

What are the dimensions of the wheelchair?
In many homes, the doorways and passages can be very narrow. The bathroom doors, in particular, are usually only 2 – 2.5 feet wide in many Indian homes. Before purchasing the wheelchair, ensure that the wheelchair is able to go to all the places you plan to take it to.

Self-propelled or attendant chair?
A self-propelled manual wheelchair will have large wheels while an attendant wheelchair may have smaller wheels and brakes for the attendant to use. Choose depending on usage. If the person using the wheelchair does not have enough strength to propel themselves, go for a wheelchair designed for attendant use.

Is it for transit purposes?
If you are planning to use the wheelchair only during travel (at airports and railway stations, etc), then go for one of the very light-weight, compact aluminium transit wheelchair models.

Is reclining an option?
Some wheelchairs allow for reclining. These usually are larger and take up much more space. If a person is going to be sitting in a wheelchair for long periods, the reclining option may be useful.

Will it rust?
Wheelchairs come in different materials from mild steel to high-grade aluminium and other alloys. If you are planning to take the wheelchair into bathrooms and toilets or expect it to come in contact with the elements, go for an aluminium one. Chrome plated wheelchairs tend to rust after a while. 

Motorized or manual?
Unless you are living in a high-end gated community with smooth roads and pavements, there is usually very little value in going for a motorized wheelchair in India as most places are not conducive for motorized wheelchair use. Needless to say, Indian roads are not safe for motorized wheelchairs.

Is a commode attached?
A few models of wheelchairs come with commodes attached, so they act as portable commodes as well as wheelchairs. Under most circumstances, it is preferable to keep the wheelchair and the commode separate for various reasons. However, if you need them together, know that such models are available.

What is the cost?
Wheelchairs, like most other things, come in different price brackets. Choose one that fits your budget.

If you have more doubts, write to us at [email protected]

Adult Diapers and their benefits

Adult diapers come in two designs – Nappy type and Panty type.

The nappy type diapers are for people who are bed-ridden or those that need to wear them while at home or overnight, while the pull-on panty type diapers are for mobile people.

The advantages of wearing pull-on panty type diapers are as follows:

1.They are relatively thin and discreet. No one will know that one is wearing them.

2.Just like regular underwear they can be easily removed and worn again. So, if one has access to a toilet, one can use it by pulling down the diaper, urinating into the toilet and pulling the diaper up back in position afterwards.

3.In case no suitable toilet is available, as most diapers are geared to absorb at least a litre of liquid, one can urinate into the diaper without worries.

4.The diapers will absorb all the liquid and keep the outer side and the inner side dry. This prevents problems due to the skin being constantly being damp.

5.The diapers are also designed to contain smell so even when the diaper is saturated, no urine smell will emanate from them.

The advantages of nappy-type diapers are:

1.They are highly absorbent

2.They have wetness indicators to tell you when they need to be changed.

3.They maintain dryness on the inside as well as outside.

4.They are easy to put on for others, especially for those that are bed-ridden.

5.They prevent smells from escaping.

Though diapers are not very environmentally friendly, they are the best option that is currently available for problems relating to bladder weakness.

Thodu Needa, heaven where marriages are made

A recent article in The Asian Age relating to elder care, companionship, and remarriage.

Excerpts below:

Thodu Needa, heaven where marriages are made

“Everyone deserves companionship, even in the final chapters of their lives,” says N.M. Rajeshwari, who, in a bid to felicitate this thought, founded an organisation Thodu Needa in Hyderabad. Her organisation works towards providing emotional support to the elderly; its sole purpose is to build lasting friendship, share ideas, encourage participation and enjoy life with like-minded people and if they wish, remarry.

“A few years ago, I read an article about a man in Mumbai who was helping the elderly get remarried. That’s when the idea of doing something similar here struck me,” she recalls. Many of them toil hard their entire lives by bringing up their children. Yet, owing to various reasons, several of them are left to fend for themselves in their old age, she says. “I wanted to create a platform for these elderly people to choose a suitable companion to live with.”

Today, the organisation has over 600 active members and has successfully conducted over 100 marriages. “We conducted three weddings this year alone,” she says with pride. The only criteria she emphasises on: They should be above 50 years of age and seeking companionship.

You can read the entire article here.( http://www.asianage.com/people/thodu-needa-heaven-where-marriages-are-made-386 )

Understanding men and women in their old age

recent article in the Times of India talks about how men tend to get depressed in their old age while women tend to get more adventurous.

Understanding men and women in their old age

This is something we have also noticed on our trips to old age homes and retirement communities. In all of these places, women appear happier and more participative while the men appear subdued and sombre. While the women band together and enjoy group activities, the men seem to shy away from the company of others.

There could be many reasons for this difference in behaviour, especially in an largely male dominated Indian environment.

Let’s look at why women may be happier at old age homes.

1.They have other women of the same age group to share their days with. There are a fair number of studies that show that women thrive in the company of their girl friends.

2.They don’t have to cook, at least unless they actually want to.

3.They are no longer expected to be at the beck and call of their husband / children.

4.They no longer have to take care of all the house work.

5.For the first time in their lives, they have the time to pursue things that interest them.

As for the men:

1.They feel they are no longer the centre of their families. They are no longer the bread-winner in the family and this can take some getting used to. Retirement deprives them of work, company of peers, and the self-esteem that comes from earning.

2.Without work, there is no vacation. Many men make elaborate plans for after their retirement with rest, relaxation and recuperation forming a large part of it, only to find themselves looking for work again, not for the money but to feel part of a society in which they are a contributing member. So the free time they should be enjoying no longer feels like an extended vacation, but makes them feel they are wasting time.

3.Many of the retirement homes do not allow liquor. Some of the men who had enjoyed some social drinking during their working days may be missing such activities.
If your parents are living in an old age home or retirement community, please do observe them and see if they are showing any signs of depression. Especially the men, they may not tell you themselves that they are feeling depressed. But with your care, some counselling and where required, proper treatment, you can help them live their senior years in a happy frame of mind.

 

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.

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.

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]