ON WORLD SENIOR CITIZENS DAY (AUGUST 21, 2022): The focus was on osteoporosis and joint pains at a function held at the New Auditorium, GMC, where keynote speaker was Dr Amarnath (trauma and orthopedic surgeon). The function also saw the felicitatiion of GMC staffers old and new and present were chief guest VK Jha (IAS), Dr SMBandekar (GMC dean), Dr Edwin Gomes (professor and HOD of Geriatric department). At the entrance of the hall there was a gloriously colourful rangoli artwork presentation by GMC staff on the theme of “Living with Dignity” for senior citizens.

By Tara Narayan

But few know about it and for that matter what geriatrics is all about! Geriatrics care in Goa still has to come a long, long way despite all the World Senior Citizens Day celebrations…

IT was World Senior Citizens Day on Sunday, August 21, 2022 and the focus was on osteoporosis in the elderly and increasingly in the young at the Goa Medical College & Hospital’s at the New Auditorium, near the Forensic department at the GMC. The keynote speaker was Dr Amarnath from Bengaluru, a trauma and orthopaedic surgeon, also director of the Orthopedic Society of India and secretary of the Geriatric Orthopedic Society of India. From the sound of it orthopdics and osteoporosis are the two manor concerns when it comes to senior citizens although many do suffer from multifactorial health conditions when they cross their 60s and get into their 70s (I believe that maximum strokes take place at the age of 72 years old, check it out if you wish). For some old age is just a number but for many it is not no matter what the cheer leaders of the medical fraternity say.
So enormous is the issue of joint arthritis and dislocations as well as osteoporosis in our new India that it should be a matter of concern. India may have an aging population and private and public homes for the elderly may be coming up all the time – but few know what the science of geriatrics is and how seriously it is taken by the medical community. Few of us may know that nowadays even 25-year-olds are facing the grim scenario of their skeletons turning porous, fragile – quite simple because of passive lifestyles led mostly indoors. Like…er…staying indoors most of the time parked before a computer. Today’s children are no longer growing up out of the sun but are cossetted and virtually starved to death on a diet of junk food indoors.

DR AMARNATH’S PRESENTATION
AT least this is what came home to many in the audience of GMC staff, mostly senior and young, who had come to listen to the aforementioned Dr Amarnath’s presentation at the GMC. I was shocked to see the graphic pictures of a 25-year-old software computer engineer’s bones looking like ivory coloured cheese with holes big and small punched everywhere. It was a horrifying graphic and that too since the patient was not an elderly citizen but a young woman. Of course, now we have treatment for osteoporosis, but the larger question is why is it afflicting the younger generation and is it aware of this?

Are young women and men in the IT industry aware of it? This particular case has a young woman post-three pregnancies and her nutritional needs were critical – mostly vitamin D, calcium, phosphorus, vitamin B…everything that goes into the making of a strong skeleton (which the GMC dean Dr Shivanand Bandekar had earlier aptly described as the foundation of the body on which all other health issues hang, he himself being an orthopaedic surgeon he should know). Take bone marrow? Your skeleton, your bones, your cardio-vascular system fed by venous and arterial blood – nutritious or anaemic – will determine what kind of joint pains and osteoporosis you will suffer from as you enter your senior or so called geriatric years which may be post-70 or earlier depending on the state of your fitness parameters.

WHAT IS GERIATRICS?
WE in India are not yet so familiar with the word “geriatrics” and neither is the medical fraternity by and large. In the developed world with aging populations the medical speciality of geriatrics or geriatric medicine is finely and extensively defined and detailed along with treatment parameters for young and old. We all go old but how we slow down the process healthily is up to us given the sunlight, salt and time or so to speak! Most of us not conscious of this in our fast-paced lifestyles chasing the good life in good, bad or ugly ways. We forget ourselves and that too in all the right ways and not the bad ways. Look around and tell me I speak the truth here. Oftentimes truth, freedom and health are out of reach for most of us.
Most elderly patients suffer maximum from joint pains and surgeries to replace hip or knee bones are a booming medical practice. In all this a key role is played by how well or how badly we are aging – in India we are lucky in some ways but all the ills of the Western world are catching up with us and because we in India are still a young population by and large, few are bothered about the science of geriatrics and it is one of the specialities few doctors want to specialize in, maybe to be cynical — there’s no money in it!
THE process of aging covers a gamut of issues or conditions like cognitive impairment, falls, incontinence, low body mass index, dizziness, vision impairment, hearing impairment and if the elderly are not treated early enough they will suffer bathing, dressing, eating, transferring, toileting problems and this can be pretty hard on them. Very often robbing them of the dignity of living to a ripe old age. Interesting the theme of World Senior Citizens Day on this year “Living with dignity.” It is very difficult to live with dignity if one is dependent on another for performing our most primary abilities and this eventually leads to emotional and psychological problems of the depressive kind.

JOINT FAMILY BLESSINGS
ARE our elderly living with dignity in family after family be it in still alive joint family systems or in our increasing nuclear family systems in which “Hum do, hamare do” rule with supreme irony? With many young working parents ready to shift the burden of bringing up their children on to the senior generation at home, that is if their parents are living with them or more likely they are living in their parents’ home. Economic factors play an altogether vital role when it comes to elderly citizens. Very often their children are in a hurry to inherit parental property even before their parents have passed on, consequent to which there are many sad tragedies as various siblings claim what is theirs and what is not theirs to claim courtesy various justifications real or unreal…leading to many needless sad tragedies.
BUT to stay with geriatric care the study of aging is called gerontology and the study of illness and diseases of the elderly is called geriatrics. Medical doctors specializing in geriatric treatment are few in India and there are few Indian gerontology or geriatric studies if any. The aging process is usually defined into biological, social and environmental issues…that is aging at cellular and molecular level, changing relationships and how to induce and inculcate early enough preventive care which leads to healthy aging. So that our senior citizens do not have to deal with the management of chronic diseases, heart disease, strokes, cancer and finally Alzheimer’s (reportedly Goa according to a 2013 statistics has over 75,000 senior citizens out of which 5,000 are Alzheimer’s patients and it’s anyone guess how they are treated. Surely only with drugs of expensive if dubious value or with some of the latest findings in nutritional science being executed at ground level in hospitals and doctor’s clinics). For example, many reports from the West testify to the benefits of coconut oil in one’s diet vis-à-vis Alzheimer’s and other ailments. It’s all about a tablespoon of coconut oil in your diet daily if you don’t want to die at cellular level in your brains which are largely made up of fat cells!

INDIA’S NPHCE
INDIA has the National Program for Health Care of the Elderly (NPHCE) which has laid down several guidelines for hospitals public and private to follow – but in Goa it still has to go places, never mind that Goa even as a small state has a growing aging population with many cosmopolitan elderly from the urban cities choosing to retire in Goa. According to one study led by Alex Cohen in India the population of India is aging rapidly and from a study it’s predicted that from 2001 to 2031 the percentage of people over 60 years and older will almost double. Geriatrics is also accompanied by geriatrics nursing care and here too there is a dearth of resources and training – nurses and attendants in any geriatrics department in public and private hospitals have to be specially trained to deal with elderly patients. They have to be well versed in such issues as morbidity and mortality, plus the kind of depressions and anxieties the elderly is prone to and very often leading to suicidal wish fulfilment.
Is this what we wish for our elders who made so many sacrifices in their earlier years just to make sure their children got shelter, food, education and opportunities to do better in life than they themselves did? Quite simply, do we love our parents and grandparents generation — like we love ourselves so vainly, selfishly and ruthlessly?!