Thursday October 7, 2010
Health concerns of older persons
by ANTHONY THANASAYAN
Not all symptoms can be attributed to old age and doing so can deprive loved ones of proper treatment.
THE world observed International Day for Older Persons last Friday. The United Nations-sponsored annual event is designed to bring attention to a global population of elderly persons who are rapidly increasing.
According to the UN, one-third of the world's population will soon be over the age of 60. The majority of older persons live in developing countries. Their population is expected to exceed 70% by the year 2030.
Against this background, Wheel Power spoke to consultant neurologist Dr Lim Shen-Yang of University Malaya Medical Centre, Kuala Lumpur, for his views on the type of neurological ailments that could affect the elderly in Malaysia.
"International Day for Older Persons offers us a chance to celebrate the fact that over the last half-century, the average lifespan of Malaysians has increased by about 20 years to 74 years of age," pointed out Dr Lim.
"This is due to a multitude of factors: better sanitation, healthier lifestyles, and advances in (and improved access to) medical care," he said, adding that people are living longer and leading productive and fulfilling lives.
"We are fortunate that deference for elders still remains a cornerstone of our culture. While ageing gracefully is a positive thing, one cannot get away from the fact that older people are at increased risk of developing health problems," cautioned Dr Lim.
"Many of the physical and mental changes that occur with age are accepted as part of the process of 'wear and tear'. However, it is a common mistake to attribute all symptoms occurring in older persons to old age. In so doing, we may be depriving ourselves or our loved ones of proper treatment."
Dr Lim has authored numerous publications in medical journals and books, and is an associate editor of Neurology Asia. He cited an example where professional intervention is necessary. A careful evaluation of an older person with walking difficulties – and falls – may point to a neurological disorder.
These could include normal-pressure hydrocephalus (in which excessive fluid accumulates in the brain), cervical or lumbar spondylosis (where arthritic changes in the spine cause nerve impingement) and Parkinson's disease (a movement disorder that frequently causes slowing of gait to the point of "freezing" or being "glued" to the floor).
Stroke, a condition where blood vessels in the brain become blocked, leading to the destruction of brain cells that are deprived of oxygen, can also be the problem.
"These conditions which become increasingly common with age, have specific treatments that can result in marked improvement," said Dr Lim. "If left untreated, progressive or permanent disability may result."
Dr Lim who is also a Parkinson's disease and movement disorders specialist, was quick to point out that some of the neurological conditions can be successfully treated with medication to restore function.
"Walking difficulties should not be automatically viewed as an inevitable part of ageing," he said. "Sometimes, there may be a treatable underlying disease."
Other neurological conditions that become more frequent with increasing age include Alzheimer's Disease, Lewy Body Dementia, neuropathic (nerve) pain, and motor neuron disease.
Although cures for these conditions are not yet in sight, certain symptoms, such as hallucinations or paranoid delusions (that commonly, for example, cause patients to constantly accuse other members of the household of stealing from them) can be effectively treated.
Dr Lim stressed that the important thing is not to ignore these problems as they cause distress to both the patient and caregiver.
"New cognitive enhancers can sometimes reduce behavioural disturbances, and improve memory and motivation," he said.
"However, it should be noted that older patients can be more prone to experiencing adverse effects from medical interventions, so the pros and cons of initiating treatment need to be considered carefully, taking into account an individual's overall situation.
"For example, whilst treatment of high blood pressure has been a major public health success in reducing strokes and heart attacks, over-aggressive treatment can sometimes lead to light-headedness and falls, a point of special relevance in some older patients who may already be frail to begin with.
"The often-complex nature of medical care of older patients underscores the importance of having a doctor who is knowledgeable and skilful, and willing to take the time to sort through the issues," concluded Dr Lim.