Long life is priceless. You are given the extra time to experience more that the world has to offer. Seems true enough, but only if you have one thing – your health. A long life, but with deteriorating health, leads to dependence on others – the antithesis of freedom and enjoyment.
Can older persons expect to have a good quality of life longer into their later years? The answer awaits you in this edition of Better Health.
Elders as the majority
The proportion of older persons within the population is increasing rapidly. A 2014 survey by Thailand’s National Statistical Office found that 14.9 percent of the kingdom’s population is over 60 years of age, approximately 10 million people. The Institute of Population and Social Research, Mahidol University, predicts that these senior citizens will continue to live for an average of 20 years for men and 23.6 years for women.
Dr. Lily Chaisompong, who specializes in geriatric medicine, analyzes this phenomenon. Thailand is shifting to a predominantly aging society, in step with global trends. “Ten years from now, it will be the first time in Thailand’s history that there will be more people aged 60 years or older than minors,” Dr. Lily says. “And in about 25 years, there will be about 20 million people over the age of 60, approximately one-third of Thailand’s population.”
The increase is a result of advances in medical technology, efficient public health management, and a continually decreasing birth rate. “People over 80 years old today average at least four children per household to take care of them, whereas those just entering old age (60 years old), now only have two children per household to look after them.” Dr. Lily notes. “Today, families have fewer children, but people live for up to 20 to 30 years after retirement. The question is, how the older person can maintain a good quality of life, independently, for as long as possible?”
To age well, start planning early
Maintaining health into older age requires long term planning. “Start planning when you’re between 30 or 40 years old,” Dr. Lily advises. “When you meet older people in good health, ask them what they did to stay fit. You’ll see their answers are quite similar: a diet of nutritional foods, regular exercise, and staying engaged in hobbies and interests to promote good mental health.”
Dr. Lily makes clear these characteristics derive from good habits established in early adulthood. “It’s unlikely that people who start exercising at 60 or 70 will get the same benefits, or even enjoy them as much, as people who started much earlier,” she says. “The same goes for hobbies and activities: for those who put in the effort now to develop skills and expertise that help ward off depression and loneliness later in life. Starting late means less time to build this foundation and reap the benefits.”
But it’s never too late to start! Today’s older persons must take charge of their health more so than in previous generations to prepare themselves for longer lives that they can enjoy.
Geriatric medicine is the answer
Geriatric medicine was developed to help older persons maintain a good quality of life as they age. With the current demographic trends mentioned above, this specialization becomes ever more critical to older persons and their families.
There are distinct changes in older adults’ bodies that require care that is different from young and middle aged adults. “The elderly are not sick adults, but rather, they are a group that changes in every aspect – whether physically, mentally, or socially due to aging. Therefore, they need a special kind of care,” explains Dr. Lily.
In order to deliver the best geriatric care to older people of various ages, we divide them into three groups:
- The youngest old (60 to 69 years) are those who have just entered older age, most of whom are still healthy, though some may have underlying diseases such as diabetes or elevated blood pressure. Care for them aims to assess and prevent the future risk of diseases such as osteoporosis, dementia, stroke, or heart disease.
The middle old (70 to 85 years) is when the presence of chronic diseases starts to increase, while the ability to self-care starts to decrease. People in this range, generally, want to rely on themselves as much as possible. The goal of care is to maintain a good quality of life, paying particular attention to skeletal and muscular problems. Care includes reducing joint degeneration from arthritis and helping maintain mobility. There is also a focus on nutrition, especially if people have chewing or swallowing problems.
The oldest old (86 years and older) is the time of increasing dependence on family or caregivers for daily living and self-care. Care for this group includes training the caregivers on nutrition and physical therapy. The geriatrician and team also serve as care coordinator between the patient and their relatives, other caregivers, and other physicians involved.
“Age-oriented categorization is not always necessary, however,” Dr. Lily says. “In practice, doctors base care on the patients’ health and ability to take care of themselves. A fit 85 year old may be stronger and healthier than a frail 75 year old.”
Medical care for the elderly
Whichever the age group, a significant characteristic of geriatric care is the coexistence of various diseases and conditions. Therefore, geriatric medicine requires a holistic approach to tackle these simultaneous health problems safely and efficiently.
“To illustrate,” Dr. Lily says, “if an elderly patient has dizziness, the caregiver knows he or she must call a doctor but might not know in which field of medicine. Many things cause dizziness: vertigo, reduced blood flow to the brain, falling blood pressure, anemia, or stress.”
Duplicated medication is a frequent problem because elderly patients commonly have several doctors treating several diseases. This can lead to the patient receiving duplicate prescriptions. “But at Bumrungrad, we have a clinical pharmacist who reviews all the patient’s medications comprehensively to avoid duplicate treatments or drug interactions. Additionally, our pharmacists are aware that certain drugs are inappropriate for geriatric patients because of side effects like depression, confusion, or causing falls,” Dr. Lily says.
Specialists in geriatric medicine work as a collaborative, interdisciplinary team, careful to ensure that they don’t prescribe treatments that conflict or duplicate. “Successful elderly medical care does not consist of individual doctors working separately, but rather, together as a team.” Dr. Lily says. “They assess all areas: general health, mental and emotional health, nutrition, and even the patient’s living environment, in reducing the risk of falls.”
“At Bumrungrad we place the older person at the center of our geriatric program and care for them as if they were part of our own family.” Dr. Lily says. “With the determination to have good health, along with the assistance of our geriatric program, the elderly can live long, healthy lives.”
Good health and an active lifestyle enable a good quality of health in the later years. That’s why Bumrungrad Hospital created the New Life Healthy Aging Clinic. Its interdisciplinary team comprising of specialists in geriatric medicine, including doctors, dentists, nurses, pharmacists, nutritionists, and physical therapists, delivers comprehensive holistic medical services to the older person.
Services for elderly patients include general health care, preventive care, geriatric health consultation, and managing complicated health problems:
- Assessment of health conditions, focusing on syndromes such as dementia, depressive disorders, and osteoporosis
- Screening test for early onset dementia
- Screening test for depression
- Assessing risk for falls, as well as plans to reduce and prevent fall risks in the home
- Assessing risk and consultation on nutritional problems in the older person
- Assessing medication management, adverse drug reactions, and side effects appropriate for the older person
- Vaccination program for older persons
- Pre-operative assessment and post-operative care, appropriate for the older person
- Cooperation with different organizations to advise and assist the elderly in adjusting their domestic environments to make them safe and functional
- Consultation and assistance regarding living wills and palliative care.
For more information, please call 0 2667 2000