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One-stop Geriatric Unit to provide holistic care
A one-stop Geriatric Unit with a multidisciplinary team providing holistic care, taking into account all physical, mental and social aspects will see the light of day next Wednesday (February 19).
The Ceylinco Assured Care Centre
Taking off within the refurbished first floor of the Ceylinco Healthcare Centre down Park Street, Colombo 2, the Ceylinco Assured Care Centre is expected to fill an evident vacuum in the comprehensive care of the elderly, in a country which has a rapidly ageing population.
It is the Founder President of the Sri Lanka Association of Geriatric Medicine (SLAGM), Dr. Dilhar Samaraweera, who provides evidence through hard data for such a need which is staring Sri Lanka in the face.
· 1 in 4 Sri Lankans will be over the age of 60 years by 2041 (which is just 21 years away)
Before looking at the needs of the elderly and what is available at ground level, Dr. Samaraweera compares and contrasts ‘paediatrics’ and ‘geriatrics’ to underline why the latter group too cannot be treated together with the general population when it comes to their health and well-being.
Dr. Dilhar Samaraweera
“There has been a long-felt need to develop a more comprehensive care package for the elderly. Currently what happens is that they too like all other patients seek treatment either in a state or private hospital. However, the elderly need a different approach to their care,” he says, going into the past when paediatrics (care of children) was part of the job description of a physician who was looking after children, the young and also the old. With time, though, the realisation dawned that it should be a different speciality. The same question that was earlier asked: Why can’t a physician treat a child in hospital is now relevant to the elderly as well.
There is a “huge” difference in the treatment and care approach for the elderly as opposed to the general population, reiterates Dr. Samaraweera, pointing out that there should be a paradigm shift from disease-centred care to person-centred care.
Now a patient participates in the decision-making and that person’s beliefs, attitudes and quality of life matter, a far cry from when it was more paternalistic and the doctor doled out medicine and the patient accepted it without a murmur.
Teamwork is the key in medical practice now and more so in geriatric medicine, with the elderly person very much a part of the decision-making. Take the case of Elderly Patient A and Younger Patient B. In the case of B who will have a single disease, a diseased-based approach will work, but in A who may have multiple diseases and also other physical, mental and social problems, will that approach work?
“Thus, we need a multi-modal approach focusing on the three aspects of physical, mental and social, delivered by a multidisciplinary team. This is why the care delivered in the usual ward setting in a hospital, whether government or private, will not work in the elderly,” he says, arguing effectively for Geriatric Units where a dedicated multidisciplinary team delivers holistic and patient-centred care.
Dr. Samaraweera says that the rapid increase in the elderly population is taking place without a major change in the infrastructure and per capita level of income. Thus, Sri Lanka needs to adopt a unique approach using the existing resources and strengths. The Integrated Care of Older Persons, a novel approach initiated by the World Health Organisation focusing on optimising intrinsic capacity and functional ability of older persons in the community by strengthening primary care would be the way forward.
Some measures are in place in Sri Lanka, the Sunday Times understands, and include post-graduate training in geriatrics, with a few physicians who have already had geriatric medicine training abroad, showing the way.
This is what we need to take forward and the Health Ministry is training nurses, physio and occupational therapists and caregivers while the team also includes social service officers, says Dr. Samaraweera, adding that in the government sector a few hospitals have focused on this crucial need. The Kalubowila Teaching Hospital has a Geriatric Unit and the Kadugannawa Hospital a Geriatric Ward. The University Medical Unit at the Peradeniya Hospital is a training centre for geriatric care while also having a unit there.
Focusing on the private sector, he says that even though people do channel the few available Geriatricians, there is no proper multidisciplinary care.
It is in this light that a one-stop centre is important and Dr. Samaraweera details how a “hand-picked” multidisciplinary team comprising doctors, nurses, physiotherapists, speech and language therapists, dieticians etc. would provide this essential service at the Ceylinco Assured Care Centre.
“Elderly patients suffer from multiple diseases and have specific syndromes which result in impairment of their activities of daily living. Geriatric syndromes such as decreased mobility, instability, falls, frailty, incontinence, dementia and depression are easily missed in routine medical clinics and medical screening. As such, we need to look for specific problems in the elderly proactively and manage them effectively,” he says, explaining how they would do a comprehensive Geriatric Assessment.
Stressing that a person need not await his/her 60th birthday to be assessed and be ready for the Silver Age, Dr. Samaraweera says that a healthy lifestyle which includes exercise and diet, is essential for successful ageing.
This centre will also offer pre-retirement counselling and guidance for active healthy living with special attention to exercises and dietary advice tailor-made for each individual, he adds.