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Call for more Geriatric Units for the holistic care of the elderly
Let’s set up more Geriatric Units in state hospitals to give holistic treatment and care, tailor-made for each and every elderly person in a multidisciplinary setting, in keeping with the Integrated Care for Older People (ICOPE) concept of the World Health Organization (WHO).
This is the strong plea from a powerful and far-sighted group who are the movers and shakers behind the Sri Lanka Association of Geriatric Medicine (SLAGM).
Prof. Antoinette Perera
Dr. Padma Gunaratne
Dr. Dilhar Samaraweera
Prof. Sarath Lekamwasam
As the International Day of Older Persons is celebrated on Thursday (October 1) with the theme ‘Think wise and age well’, the Sunday Times meets this group which is making a concerted effort to give a better deal to the elderly who have contributed much towards the development of this country.
It is SLAGM Founder President Dr. Dilhar Samaraweera, in charge of the Colombo South (Kalubowila) Teaching Hospital’s Geriatric Unit, who looks in-depth at what needs to be done.
Pointing out the reality of a rapidly-ageing population in Sri Lanka with 1 in 4 being ‘elderly’ (over 60 years of age) by 2041, Dr. Samaraweera focuses on the increase in the admission of elderly patients to the general medical wards of state hospitals.
“Around 70% of the admissions are of the elderly and whether we are able to identify their specific health problems in a general ward setting should be looked at seriously. The need is to reorient Sri Lanka’s health system to face this burgeoning issue with geriatricians who understand elderly care best,” he says.
Dr. Samaraweera points out that whenever an elderly patient comes to hospital, a Comprehensive Geriatric Assessment needs to be done. However, this cannot be performed in a routine medical ward. This is why the establishment of Geriatric Units with multidisciplinary teams in attendance is of paramount importance.
The new concept of ICOPE details a system to identify physical, social and psychological issues of an older person, while giving a simple way of assessing ‘intrinsic’ capacity (a combination of physical and mental capability) through six domains, it is learnt.
These domains are – hearing, vision, mobility, vitality (nutrition status), dementia and depression.
“This has to be done in all elderly people as it is important to give them a good quality of life which would be inclusive of functional ability. This is the interaction between their intrinsic capacity and the environment,” says Dr. Samaraweera, highlighting the important role the Health Ministry can play in this arena.
Citing the numerous interventions that would enable an improvement in the interaction between the intrinsic capacity of elders and the environment, he says they are as simple as providing a pair of spectacles or boards with big letters for those with reduced vision or setting up ramps to facilitate mobility.
More Geriatric Units in hospitals under multidisciplinary teams can be made a reality as there are many under-utilized district hospitals which can be developed to accommodate the elderly, he adds.
“With the expansion of the elderly population, there is a need to revamp and redesign health and social services, as they are not capable (eg. transport services) of meeting the specific demands of older adults,” says SLAGM President Prof. Sarath Lekamwasam who is Professor of Medicine at the University of Ruhuna.
He says that it is also important to think of possible ways to enhance the quality of life of older adults. As this process should begin early, attention should be paid to those in their youth and middle age. In keeping with this year’s theme, many activities would be initiated to promote this concept and educate people on healthy practices such as diet, exercise, avoidance of tobacco/alcohol and other substances. These measures can have a greater impact on health and the quality of life than drug therapy at individual level.
With information technology skills and computer literacy among older adults being discussed in the light of the COVID-19 pandemic, their digital inclusiveness has become a necessity, he adds.
Brain health is what SLAGM Immediate Past President & Consultant Neurologist Dr. Padma Gunaratne talks about as she says that elders are a heterogeneous population who are likely to differ dramatically from one another in fitness levels and physical status. A range of neurological disorders are common among older people. They account for about half of those patients older than 65 who are incapacitated and for more than 90% of those whose incapacities are severe.
She stresses that being concerned about ‘brain health’ would prevent or delay many neurological disorders of older people. Avoiding/cessation of smoking and alcoholism along with physical exercise and a balanced diet would prevent diabetes, high blood pressure, dyslipidemia and obesity ensuring heart, kidney and brain health. Psychosocial behaviour and brain teasing activities would be important to preserve the functional status of cerebral cells longer.
Meanwhile, SLAGM Council Member and Family Medicine Specialist Prof. Antoinette Perera described the important role that a family doctor can play in the life of the whole family including the elderly.
She said that the family doctor knows the family well and can advise each member, whether old or young, on a healthy lifestyle which includes a proper diet and exercise. He/she would also guide the family on how to keep non-communicable diseases (NCDs) at bay, but if a member is hit by an NCD, the family doctor would instruct that person on how to keep it under control and provide a referral to a relevant specialist in that field.
“The family doctor is also there to advise on palliative care and be with the family when someone is dying,” added Prof. Perera.
The others who chipped in with important suggestions were SLAGM Secretary Dr. Shehan Silva and SLAGM Council Members Prof. Shyamalee Samaranayaka, Dr. Anushika Abeynayake and Dr. Madhushani Dias.
