Keynote Speaker:-
Dr George Paul, Renowned Geriatric professor and practitioner.

Geriatrics: Definition:
Geriatrics or Geriatric medicine is a medical speciality focussed on addressing the unique health needs of older adults. The term geriatrics originated from the Greek word “Geron” meaning “old man” and “iatros” meaning “healer”.

In India the practice of this branch of medical speciality is at its infancy.

History of Progress

About 2000 years ago a Roman philosopher Reneka stated that old age is an incurable disease and cannot be treated. But during the 18^th century a Scottish Scientist Sir James Sterling Rom expressed the opinion that we need not treat or cure the old age. But we need to protect it, safeguard it and prolong it. The present form of Geriatrics was started in 1940 in England by Dr. Margery Warren who is known as the mother of Geriatrics. The speciality was first started in Kerala in Amritha Institute of Medical Sciences Kochi in 2007. Now this is being provided by 9 medical collegesin Kerala. The main reason for this slow progress is the inept attitude of the Association of Physicians of India. Not only that they don’t encourage it to develop but they discourage the growth .Even though this branch was started in late 1940s in England it was properly established there by 1970. This was made possible by the proper legislation from the initiative of the interested medical fraternity. Unless and until we make the lawmakers a. ware that Geriatrics is as important as paediatrics or any other speciality and its facility should be lawfully implemented by proper legislation, this speciality is not going to grow at a desired and needed pace. So such an order from the Govt. is a must need for the growth , development and effective functioning of this particular speciality.

During the past 50 years, the life span has increased in India. It is due to many reasons including better health care management, availability of good quality drinking water, low infant mortality, proper diet, proper exercise etc. So every year the percentage of older people, especially in Kerala is increasing. The average life expectancy is 60 in India while in foreign countries it is 65.

Difference between geriatric medicine and other branches.

• In geriatric medicine no case is presented to the doctor with specificity unlike in other branches. Where there is specific symptoms and history. For example cardiac problems, kidney dysfunction, prostrate problem, nervous system problems etc. In geriatric medicine the doctor approaches the patient in total , going into physical, mental and psychological interactions of the incumbent .
• In other branches there is importance for the increase in the quantity of life, but in geriatrics , unless and until improvements of quality of life is not possible a geriatric practitioner never advocates a quantitative increase.

Ageing

There are two types of ageing.

• Chronological ageing ie:- according to one’s date of birth.
• Physiological ageing.

These two may not coincide always. It depends on the functionality or how good is your physiology. Ageing is to happen to everybody and it is inevitable . The fittest or physiologically most powerful age in the life of an individual is 29 years. From there on it starts to decline.

What is the cause:-

Cell death is the cause of ageing, affecting all organs and parts of the body. For example in a person aged 70 yrs his/her kidney function will be 20 to 30% less than normal. Apart from that , so many conditions like vision , loss of mobility, hearing impairment, diabetes, prostrate problem, incontinence especially among women on stress, mental problem etc can act as causes. Other area where this phenomenon is usually noticed is among retirees especially from elevated positions. Added to this will be a list of losses, loss of loved ones, separation of children etc. Irrespective of reasons,our approach should be to overcome all those situations and live with dignity.

Live with dignity in old age

• Have an attitude to life. Say to yourself, I face life with
  1. Fortitude
  2. Resilience
  3. Courage
  4. Grace
  5. Humour
• Forget and Forgive – Try to forget about the past evils and forgive the defects of others. Try to remember the healthy incidents of the past.
• Face the truth of death with dignity- Normally everybody will be aware of the impending death and will not worry about it. But the fear of the thought of dependence is the problem with most people. According to the experience of the doctoor, about 45 to 50% of patients’, main problem is the fear of dependence. This may even lead to depression. This is more common in the present nuclear family set up where aged parents are left alone. Here the doctor has to attend the patient and the care taker. So we have to train our minds to have an old age life with grace, dignity and joy.

Importance of team work in geriatric practice.

Unlike in other medical practices geriatric practice is based on team work . Normally the team comprises of

1. Physiotherapist
2. Trained nurse
3. Social worker
4. Clinical Psychologist

Each wing collects data for their area and the patient is presented to the consultant geriatrist with this information. The physiotherapist records the data on mobility, the social worker records data on memory or depression through a 30 point questionnaire.

The clinical psychologist records  psychological problems if any. The trained nurse compiles all these datas and presents it to the consultant with the patient. If the doctor on examination finds any difference of observation with the recorded data, it is clearly indicative of some mental problems. Then he talks with the patient and the family jointly and separately and arrive at a conclusion. So it is an all-inclusive approach.

Also they are providing community outreach program even though it is in the premature stage in India. It is richly practiced in developed countries.

Health Education:

They provide health advise like physical health and mobility, regular check ups like monitoring blood pressure, cholesterol , diabetes ,vision, hearing, PSA etc regularly , prevent falls, medication management, nutrition and hydration, monitor salt and sugar intake, take care of mental and cognitive health, stay socially active, brain exercise, manage stress and sleep well, emotional wellbeing, stay purposeful, , get vaccinated – especially against pneumococcus pneumonia and herpes for people above 60 if not already done, screening and early detection of cancer , osteoporosis and memory loss and routine check up for oral and eye health . All of these need care and attention.

For youngsters the need for saving for old age and to practice a healthy lifestyle are important.

Value of Millets

Doctor advised to include millets in our daily diet , once at least. Apart from the nutritive value millets are better than wheat and rice due to various reasons. Millets are rich in proteins , vitamins and minerals. It is a good food for people with diabetes because it has very low glycaemic index. It regulates blood pressure , cholesterol , prevents atherosclerosis , increases efficiency of insulin , improves the function of the gastrointestinal system because it retains the nutrients in the G1 tract and facilitates the absorption . It is rich in fibre which prevents constipation and aid in the relief of constipation. It is gluten free and hence safe for gluten sensitive people. It reduces the risk of cancer especially colon cancer , breast cancer and oesophagus cancer due to the presence of anti-oxidants. During the oxidative metabolism in the body, enough free radicles are produced which is a causative agent for cancer. The antioxidants present in the millets prevents the action of free radicles and thus prevents the incidence of cancer. For these reasons he recommended the inclusion of millets in our daily diet.