When an older person has a fall or health condition, the body reacts differently than it does in younger people and the recovery can be prolonged. Geriatric physician, Dr Letasha Kalideen explains why the health and care of older people needs a specialised, holistic and individualised approach.
“The functioning of every organ system including our immune system changes as we age, and doctors working in geriatric medicine are trained in the specific physiological changes an older person experiences,” says Dr Kalideen, who practises at Netcare St Augustine’s Hospital.
“There are various dimensions of wellbeing, and a geriatrician works as part of an inter-disciplinary team to support healthy, fulfilled and dignified living, beginning with a comprehensive geriatric assessment. We don’t only focus on treating the person’s disease profile and medical conditions, we look at quality of life and the complications that come with old age, such as falls and having multiple medical conditions, and put strategies in place to help prevent complications.”
| Pic: Dr Letasha Kalideen, a geriatric physician practising at Netcare St Augustine’s Hospital, is pictured with one of her longstanding patients, 83-year-old Mase Shirley Mthiyane. |
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Dr Kalideen, a specialist physical, geriatric physician and palliative care practitioner, works with a team of GPs, specialists, nurses, social workers, physiotherapists, occupational and speech therapists to fulfil the person’s healthcare needs.
“Our approach encompasses not only biomedical but also psychosocial and spiritual aspects of a person’s wellbeing as a basis for a holistic care plan, either in the home, in long-term care facilities or the acute hospital setting.”
Dr Kalideen points out that simple interventions can address deteriorating vision, hearing loss and incontinence, which become more common as we age and are often socially isolating for older people, increasing secondary risks of depression.
“It is not always easy for a parent or grandparent to communicate their discomfort or ailments to their younger relatives or caregivers, and we would encourage everyone to be sensitive to this and mindful that the older people in their lives may require some gentle prompting to seek help for age-related concerns.
“It is often easier for a person to open up to their trusted General Practitioner than to their own family about these matters, although sometimes an older person may need some support from a family member to facilitate the doctor’s appointment to discuss healthy ageing,” she says.
Loss of independence and decline in people older than 65 are often attributable to the ‘geriatric giants’ of immobility, instability, dementia, incontinence and side effects or treatment interactions. These need to be assessed and identified so that management of these syndromes can start early to arrest or slow decline as far as possible.
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“The goal of geriatric care is to help people enjoy a persistently good quality of life and help safeguard an older person from risk. One of the major threats to wellbeing is the possibility of having a fall, as there is very high mortality associated with this age group after a fall. An older person’s bones are more likely to fracture, especially if they have osteoporosis, and recovery can be complicated,” she says.
“It is not uncommon for an older person to have more than one chronic condition and they may therefore be taking several medications concurrently. As part of the assessment, we look at all the treatments the person is on to support the healthy functioning of their systems. Side-effects can often be mitigated through rationalising or reducing the medication regime, as appropriate to the person’s age and physical health.”
Netcare St Augustine’s Hospital is creating geriatric units with trained staff and caregivers experienced in the care of older persons and wards that are conducive to their needs while admitted to the hospital.
“It can be a disorientating experience for older people to undergo surgery or be in hospital, and so we make every effort to provide a comforting environment with aids to help these patients feel more secure, including clocks, a reminder of the day of the week and date, dedicated carers as well as the daily orientation updates,” she says.
Dr Kalideen’s work also encompasses end-of-life care and communication for patients of any age and she assists their families through this deeply personal and spiritual time, minimising pain, improving quality of life and distress without expediting or delaying this natural transition.
“I would encourage older people to make a living will and consider putting in place important legal documents such as advanced directives that can speak for you if you are unable to express your wishes, and also provide directions to doctors on specific indicators. If these are not in place, a healthcare proxy – usually your next of kin – will need to take these decisions for you if you cannot communicate,” Dr Kalideen says.
“As a society, we need to look out for older people who may be vulnerable and make provision for our elderly relatives and ourselves. Elder abuse takes many forms, and we must be watchful in our communities to ensure older people are treated with the respect, kindness and dignity they deserve.”
Tips for preventing falls
Prevention of falls should be a top priority for older people and their caregivers. Geriatric physician Dr Letasha Kalideen has developed guidelines to practically support this in facilities for long-term care of older people that are also applicable in the home environment.
“There are both individual and environmental risks that should be considered, and preferably professionally assessed. The following simple tips provide a starting point,” she says.
- Check floors are not slippery, uneven or cluttered.
- Install sturdy grab rails wherever they may be needed.
- Walking aids and grab rails should be used consistently.
- Remove trip hazards and ensure electrical cords are secured out of the way.
- Ensure the home is well lit.
- Keep active to maintain balance.
- Drink enough water and eat a wholesome diet.
- Wear well-fitting, non-slip shoes, don’t walk around in socks alone.
- Check beds and chairs are at a comfortable height.
- Do not leave anything unnecessary on the floor that might create a trip hazard.
Ends
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