The United Nations declared October 1 as the International Day for Elderly. On this day UN and its allied groups raise awareness on issues affecting the elderly and our responsibilities towards our elders. It is also a day to appreciate the contributions of the elderly to society. The elderly population is defined as people aged 65 years and above. This year we are still under the siege of the Covid- 19 pandemic and it is the elderly who have been afflicted the most by Covid.
Currently the total population of the world is 7.8 billion. It is estimated that there were 703 million persons aged above 65 in 2019. This number is projected to double to more than 1.5 billion people by 2050. One can imagine how seriously this rise in geriatric population will bring changes to the ailing Indian health system.
It is common knowledge that as our age advances, the immunity of our body decreases to fight against even less virulent virus or bacteria which can give rise to illness. Additionally, elderly people usually have other associated comorbidities like diabetes, hypertension, heart, lungs and kidney problems.
Being an orthopaedic surgeon, in addition to these above mentioned comorbidities, I mainly see two peculiar orthopaedic problems in elderly people- osteoporosis and osteoporosis related fractures. Osteoporosis is a disease which can cause generalised body pain and bending of these fragile bones which is more marked in the lower limbs and the spine. These deformities usually increase as the age advances. The quality of the bone becomes more porous hence the bones become more bent and more fragile which fracture with trivial trauma. Osteoporotic fractures usually occur in the spine, hip and wrist bone. The common mode of injury is a minor slip in the bathroom in cases of hip fracture and after travelling on bumpy roads, which is quite a common scenario in our country to sustain osteoporotic spine fractures. Wrist fractures usually occur when one falls on an outstretched hand.
Wrist fractures can usually be managed by simple plaster while most osteoporotic spine fractures can easily be managed with brace. But, in the current scenario, there is not much scope for conservative treatment in managing hip fractures. These hip fractures are difficult to manage due to the age of the patients and their comorbidities. These fractures are almost always managed surgically but the results after surgery are also not very predictable. In my own experience -also supported by scientific studies, a third of the patients with hip fracture who are treated surgically die within a year of the injury irrespective of any surgical treatment and the hospital facilities not only in our country but in developed countries too. Not only do the elderly suffer from physical deformities and problems but also occasionally have mental problems like anxiety, depression, psychosis and Alzheimer’s disease or some other sort of neurological problem like Parkinsonism etc.
The UN is promoting the decade of healthy ageing and bringing together UN experts, civil society, government and health professionals to prepare a global strategy and action plan on ageing. This strategy will be integrated into the Sustainable Development Goals (SDGs) especially goal 3 which is to ensure healthy life and promote well being of all at all ages. One of the aims in the present proposal is reducing the health disparities between elderly people in developed and developing countries so as to leave no one behind. Currently, the Covid pandemic has increased the burden on the health system in treating elderly people in a short period of time, hence the policy, planning and the attitude of the public, social workers and policy maker’s needs to change.
Ageing and osteoporosis are creating a burden on the already constrained health services in both public and private sectors in India hence, an attempt should be made to prevent osteoporosis and osteoporotic fractures. Primordial prevention by eating a healthy, nutritious and balanced diet containing calcium, vitamin D and the other micro nutrients, daily exercise in any form, any physical, professional or recreational work improves bone strength. This will definitely reduce the incidence of osteoporosis and related fractures. The other preventive measures to reduce incidence of fractures is using a walking aid like cane or walker, keeping the floor dry, turning on the light bulb in the bathroom particularly during the night.
Human resource is the biggest resource but its worth depends upon the health of the individual. Elderly people can play a critical and an important role through volunteer work and even helping their family with responsibilities and sharing their vast experience. Though elderly people cannot do rigorous physical work they can do many other supervisory works. They can transfer their experience and knowledge to the younger generation which will greatly benefit the family, society and nation. The elderly people particularly the well trained and experienced professionals should be motivated to make contributions to local communities. This will help both the community and the elderly while boosting their self esteem and making them feel more dignified as they age.
Ageing is a natural and physiological phenomenon which starts from conception of an individual. This process cannot be stopped but can be modified. According to the 2011 Indian census there are nearly 104 million elderly persons in India and we all should be concerned about their mental, physical and nutritional requirements at large. People are now living longer but not living healthier. Everybody’s goal should be to improve quality of life so that all can live comfortably and independently for the rest of their life. For that there is an urgent need to build a stable infrastructure and health care support system for the elderly.
(The writer is an orthopaedic surgeon based in Dehradun)
