Eight points all doctors must keen in mind before treating an Elderly Patient- IMA
N The increase in life expectancy over the years has resulted in a drastic rise in the number of elderly residing in our country. Reports indicate that while the overall population of India will grow by 40% between 2006 and 2050, the population of those aged 60 and above will increase by 270%.
Medically, the treatment of an elderly patient is always a high-risk job since an aged body is different physiologically from the younger adult body, and during old age, the decline of various organ systems becomes manifest. Given this, special care and attention need to be given to them.
Keeping this in mind, the Indian Medical Association recommends certain guidelines that all doctors must follow while dealing with elderly patients.
Speaking about this, Dr SS Agarwal National President and Dr K K Aggarwal Honorary Secretary General IMA in a joint statement said, “Doctors need to be aware and meticulous while treating the elderly and thus we have framed proper guidelines for the doctors to look upto. It is projected that by 2030 nearly half of India’s disease burden will be borne by older adults. Thus, there would be a large number of chronic conditions that would need care and attention”.
The IMA recommends that the following points must be kept in mind while attending to elderly patients:
1.All doctors should be educated in the basics of Geriatric Care: With the explosion of the aging population, it is impossible to train the required number of geriatricians. To ensure that elderly patients receive good care there need to be 10 times as many geriatrics savvy internal medicine physicians as certified geriatricians.
2. Focus on managing the patient’s mobility than the disease: Most older adults spend majority of their days lying on the hospital in bed, even when they are able to walk independently. This is a major risk factor for functional decline. One should ambulate three times a day under nursing supervision.
3. Follow the ten Choosing Wisely Guidelines set forth by the American Geriatrics Society: Taking care when prescribing medications for the elderly, guarding against the dangers of polypharmacy, and avoiding restraints in cases of delirium
4. Follow an interdisciplinary team-based approach to cover the patient's and family's needs and individual goals for care.
5. Guard Against Delirium: Do not wake patients up multiple times in a night, it can add to delirium. Dementia patients’ especially are at a high risk for delirium and must be observed more closely.
6. Beware of polypharmacy and high-risk drugs. Polypharmacy is a major contributor to delirium. Ensure the right drug in the right dose is ordered for the right patient at the right time.
7. Follow the syndrome approach rather than independent cause based approach. For example, in a patient with post-operative delirium, incontinence, or an increased risk of falls, look for multiple contributing factors rather than a unique cause.
8. Focus care on the patient as a whole, and on individual goals for treatment. Treat the patient and not the disease. Do not treat high blood pressure aggressively if the drugs make a patient dizzy to the point of falling.
The elderly constitute 8% of the Indian population and proper disease management and treatment is the responsibility of each and every medical professional