Care for the Elderly

Care for the Elderly

 

 The elderly are special group of people whose healthcare needs are unique. For our purpose, we can say an elder is anyone who is 65 years old and above. The old age group as they are sometimes called do suffer from degenerative diseases such as wear and tear of osteoarthritis, dementia (degenerative diseases of the brain), poor mobility, poor eyesight, poor hearing, low appetite, weakening heart and lung functions. Others care constipation, and such illnesses as hypertension and diabetes mellitus to mention a few. Further, they may be lonely and live alone: their children having left them to fend for themselves.  Frequently, elderly people are vulnerable and defenceless.

Mentally, elderly people are prone to depression and anxiety: some due to fear and apprehension of one thing or the other. Sleep could also suffer.

Moreover, being unable to gainfully earn a living, they may be poor and their purchasing power significantly reduced.

The elderly thus require a special attention and care. The general advice that had been provided in other areas in this book applies to the older age but more especially the following.

Individuals should prepare for the period of growing old and children and family members should set aside resources to prepare for the needs of old age.

  1. An elderly person requires special or modified accommodation. This is because the muscles and bones may no longer cope with climbing or descending stairs. An elderly person may become disabled through illness. As a result, he or she may need assistance in moving around such as requiring the use of wheel chairs or other form of motorability. 
  1. Personal hygiene may deteriorate and family should consider paying close attention to this especially if there is physical or mental illness in the elderly person. 
  1. Liaising with healthcare professionals, the elderly may need a special bed and chairs to give a comfortable living. 
  1. Nutrition. Appetite is often low in old age.  Dehydration is common in all climes. Food supplements, fruit meals and encouragement to eat properly may help too. They should be encouraged to have proper meals and drinks. 
  1. Old people need company especially if the spouse had died or become infirm.  In our tradition, the grand children would normally fill this void if the immediate children cannot. 
  1. Illnesses no matter how minute or inconsequential should be aggressively pursued and treated. Elderly persons do not have the strength—mental and physical—to withstand infirmities. Therefore, there is a need to take care of every complaint. 
  1. Dementia is a disabling illness which is either due to old age or Alzheimer or any other cause, is characterised by loss of memory and confusion which often get worse in time.  As soon as memory loss is identified, it’s important to take the individual to the doctor as soon as possible.   A consultation with specialist doctor of old age is perfectly in order. Falls are common as is disorientation. Elderly people do get lost so easily and wandered about in adversity in a condition that exposes them to social indignity and health hazards. Dementia may also cause the elderly to lose control of her/his body functions such as inability to control bowels and urine movements. Because of disorientation and confusion with time, nutrition may suffer and body reserves may be depleted.  Social inhibition that normally restricts some behaviour may be lost.  Patients suffering from dementia are vulnerable. 
  1. Other mental illnesses such as anxiety, depression or even sleeplessness or loneliness should be addressed and not dismissed as coming from an irritant old “witch” woman or man. Bereavement from lost of a spouse or lost of long-standing friend or family member can be very severe in the elderly and this development should not be dismissed. It may lead to depression, anxiety or early death of the old person if not handled with care and caution. 
  1. Financially, elderly people can be muddled and they are thus prone to manipulation and exploitation by other capable minds. Thus, the aged person needs protection from such exploitation. Honest family members or friends, legitimate and transparently sincere solicitor should be used to defend the cause of the elderly especially in dealing with the estate and finances of the individual.  Such instrument as Power of Attorney should be vested in the hands of the solicitor or family member.  Such persons should deal with finances of the aged and muddled person who had lost the mental capacity to act for himself. Where the role of the solicitor is not possible, the family should consider the possible use of non-legal advocate whose role is to protect the interest of the elderly individual. Such solicitor and or non-legal advocate can even pursue a case for the individual in court. It’s crucially important that the family work with healthcare professional to determine the state of mind of the aged person.   
  1. It’s crucial that we all prepare for our old age getting our will and testament done legitimately and clearly. Also, while still capable, individuals should set in place what and how he or she will like to be handled in case of incapacitation: stating who does what and how it’s to be done.  
  1. We all need love; anyone who had lost a spouse should be encouraged to find love no matter the age. 
  1. If the family cannot take care of the elderly at home, considering and in spite the  country’s culture, the family and the individual elder should seriously consider relocating to or being placed in Old-People’s Home, where in the minimum, the health and welfare of the aged person can be better protected.

 

May 25, 2014 / clients

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Care for the Elderly

Benefits of Exercise. Your Solutions for Manifold of Diseases: Part 1 I have been labelled as Exercise Evangelist by the many people who receive my regular electronic messages on the subject of exercise. A lot of such recipients have taken to my messages and the exercise evangelism concept. Nothing can gladden a medical doctor than when he sees his patients and followers get a better health and they also follow medical advice. From all indications, it appears human beings are not made to be stationary. We are supposed to constantly be in purposeful motion. It’s on the basis of such joy as I mentioned above that I now write the current public health promotion and education series. The message in the next couple of weeks will focus on Exercise which is also called Physical Leisure Activity. As it’s the custom in writing this series, let us start by booking at the scope and definition of exercise. What is exercise? In keeping with medical dictionary, “Exercise is physical activity that is planned, structured, and repetitive for the purpose of conditioning any part of the body.” We may also consider physical exercise as being any bodily activity that enhances or maintains physical fitness and overall health and wellness. Whereas, brain exercises are those activities which give the brain new experiences by use of physical senses of hearing, smelling, touching, tasting, visual and emotional activities. I once told someone living in Lagos to exercise as part of clinical consultation, he responded by telling me that running after “danfo” or “BRT” and walking home when there is no bus to join is enough exercise for him. Pointing at his relative slim figure, he reminded me of the “benefits” of such “exercise” as struggling on daily basis to catch a “danfo” bus as a commuter had made him slim down. Yet, this individual’s blood pressure and sugar remained very high in spite of his perceived “exercise”. As we can see from the above definition, to have any reasonable and beneficial effect, exercise should be “planned and structured”. Exercise is not a sudden, chaotic and irregular activity embarked upon on an impulse due to imposing transport challenges. Another common error is in matter of sexual intercourse. While there is a definitive scientifically published article indicating that sexual activity results in a loss of energy up to 200Kilocalories (about 10% of daily energy requirement for a standard male) in a single sexual encounter lasting 30minutes and intercourse is considered as a form of exercise, it is clearly irrational to use sexual intercourse as a “planned, structured and repetitive” form of exercise. Sex by its very nature is vulnerable to emotion, subject to mood changes and because sex involves two individuals, intercourse may be unplanned as well as being seriously influenced by the feelings or motives of the other person. Exercise may not be so influenced by the variables which I have mentioned. Any reasonable exercise by adults is a definite and determined course of action. What exercise is not: one of my very good clinical and a personal friend once sent me a message asking for my view if arguing with one’s spouse can be considered as a form of exercise. Well, mere loss of or expenditure of energy as in the case of arguing with anyone not the least, one’s spouse, should not be considered as a form of exercise. Such argument does not fit the definition of an activity that is “planned and structured.” While I concede that conjugal argument may result in sweating, expenditure of energy, squabbling may be purposeless. What is the point in engaging in useless expenditure of energy? Argument may lead to mental stress, headache, impaired judgement, poor sleep and body aches---The very opposite features that real exercise is meant to achieve as we shall see later. As I have explained earlier, sex cannot be said to be structured, reasonable, planned activity that is meant to improve on certain muscles and organs of the body outside the muscles and organs that are involved in reproduction. To our able mothers and housewives, going about several times around the kitchen, living room and bed room in pursuit of domestic chores cannot be considered as a form of structured and planned physical exercise. Often, by the end of the day, a mother chasing after youngsters and housewives trying her best to ensure orderliness at home cannot be said to be exercising. Very often, the consequences of the activities that I have described in this paragraph, frequently leads to stress, hypertension and obesity: the very illnesses that physical exercises is meant to prevent as we shall see later on. Exercises such as laborious working of physical labourers, the restlessness of civil and mechanical construction workers, tedious efforts of subsistence farmers, the hassling of market women and men, the daily wearisome activities of bus conductors and drivers, spending endless times in the same office chair pouring over intractable problems by political and business executives as well as continuous mindless trekking on city streets cannot be said to be beneficial or structured exercises. At best, they are a waste of time and energy, resulting as it often does, in actual illnesses that structured, purposeful exercise is meant to prevent. Therefore, the subsequent articles will elaborate on exercise, the scope, the advantages and scientific recommendations on how best to get the highest benefits from exercise. Benefits of Exercise. Your Solutions for Manifold of Diseases: Part 2 In today’s article, we shall deal with various forms of recommended exercises. There are various forms of exercises that individuals and groups or families can engage in. I will set out below, these types of exercises. Physical exercises are in general classed into three types, based on the particular effect that the said exercise do have on the body. In contract to the random and chaotic nature of some individuals who are claiming to be exercising, these classes of exercises will help guide us as to know what activity we are engaged in at a particular time. Let us deal with aerobic exercise: This is a form of physical activity that uses big or large muscle groups. In effect, such activities cause the body to expend more oxygen fuel (hence the name aerobic) than it would while at rest. The aim of aerobic exercise is to increase the heart and blood vessels’ staying power or stamina. Examples of aerobic exercise include cycling, swimming, and brisk walking, jogging, skipping rope which women and children often ask me if rope skipping is a form of acceptable exercise, rowing and playing table or lawn tennis. The list goes on. Anaerobic exercise on the other hand is another form of exercise. Anaerobic means going without oxygen. This class of exercise includes strength training for example: weight lifting. Other form of anaerobic exercise includes leg and hands resistance training. Anaerobic exercise does strengthen, and tone muscles. Similarly, anaerobic exercise serves to improve bone strength, balance, and coordination. Examples of strength exercise, according to online Encyclopaedia (Wiki) are push-ups, pull-ups, lunges, and bicep curls using dumbbells. As I mentioned earlier, anaerobic exercise also include weight training, functional training, sprinting, and high-intensity interval training increase short-term muscle strength. On the other hand, the third class of exercise is called flexibility exercises. Flexibility exercises involve stretching of joints and lengthening of muscles. Examples will be abdominal exercises, squatting, backward bending, bending and extending the joints and various muscles that are attached. Activities such as stretching help to improve joint flexibility and keep muscles agile. The objective is to improve the range of motion and degree of movements of the joints including their attached muscles which can as a result reduce the chance of damage. As can be seen therefore, the claim that frequently loitering in the kitchen, mindless walking along the street with heavy emotional load or jumping into commuter buses cannot be, in the true senses, considered as a form exercise. Meanwhile, physical exercise can also include an activity that focuses on accurateness, dexterity, power, and speed. Thus, sometimes the terms 'dynamic' and 'static' are used instead of above categorizations. 'Dynamic' exercises include such activities as steady running (jogging) which tend to produce a lowering of the diastolic blood pressure during exercise, due to the improved blood flow. On the contrary, static exercise (such as weight-lifting) can cause the systolic pressure to rise significantly again during the exercise. The moral of this explanation is that one should get involved in a mixture of different classes exercises (aerobic or dynamic as well as say stretching exercises) to enhance the overall benefits. Now, having dealt with the types or classes of exercises as discussed above, you will be right to ask me: what is the amount of exercise that is scientifically recommended to ward off illnesses? In other words, how much physical activity should I do? For this let us turn to some official guidelines. I will refer to the National Health Service (NHS Choices) in the UK for guidance which is copied but slightly edited below: For 19-64 years: To stay healthy or to improve health, adults need to do two types of physical activity each week: aerobic and strength exercises which I also mentioned above. I will deal with other ages later. How much physical activity you need to do each week depends on your age. To stay healthy, adults aged 19-64 should try to be active daily and should do: at least 150 minutes of moderate aerobic activity such as cycling or fast walking every week, and strength exercises on two or more days a week that work all the major muscles (legs, hips, back, abdomen, chest, shoulders and arms). 75 minutes of vigorous aerobic activity, such as running or a game of singles tennis every week and strength exercises on two or more days a week that work all the major muscles (legs, hips, back, abdomen, chest, shoulders and arms); A mix of moderate and vigorous aerobic activity every week. For example, two 30-minute runs plus 30 minutes of fast walking equates to 150 minutes of moderate aerobic activity, and strength exercises on two or more days a week that work all the major muscles (legs, hips, back, abdomen, chest, shoulders and arms). A good rule is that one minute of vigorous activity provides the same health benefits as two minutes of moderate activity. Benefits of Exercise. Your Solutions for Manifold of Diseases: Part 3 One way to do your recommended 150 minutes of weekly physical activity is to do 30 minutes on 5 days a week. All adults should also break up long periods of sitting with light activity. What counts as moderate aerobic activity? Examples of activities that require moderate effort for most people include: walking , water aerobics, riding a bike on level ground or with few hills, doubles tennis, pushing a lawn mower, hiking, skateboarding, rollerblading, volleyball, basketball. Please take note that if you cannot exercise every day, a new research in January 2017 has given support to “Weekend Warriors” who chose to exercise on weekends only. Moderate activity will raise your heart rate and make you breathe faster and feel warmer. One way to tell if you're working at a moderate level is if you can still talk, but you can't sing the words to a song. What counts as vigorous activity? There is good evidence that vigorous activity can bring health benefits over and above that of moderate activity. Examples of activities that require vigorous effort for most people include: jogging or running, swimming fast, riding a bike fast or on hills, singles tennis, football, rugby, skipping rope, hockey, aerobics (see above), gymnastics, martial arts Vigorous activity makes you breathe hard and fast. If you're working at this level, you won't be able to say more than a few words without pausing for breath. In general, 75 minutes of vigorous activity can give similar health benefits to 150 minutes of moderate activity. What activities strengthen muscles? Muscle strength is necessary for: all daily movement to build and maintain strong bones, to regulate blood sugar and blood pressure, to help maintain a healthy weight. Muscle-strengthening exercises are counted in repetitions and sets. A repetition is one complete movement of an activity, like a bicep curl or a sit-up. A set is a group of repetitions. For each strength exercise, try to do: at least one set, eight to 12 repetitions in each set. To get health benefits from strength exercises, you should do them to the point where you struggle to complete another repetition. There are many ways you can strengthen your muscles, whether it's at home or in the gym. Examples of muscle-strengthening activities for most people include: lifting weights, working with resistance bands, doing exercises that use your own body weight, such as push-ups and sit-ups, heavy gardening, such as digging and shovelling. You can do activities that strengthen your muscles on the same day or on different days as your aerobic activity – whatever's best for you. Muscle-strengthening exercises are not an aerobic activity, so you'll need to do them in addition to your 150 minutes of aerobic activity. Some vigorous activities count as both an aerobic activity and a muscle-strengthening activity. Examples include: circuit training, aerobics: running, football, rugby, netball and hockey. Exercise for Babies: Before your baby begins to crawl, encourage them to be physically active by reaching and grasping, pulling and pushing, moving their head, body and limbs during daily routines, and during supervised floor play, including tummy time. Once babies can move around, encourage them to be as active as possible in a safe, supervised and nurturing play environment. Children who can walk on their own should be physically active every day for at least 180 minutes.(three hours). This should be spread throughout the day, indoors or outside. The 180 minutes can include light activity such as standing up, moving around, rolling and playing, as well as more energetic activity like skipping, hopping, running and jumping. Ages 5-18years: To maintain a basic level of health, children and young people aged 5 to 18 needs to do: at least 60 minutes of physical activity every day – this should range from moderate activity, such as cycling and playground activities, to vigorous activity, such as running and tennis on three days a week, these activities should involve exercises for strong muscles, such as push-ups, and exercises for strong bones, such as jumping and running. Older adults aged 65 or older, who are generally fit and have no health conditions that limit their mobility, should try to be active daily and should do: at least 150 minutes of moderate aerobic activity such as cycling or walking every week, and strength exercises on two or more days a week that work all the major muscles (legs, hips, back, abdomen, chest, shoulders and arms). Benefits/Advantages of Exercise: Physical leisure activities have phenomenon amount of benefits. Exercise has incredible social and medical advantages. Human beings after all, seem to have been made to frequently be in motion. That is to say, sedentary lifestyle poses a danger to a person’s existence. For example, sitting too long or lying down for too long a period may lead to obesity, diabetes, deep vein thrombosis and anxiety. Engaging in physical exercise does help in maintaining overall physical well-being, contributing to ensuring healthy weight amongst others. Physical exercise induces happiness, improve the mood, helps overcome pain and prevent mental health breakdown. Let us now go in more details on the benefits of physical exercise. Benefits of Exercise. Your Solutions for Manifold of Diseases: Part 4 Human fertility. Its well established that regular exercise can help you shed weight. Obesity is bad for your fertility either as a male or female. For the female, obesity can distort the female reproductive organs and thus delay or even prevent conception from occurring. Further, excessive weight may require or produce excess hormones that regulate female function and appearance. The result is that excess circulating hormone such as estrogen may lead to uterine fibroid, cancer of the breast as well as infertility. A lean body or “figure 8” is a great helper of female fertility. For the man, generally what is said above for the female is applicable for the male save that excess testosterone (male hormone) may not be healthy for the prostate gland. High testosterone may also lead to high blood pressure. A recent research advised men to maintain a lean body mass so as to improve their own fertility. Regardless of the gender, obesity can impair fertility by creating diseases that affect fertility. Such illnesses include diabetes mellitus, high cholesterol and hypertension. These set of infirmities for the man can lead to erectile dysfunction. For the woman, polycystic ovarian disease may result. In both genders, obesity may physically impair enjoyment of sexual intercourse. Benefits of exercise on Cardiovascular System: Low levels of physical exercise increase the risk of death from cardiovascular diseases (diseases of the heart and blood vessels). For children, children who take part in in physical exercise produce greater loss of body fat and improved cardiovascular fitness. Experience has shown that academic stress in the young poses increased risk of cardiovascular disease in subsequent years; nonetheless, these dangers can be significantly lowered with structured physical exercise. Exercise can be used to lower high blood pressure or prevent one from developing. On Metabolism: There is scientific evidence to support the fact that exercise lowers blood pressure, LDL and total cholesterol as well as body weight. Exercise increases HDL cholesterol, insulin sensitivity, and exercise tolerance of the individual thus lowering the risk of diabetes mellitus. On Immune System: reasonable exercise has an advantageous consequence on the human immune system. For example: modest exercise has been linked with a 29% lowering of occurrence of upper respiratory tract infections (URTI). On Cancer: There is abundant evidence that structured physical exercise can prevent up to 13 different cancers in human beings: In particular, cancer of the breast, cancer of the lung, cancer of the stomach, cancer of the colon, cancer of the womb, cancer of the oesophagus, cancer of the blood such as myloid leukaemia and myeloma. Other cancers that exercise can keep at bay are cancer of the bladder, cancer of the head and neck as well as cancer of liver and rectum. Rehabilitation: Even in patients that had unfortunately suffered from cancer, exercise has been shown to improve the outcome of cancer treatment. Remember though that exercise is a non-medication and has no toxic side effects. Regardless of the age and gender, the same thing can be said for anyone who is recovering from surgery, accidents, fractures and long term bed immobility. Exercise helps in rehabilitation and recovery from countless number of diseases. On the bones and muscles: In women and men, exercise can help to strengthen the bone and muscles. In no age is this more important and well demonstrated as in middle ages in women who had undergone or undergoing menopause. Later in life, men tend to have their own “menopause.” Exercise helps to prevent osteroporosis and muscle wasting. This is especially so in older women. Regular and determined exercise is the preferred choice, ironically, to prevent and treat osteoarthritis of any bone or joints. Mental Illness: Its well documented and indeed proven that exercise has positive impact on our mental health. Let us examine this fact a little further. A mammoth body of research in human beings has shown that consistent aerobic exercise (for example, 30 minutes of every day) encourage continual enhancement in certain brain and intellectual functions. Individuals who regularly carry out aerobic exercise (such as, running, jogging, brisk walking, swimming or cycling) have superior score on brain functions and performance tests such as attention control, inhibitory control, working memory updating and capacity, and information processing speed. Clinical proof also maintains the use of exercise as an additional therapy for certain brain illnesses in particular Alzheimer’s disease and Parkinson's disease. Structured exercise is also associated with a lower risk of developing neurodegenerative disorders. Exercise and in particular, aerobic exercise is also a powerful antidepressant as well as producing euphoria leading to improvements in mood and self-esteem. On depression: Physical exercise is well established form of as an antidepressant in persons with depression. In fact, clinical evidence supports the use of exercise as both a preventive measure against and also supportive therapy with antidepressant medication for depressive illnesses. Persons suffering from anxiety can also benefit from moderate exercise. Exercise can thus banish sadness and improve happiness in individuals. Benefits of Exercise. Your Solutions for Manifold of Diseases: Part 5 Pain relief: Apart from the use of exercise in rehabilitation of persons with surgical, mental health and other physical illnesses, exercise can help banish or reduce psychological pain whatever its origin: such as grief, divorce and life failures. This is because exercise produces endorphins in the brain. Endorphin is a powerful pain killer like morphine. Sleep: exercise generally speaking, improves sleep for a lot of people. It also alleviates sleep disorders such as insomnic illness. However, the best time to exercise may be 4 to 8 hours before bedtime. Vigorous exercise which is done close to bed time may impair sleep as it may cause alertness. Other Circumstances: Fibroid is a common disorder in women more especially so in African women wherever they may be on earth. As mentioned earlier, inactivity and obesity may cause the body to require or produce excessive estrogen hormone. Thus, a lean body mass will require less. Exercise is therefore a non-medical way to prevent development of fibroid. Further, women who are pregnant and anticipating delivery are encouraged to exercise from mid-pregnancy. This is so, to prepare the birth canal and the entire body of the woman for labour. A well toned muscles of the pelvis and thoroughly prepared body will be less tiring and will be able to cope with the rigours of labour. Warnings/Cautions: As in any form of medical treatment, there may be unwanted side effects. Exercise is not different even though it’s free (or supposed to be) and is not a medication. I cannot over emphasize the fact that exercise may not necessarily be suitable for everyone. Anyone with heart disease, physical disability, hypertension or a person who has not done exercise for a long time should exercise caution especially at the initial stages. I will caution that anyone with the illnesses of hypertension, heart problems, diabetes along with obesity or any illness for that matter should first consult with his or her doctor for a check-up. An ECG may also be ordered to cross-check the heart activities ahead of proposed scheduled exercises. Also, as in everything in life, too much exercise can be harmful. Moderation and reasonability are called for. Excessive, unrelenting, prolonged exercise may cause heart diseases because of work overloading of the heart. Excessive exercise in individuals with distorted overweight perception of themselves may lead to excess weight loss which may cause such person to look emaciated. Unguarded exertion of muscle and joints may cause physical injuries and also diseases such as rhadomyolysis (muscle damage). In addition, overtraining may suppress your immunity leading to such illnesses as frequently having respiratory infections. Wrong exercise can do more harm than good, with the definition of wrong varying according to the individual concerned. For many activities, especially running and cycling, there are significant injuries that may occur with poorly regimented exercise schedules. Injuries from accidents also remain a major concern, whereas the effects of increased exposure to air pollution seem only negligible: Not everyone exercises outside or on the streets. Some do so in their private spaces and some do exercise in commercial centres (gym, as it’s popularly called). In the female adult, excessive training may cause amenorrhoea (absence of the menstrual periods). If this continues and or untreated, amenorrhoea may lead to infertility. However, amenorrhoea of this nature is reversible once a correction is made to the underlying cause. However, while exercise should be a lifestyle for the duration of one’s life, exercise should if so desired, be stopped gradually. Sudden stoppage of exercise can lead to downward shift in the mood of the individual. Suitable nutrition and hydration (water intake) are important to health as exercise. When exercising, it becomes even more important to have a good diet and rehydration to ensure that the body has the correct ratio of macronutrients that it needs while providing ample micronutrients as well, in order to aid the body with the recovery process following strenuous exercise. We should remember that we should not overload or reload the excess food or fat that has been lost through exercise. You should also have adequate rest in intervals. This will allow the body to recover from previous exertion. Finally, while exercise is to be encouraged for individuals (children and adults) as well as the communities, caution should be exercised and note should be taken that one person is not the same as the other. If Mrs Z can tolerate 30minutes, it does not imply that Mr B can do the same. Every person should find their own level according to one’s ability especially within the recommended regime. As I have indicated before, do seek the opinion of your medical doctor and clinical adviser if you are considering engaging in exercise for the first time. All the same, you can banish illnesses by the choice of your lifestyle. Good luck.

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