What is geriatric rehabilitation?

People are living longer. The average mortality rate has gone up by almost twenty years over the last century. Advancement in technology, medical procedures and treatment has made this possible. The need now is to make sure that the quality of life for the aged doesn’t degrade. That is the purpose of geriatric rehabilitation. It offers the aged a means to live a quality life for as long as they can.

How does geriatric rehabilitation help?

Communication, movement and non impairment of mental faculties are what the aged require. As people get old, their hearing and eyesight become impaired. Their movement may get restricted due to wear and tear in the joints, osteoporosis and other age related factors. Another cause for concern for geriatrics is malnutrition. Older people need an excess of certain nutrients to balance their health. Good nutrition promotes healing and provides energy and improves quality of life. Life slows down for the aged, and for the active, this can lead to a feeling of not being a useful contributor to society. This, in turn, can lead to depression. Hence, attending to the mental health of geriatrics is as important as managing physical health. 

Different kinds of geriatric rehabilitation

The geriatric rehabilitation includes a wide range of treatments and medical help for a variety of ailments that the aged face.

1. One of the major problems that geriatrics deal with is decrease in movement. Earlier, stiffness in the joints, and aches and pains were taken as part and parcel of getting old. But these days, with joint replacement procedures, and physical therapy the aged can get past these problems.

2. Loss of hearing and vision can be addressed these days with simple procedures like laser treatment, advanced hearing aids etc., that help restore or at least better eyesight and hearing. 

3. There are specialized dieticians for geriatrics who will prescribe a food plan that includes foods and supplements to ensure that they are getting all the nutrients their body requires. 

4. As a person ages, small activities like eating or bathing become difficult. Occupational therapy focuses on helping the aged stay independent. The goal is to help them learn to help themselves.

5. The awareness among doctors and the aged that geriatric mental health needs to be addressed is a boon to the aged. Counselling is available for older people and this can help them adjust to a difference in lifestyle.

Focused geriatric attention

Many hospitals have geriatric departments which focus completely on geriatric health and rehabilitation. They take a holistic approach to the health and wellness of the aged. They have regular medical check-ups for older people and a complete and comprehensive battery of tests that will keep an eye on the person’s health so that preventive action can be taken at the first sign of an illness. This is a boon to the patients as they can live their life comfortably in the knowledge that their health is in safe hands.

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Nutrients older people need for health and wellness

As people get older their metabolism changes, there is a decrease in hormones produced in the body and they need a well balanced diet with enough supplements to stay healthy

A healthy geriatric diet plan should include:

• A variety of fruits(for vitamins and fibre)
• A variety of vegetables(for vitamins and fibre)
• Meat or lentils(for proteins)
  *Meat eaters should stick to lean meat to ensure that they get proteins without the calories
  *Vegetarians should have a large helping of protein rich foods like lentils
• A sufficient quantity of milk
• Water

*Older people have less muscle mass and so they need less calories in the food they eat. They also metabolize food slower and hence it takes them longer to burn calories. The amount of activity they do is less and they should have a low fat diet to prevent them putting on weight.

Geriatric diet supplements: Why?

• The aged absorb nutrients from food at a slower rate.
• The amount of nutrients required by geriatrics increases
• Due to their age, geriatrics require certain supplements that is not easily available in the food we eat

Necessary supplements for geriatrics include:

• Omega 3 Fatty acids: Decreases the risk of heart disease, cancer and arthritis (found in flax seeds, walnuts, and fish)
• Calcium: Preserves bone health and it lowers blood pressure (found in milk and dairy products. For the lactose intolerant, there are fortified non-dairy milks like almond or soy, and fortified orange juice)
• Potassium: Keeps bones strong. Antidote for depression, reduces blood pressure and risk of kidney stones (found in bananas)
• Magnesium: Helps the immune system and the heart. Older people sometimes use diuretics and this flushes out the magnesium in the body (found in dried fruits, and leafy vegetables)
• Fibre: Helps digestion. As people age, digestion and ridding the body of waste becomes difficult (found in fruits and vegetables)
• Vitamin B12: This is important for the red blood cells and for maintaining nerve function. This may have to be taken as a supplement as fresh food does not contain enough.
• Folate/Folic Acid: Prevents anaemia. Certain vegetables are rich in folates but geriatrics may need to take a supplement
• Vitamin D: This helps maintain bone density, helps the body absorb calcium and prevents osteoporosis.

*Young, healthy adults get their dose of Vitamin D naturally from the sun. But as we get older, due to lifestyle and decrease in the rate of absorption, the Vitamin D in the body gets less and will have to be supplemented. 

Tip: Consult your physician before you pop in supplements. 

Diet tips for geriatrics

• Lessen salt in food
• Avoid very sugary treats
• Keep hydrated
• Have smaller, more frequent meals
• Have an early dinner
• Sip water through the day
• Avoid fatty food and deep fried food

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Difficulty in breathing - What it could mean and emergency response

Breathing - The process

When we take a breath, we take in oxygen through our nose, down the trachea, through the bronchi and into our lungs. It helps our body take in oxygen and other gases and disperses it into the bloodstream and it absorbs and expels carbon dioxide. A number of small processes using different parts of the respiratory system make this intricate process work. A problem with any one of these processes could result in difficulties in breathing.
What are the common causes for breathing difficulties?

Sometimes the cause of a breathing problem could be congestion due to a simple cold, sinusitis, a mild allergy or asthma. This can be eased with inhalation and medication at home. But since breathing is an important process, a severe cold or wheeze could necessitate hospitalization and more aggressive treatment.

Serious causes of breathing difficulties could include:

• Congestive heart failure
• Respiratory infections like pneumonia, croup, and whooping cough etc.
• Chronic obstructive pulmonary disease
• Pericardial or pleural effusion.
• A very severe allergic reaction could cause the throat to swell up, and block it, preventing breathing.

In these cases, emergency response and immediate hospitalization would be required.

Emergency response

Remember that any sort of breathing difficult should always be treated as an emergency. The first response is to call a hospital and get an ambulance. While you wait for the ambulance here are some things that you should do and should not do.

1. Loosen the clothing (Tight clothing can restrict breathing. Check the under clothing too)

2. If there is prescribed medication that has to be taken in an emergency, administer it immediately (Sometimes the person may just need a puff from their inhaler to free the airway)
3. Make them sit up straight. This extends the respiratory tract and frees the airway.
(Never make them bend over or put a pillow under their heads as this restricts air flow)

4. Check to see if they have any other accompanying symptoms like nausea or dizziness, pain, sweating, rapid heartbeat or wheezing. (This could explain the reason for the breathlessness and if they faint on the way to the hospital or are unable to articulate the symptoms, you can notify the doctor)

5. Do not give them food or anything to drink if they are in severe distress

6. Check to see if there are any open wounds
(If there is an open wound and bleeding, especially in the head and neck, and if bubbles appear, staunch the blood flow at once and apply a bandage. Try to do this without moving them)

7. Check for visible rashes. You can inform the doctor as soon as you reach the hospital

8. In severe cases, you may have to do CPR till the ambulance gets there

It is important to call an ambulance from a hospital as it will be better equipped and will arrive with experienced medical staff that can monitor the patient along the way.

Accompany the ambulance to the hospital so that you can update the doctor on what happened and if any help or medication was given. Carry the patient’s medical records with you, so the doctors on call can check the patient’s medical history before starting treatment.

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Fire Accident - Emergency Procedures

Types of fire accidents

• Kitchen accidents like burns from hot liquids, steam, hot oil, gas explosions
• Fire due to faulty appliances from heaters, irons, faulty wiring etc.
• Smoking – related fires
• Burns due to chemicals, radiation and electric current

Categories of burns

The category of a burn depends on the severity of tissue damage.

1. First degree burns symptoms

• They are superficial
• There may be swelling, redness, pain
• There may be small blisters
• Appearance of white skin around the burn area

Emergency response

• Remove clothing from around the affected area
• Pour cold water over affected area till burning subsides (this reduces the chance of blisters)
• Pat dry and apply a topical antibiotic prescribed for burns (do not rub dry-you could peel away skin)
• It is better to see a doctor and get the wounds checked and to take a tetanus vaccination

2. Second degree burns symptoms

• The burned area stretched to the dermis
• There may be swelling, redness and pain
• Large blisters may form, which may ooze liquid
• There could be scarring and tightening of skin
• Dehydration may occur
• Movement may be restricted if it is around a joint

Emergency response

• Remove clothing from around the affected area
• Keep the area dry/ use sterile cotton to avoid infection
• Keep the burnt area raised to avoid swelling
• Keep the injured hydrated
• Take the injured to the emergency care in a hospital immediately or call for an ambulance

3. Third degree burns symptoms

• The damage goes through all three layers of skin
• Nerve endings may get damaged causing lack of pain
• Will not turn white and there will be no blisters
• Skin may be discolored and becomes leathery
• Injured could go into shock
• Dehydration may occur

Emergency response

• Do not move the injured
• Do not give the injured anything to eat or drink
• Do not try to remove clothing. You may inadvertently remove skin
• Call a hospital ambulance as the injured may need emergency assistance on the way to the hospital
• Take the victim’s medical records and inform the doctor of the precise nature of the accident

Tips to prevent fire accidents

• Get your gas cylinder checked when it is delivered and get the pipeline checked regularly
• Get the wiring in your home checked in case of water damage or leaks
• Make sure your appliances are working properly
• Stop smoking or be careful with smoking accessories

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Geriatric Health Care

Thanks to advances in medicine and health care, people today are living longer than ever before and their senior years can be active and fulfilling. However, that does not mean that your body is the same now as it was when you were 20. Your body has changed over the years, often in ways you do not notice or realize. Just as there are medical specializations dealing with children’s’ health, women health, sports medicine and so on, there is also a specialization in the health of senior citizens. It is known as geriatric medicine and it focuses on the medical issues and diseases associated with aging.

The Problems With Aging

As you age, you will find that there are activities that you could easily do in the past that are now becoming increasingly difficult. Generally speaking, this is normal and not a cause for concern. However, because your body is aging, they could also be signs of health issues that need to be addressed to prevent them from escalating into more serious concerns. Remember, an older body is less able to fight off and recover from sickness and injury than a younger one.

There are some health issues that are common as you age. Getting regular checkups from a geriatric specialist will allow for treatment to begin early so as to minimize the effects and maximize the speed and quantum of recovery. Among these are:

•          Arthritis
•          Osteoporosis
•          Vision loss
•          Hearing loss
•          Heart disease
•          Constipation and incontinence
•          Cognitive impairment
•          Balance and equilibrium issues
•          Respiratory diseases
•          Cancer
•          Diabetes
•          Obesity
•          And more

Age Is Not Just A Number

Common sayings like “You are as old as you feel” and “Age is just a number” reflect the active lives that seniors now live. But they are only partially true.  If you are near or over 60, your body has changed and its medical needs are different. Getting the health care you need from a specialist in geriatric medicine will enable you to remain as active as possible and assist in the recovery from sickness and injury. Listen to your body and when the signs of problems arise, have them checked up. Often there may be signs of age-related problems that you may not notice but which your family members do. Listen to what they have to say and consult a geriatrician. The signs of aging are not things to be frightened of or hidden. They are part of the natural life cycle. With the right medical care and treatment, controlling them and living a comfortable and active life is possible.

If you are over 60, your primary health care should be given to a geriatric specialist. He will be able to evaluate your health based on age-related factors and prescribe the treatment that is right for you or, if required, refer you to a specialist. A hospital with a specialized geriatric care clinic will offer the most comprehensive health care for senior citizens to enable them to maintain, and often improve, the quality of their lives. 

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Food Poisoning - Causes, Symptoms, and Treatment

How does food get contaminated?

Food can get contaminated at any time from harvesting, processing, shipping or even when it is being prepared. Cross contamination which is the transfer of harmful bacteria from one surface to the other is quite often the cause. The popular belief that food cooked at home cannot cause food poisoning is erroneous. If not washed or prepared well, even home cooked food can be harmful.

Tips to prevent food poisoning

• Wash all fresh foodstuffs well 
• Make sure that canned food is well within its expiry date
• Keep raw food and canned food separate
• Refrigerate food if you plan to eat it later
• Make sure food is fully thawed when reheating
• Pick good restaurants when you eat out
• Don’t eat food from road side carts
• Carry water with you when you go out
• Make sure that the food prepared at home is cooked well

Foods that can cause food poisoning

• Meat and poultry that are infected
• Raw or undercooked eggs
• Canned food that have not been packaged well
• Shellfish and seafood can be contaminated by chemicals in seawater
• Leafy vegetables can be ridden with worms
• Fresh vegetables that have been sprayed by pesticide
• Milk and milk products that haven’t been processed well

Symptoms of food poisoning

• Diarrhoea
• Nausea and vomiting
• Fever
• Stomach cramps
• Blood in vomit or stools
• Headache

Most at risk

• Infants and young children: Immune systems may be more susceptible
• Geriatrics: Older people may have compromised immune systems
• Pregnant woman: Hormonal changes cause them to be risk prone to food poisoning
• People with illnesses are weaker and their immune system may be compromised

*This doesn’t mean that healthy adults don’t get affected. Anyone can fall prey to food poisoning if they don’t take precautions

Immediate treatment

• Keep the person hydrated. Water with electrolytes should be given at regular intervals. It is important to flush out the system
• Bland food with less oil should be given.
• Food stuff high in acidity should be avoided
• Rest is essential since dehydration can cause fatigue

If the person has any of the following symptoms, they should be taken to a hospital:

• Blood in stools
• Increased heart rate
• Fainting or dizziness
• Decreased urination
• Difficulty in breathing
• Diarrhoea and vomiting for more than a day
• Extreme dehydration
• High fever

At the hospital:

• Give the attending doctor a list of things that the person ingested the day before. It can help narrow down the cause and help decide treatment
• Let the doctor know if the person is allergic to anything specific
• Give the doctor the history of what treatment was given before bringing the patient to the hospital.

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Benefits of Joint replacement

When to consider joint replacement?

You should consider joint replacement

• When stiff joints restrict movement
• If there is considerable pain in the joints
• If normal day to day activities are restricted
• If you have to depend on others for routine tasks
• If pain medication and physiotherapy doesn’t help
• If you quality of life is decreased in any way

Procedure for joint replacement

In a joint replacement surgery

• the damaged cartilage and corresponding bone will be removed from the joint.
• a prosthetic component will replace the original bone.
• the prosthesis will be in the shape of the natural joint and will move as easily.

Types of joint replacements

• Total Hip Replacement
• Total Knee Replacement
• Unicompartmental Knee Replacement
• Shoulder Joint Replacement
• Reverse Total Shoulder Replacement
• Total Elbow Replacement
• Wrist Joint Replacement (Wrist Arthroplasty)

Benefits or joint replacement

• Increased Mobility: Stiffness due to injuries or arthritis or age will be relieved
• Pain relief: There is considerable decrease in pain to no pain at all
• Independence: Dependence on others decreases as the person is able to handle activities on their own without stiffness or pain
• Less expenditure in the long run: Weigh the cost of the surgery against years of doctor’s bills and physiotherapy and you will find that replacing the joint is less expensive.

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Advantages of choosing a hospital with an ICU

What is an ICU?

The acronym ICU stands for Intensive Care Unit. These are special hospital areas to look after people who are very ill. The ICU staff will be specially trained to handle emergencies and the room is usually secluded from the usual hustle bustle of the hospital. 

Why is it important to choose a hospital with an ICU in case of an emergency?

An ICU is different from other units of a hospital. It is a much more specialized place where

1. Seriously ill patients are closely monitored
2. Special equipment is available to aid in patient monitoring, stabilizing and recovery
3. Specially trained nurses work around the clock
4. The ratio of nurse to patient is 1:2 usually
5. There are resident doctors on call around the clock 

What kind of facilities does an ICU have?

Usually the equipment in an ICU would include:

• a ventilator (This is a machine that helps with breathing. It uses a tube that is placed in the mouth, nose, or through a small cut in the throat)
• monitoring equipment ( These are used to continuously monitor heart rate, blood pressure, the level of oxygen in the blood and other organ functions)
• IV lines and pumps (These include tubes that will be inserted into the vein to provide blood, fluids and medication)
• feeding tubes (Most patients in the ICU may be unable to eat normally, so tubes will be inserted in the nose, or through a small cut made in the tummy, or into a vein to ensure that the person gets adequate nutrition)
• drains and catheters (Patients may be unable to release bodily waste normally and hence drains are tubes are used to remove any build-up of blood or fluid from the body)
• other equipment like dialysis machines for patients with kidney failure, ECMO for people with heart failure etc.
• some types of movable equipment like scanning and X-ray machines may also be brought to the room for use. 

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