Dr. Shyam P Lohani

Increased life expectancy and greater prevalence of chronic illnesses such as diabetes, hypertension, liver and kidney problems in older adults have placed a greater demand on the existing healthcare system. Most of us need some type of care assistance after the age of 65. We become increasingly dependent on others as age increases, and getting around and taking care of ourselves can become more and more challenging.
Once our mobility becomes increasingly limited, home adjustments may help us keep our existing residence comfortable and accessible. Adjustments may include additions such as grab bars in the shower, ramps to avoid or minimise the use of stairs, or even installing a new bathroom on the ground floor. However, needs are different for the different individuals depending on factors like the amount of support we have, our general health and mobility, and our financial situation.
Changing trend
It is normal to feel confused, vulnerable, or even angry when we realise we cannot do the things we used to be able to do. We may feel guilty of the imagination of having to rely on outsiders to do things we would do for ourselves. Or, often we may feel uncomfortable about having strangers in our home. By acknowledging these feelings and keeping our minds open to new ways for making life easier, we will not only cope with change in a situation better but may also be able to prolong other aspects of our independence for longer. Losses are a normal part of aging and losing some of our independence is not a sign of weakness.
There is variation in the form of care provided for older people among different countries and is changing rapidly. It is a known fact that older people consume the most health expenditures than any other age group throughout the world. In the past, care for older adults has been the responsibility of family members and was provided in a joint family. But in modern societies, care is now being provided by state or charitable institutions or private institutions. Decreasing family size, greater life expectancy, and the geographical dispersion of families are implicated for the change of care practice.
Disability resulting from illness is fairly obvious from the diagnosis among young and middle-aged people. The elderly people frequently have multiple chronic and complex illnesses, and loss of function is the sum of these interacting disease processes. The evaluation of any geriatric patient must include functionality assessment. Caring for older patients must be integrated with preventive practice as it has an important impact on the quality of life in the later years. Changing locations of treatment and rehabilitation can save money. Well-managed care homes save substantial amounts of money and reduce the stress on the residents by treating medical conditions of care home residents in the old age care home.
The diet of elderly people should contain sufficient dietary fibre to prevent high prevalence of constipation. Dietary interventions in geriatric care institutions have shown obvious benefit. Dietary fibre can be easily integrated into the daily diet and improves bowel function and reduces the use of laxatives in older populations. Adverse Drug Events (ADEs) are associated with high rates of hospitalisation in older adults. Polypharmacy (use of five or more drugs) may confuse ADEs with a new disease process, drug-drug interactions, and inappropriate drug doses are some of the most common causes of preventable ADEs in this population.
Owing to better public health and improved nutrition, the life expectancy in Nepal increased from 27 years in 1951 to 71 in 2017. Approximately 85 per cent of elderly Nepali people live in rural areas. In Nepali culture, traditionally, parents live with their children and about 90 per cent of elderly populations live in homes of their children. However, the scenario is rapidly changing as more children leave home for work or for education.

Allowance
The government provides medical facilities to the elderly and free medicines as well as health care to people who are poverty-stricken in all districts. The government has planned to support free health care for all heart and kidney patients older than 75 years. It also provides a monthly stipend to all citizens over 70 years and widows above 60 years. This stipend may help elderly people living with their family as a caretaker. However, people who have no family members as caretakers are facing tremendous problems both physically and psychologically.
There are fewer private day-care homes in Nepal and are limited to the capital. Therefore, more care homes are needed in both public as well as private sectors to support the growing number of elderly people. The ideal care homes should be able to cater to the need of functionally and cognitively fit elderly as well as elderly with mild functional limitations or mild cognitive impairment to fully functional and cognitive impairments.

(A Professor, Lohani is the founder and academic director at Nobel College. lohanis@gmail.com)