Navigating Elderly Care

Conversations with a seasoned geriatrician

As our world population ages, the intricacies of elderly care take centre stage. This demographic shift presents both challenges and opportunities for healthcare systems across the globe. With longer life expectancies and a growing proportion of older adults, understanding the unique needs of this ageing population becomes essential.

In a recent interview, Dr. Seenikatty Abdul Hakim, a seasoned Consultant Geriatrician at Pantai Hospital Kuala Lumpur, shared invaluable insights into the evolving landscape of elderly care. With years of experience in geriatric medicine, Dr Seenikatty’s expertise offers a profound understanding of the challenges and advancements in caring for older individuals. This article delves into the discussion with Dr Seenikatty, exploring key aspects of geriatric care and strategies to enhance the well-being of the ageing population.

 Dr. Seenikatty Abdul Hakim, Consultant Geriatrician at Pantai Hospital Kuala Lumpur

1Twenty80: What are the common reasons mobility becomes more challenging as people age?

Dr. Seenikatty Abdul Hakim:

As people age, various factors come into play that significantly impact their mobility. One critical aspect is the physical toll of ageing, characterised by wear and tear on the body, particularly evident in joint health. For instance, many individuals develop osteoarthritis in their knees and hips due to the strain endured during their younger years.

This decline in joint health leads to pain, which in turn restricts mobility and hampers movement. Additionally, age-related illnesses such as strokes can result in the loss of limb function, further limiting mobility. Over time, muscle strength diminishes, making it challenging to move quickly or with the same agility as before.

Moreover, cognitive issues like memory problems can exacerbate mobility issues. Patients experiencing cognitive decline may struggle with venturing outside, leading to social withdrawal and reduced physical activity. This withdrawal contributes to muscle weakness, joint stiffness, and a vicious cycle of declining mobility.

Emotional factors also play a significant role. Loss of a loved one, depression, or low mood can further deter individuals from engaging in physical activities or social outings. Social circumstances, including lack of support or transportation options, can further restrict movement and exacerbate mobility issues.

Ultimately, these interconnected factors create a complex web where physical, cognitive, emotional, and social elements converge to influence an individual’s ability to move and maintain mobility as they age.

1Twenty80: How important is a holistic treatment for ageing patients?

Dr. Seenikatty: 

Treating patients holistically involves addressing not just their physical ailments but also their psychological well-being. Neglecting mood can result in only partially treating the problem, leaving underlying issues unaddressed. For instance, patients may recover from acute illnesses like pneumonia or dehydration-related infections during a hospital stay, yet they may still face challenges in their environment that hinder their recovery. This is particularly evident in cases like strokes, where emotional impacts can be significant.

The emotional toll of illness can lead to fears, such as a fear of falling again after an injury or feeling weak and fatigued, which can contribute to depression. Without addressing these mood components, achieving full recovery becomes challenging. Mental health care should not be neglected, even in a rush to address immediate medical issues. Collaborating with mental health experts is crucial for comprehensive care, especially in complex cases or when psychiatric conditions like schizophrenia or bipolar disorder are involved.

Geriatricians are trained to recognise and treat depression in older adults, although detecting depression in this population can be subtle and easily overlooked compared to younger adults. Changes in behaviour, appetite, weight loss, or sleep patterns may signal underlying mood issues that require attention. Therefore, thorough assessments that include mental health evaluations are essential for providing effective care to older adults.

1Twenty80: How do reduced muscle strength and joint flexibility impact an elderly person’s ability to move around independently?

Dr. Seenikatty: 

Muscle strength is crucial not just for movement but also for providing support to our joints. As we age, a condition known as sarcopenia can cause a decline in muscle mass and strength. This decrease in muscle strength is evident in everyday tasks like walking, standing up, and moving quickly. Additionally, reduced muscle bulk means diminished support for vital joints such as the knees and hips.

Moreover, ageing often brings about issues like wear and tear, leading to joint pain. When muscles are unable to adequately support these joints, the pain intensifies, creating a vicious cycle. This cycle limits mobility, further weakening the muscles and exacerbating the pain.

Addressing this cycle requires attention to either alleviating joint pain or enhancing muscle strength. Nutrition plays a significant role in maintaining muscle mass and strength as we age. Challenges like decreased dentition, reduced chewing ability, and changes in taste and smell can lead to inadequate protein intake, further contributing to muscle loss.

Therefore, maintaining strong muscles is not just about mobility but also about ensuring the proper support for our joints, which can significantly impact our overall quality of life.

1Twenty80: Does proper footwear help in preventing falls and improving mobility for older adults? 

Dr. Seenikatty:

When patients visit my clinic, I make it a point not only to conduct a thorough examination but also to check their shoes. This may seem unusual, but it’s crucial, especially considering that the risk of falls increases as we age due to various factors. One easily preventable aspect is footwear.

I often observe that many patients wear worn-out shoes with balding soles, significantly increasing their risk of slipping, especially on slippery surfaces. Ill-fitting shoes, like flip-flops or slip-ons, are also common culprits. These types of shoes can easily slip off or cause tripping, leading to falls. As we age, our foot arches may become less pronounced, resulting in flat feet and increased pain that can radiate throughout the body.

Proper footwear plays a pivotal role in absorbing the impact of walking and providing comfort and safety. When selecting footwear for elderly adults, there are several key considerations. I advise choosing shoes that can be securely strapped on to prevent slipping while walking. Sandals, particularly loose-fitting ones, are discouraged as they can easily slip off. Opting for shoes with good grip and adequate arch support is essential for stability and reducing pain.

For diabetic patients, closed-toe shoes are particularly important to prevent injuries. Therefore, when purchasing shoes for elderly parents or loved ones, it’s crucial to prioritise safety, comfort, and proper support to minimize the risk of falls and ensure overall foot health.

1Twenty80: Do assistive devices help enhance mobility and independence for older adults? Could you please provide some examples of assistive devices and their benefits?

Dr. Seenikatty:

Assistive devices come in various forms, such as walking sticks, quadripods, walking frames, and rollators with wheels. There are also simpler options like rollers with shopping carts attached. Some devices even integrate a chair with a walking stick, allowing users to walk and then sit as needed.

In addition to these, mobility scooters and wheelchairs offer more comprehensive support. However, the abundance of choices in the market means it’s crucial to find the right device that suits the specific needs of each patient. Some patients may have devices they don’t actually require or ones that aren’t adjusted to the proper grip height. On the other hand, some patients resist using any walking aids due to feeling old, despite the increased risk of falls without assistance.

Determining the appropriate assistive device for a patient requires a tailored approach. It’s essential to consider the patient’s medical condition and mobility issues. Physiotherapists often play a vital role in assessing and recommending suitable mobility aids based on individual needs. There’s no one-size-fits-all solution; the choice of device depends on the patient’s impairment and mobility requirements.

For example, a patient with Parkinson’s disease and a stooped posture may benefit more from a walking frame or rollator to provide better support than a single-point walking stick. Conversely, someone with minor osteoarthritis in one knee might find a single-point walking stick sufficient. Patients with severe back pain may require a stronger support device like a quadripod.

Innovations in assistive devices continue to evolve, with options like walking sticks that double as stools or shopping carts with seats gaining popularity. These devices offer added convenience and safety, especially for those who may need to rest intermittently while walking or shopping. Overall, getting assessed by an expert can help patients find the most suitable assistive device tailored to their specific needs and mobility challenges.

1Twenty80: Can you discuss the importance of home modifications in promoting mobility and independence for older adults?

Dr. Seenikatty:

Home environments play a crucial role in ensuring the safety and mobility of older adults. In areas like Petaling Jaya and Bangsar, homes built in the 1980s often pose challenges for ageing individuals due to features like split levels, narrow doorways, and carpets. These factors can make it difficult for wheelchairs or stretchers to manoeuvre, posing risks in case of emergencies or daily mobility needs.

However, in recent years, there’s been a shift towards constructing elder-friendly homes. New constructions prioritise features like ramps, handrails, and single-level living to accommodate older adults’ needs better. Bathrooms, in particular, are being designed with grab rails and accessible layouts to reduce hazards like slipping or grabbing onto unstable fixtures.

Working closely with occupational therapists, healthcare providers assess patients’ home environments during home visits. This assessment helps identify necessary adaptations like grab rails, handrails, and clutter reduction to enhance safety and reduce fall risks. Special attention is given to crucial areas like bedrooms, bathrooms, and pathways between rooms to ensure ease of movement and minimise hazards.

Moreover, technological solutions like call alert systems or neighbourhood support systems are being explored to provide a safety net for older adults living alone. These systems allow for quick assistance in case of emergencies, reducing the risk of prolonged falls or injuries going unnoticed.

However, challenges still exist, especially in older constructions with split levels, narrow doorways, and inaccessible bathrooms. Modifications to accommodate mobility aids like wheelchairs or stretchers may require significant renovations.

Overall, the focus on elder-friendly home designs and safety measures reflects a growing recognition of the importance of creating environments that promote independence, mobility, and safety for older adults as they age in place.

1Twenty80: How do cognitive changes, such as memory decline or impaired judgment, factor into home modifications for seniors who may have mobility limitations?

Dr. Seenikatty:

Cognitive changes, such as memory decline or impaired judgment, significantly influence the need for home modifications to ensure safety and accommodate mobility limitations. Impaired judgment, in particular, can lead to situations where patients engage in risky activities without realising the potential danger. For instance, a patient with dementia might attempt tasks like changing a light bulb on a ladder, leading to accidents and injuries. Cognitive impairment, in such cases, contributes to a higher risk of falls, which can result in pain, fractures, and decreased mobility.

Moreover, cognitive changes also impact a patient’s social interactions and overall lifestyle. Patients with cognitive impairments may face challenges in going out, driving, or maintaining social connections, leading to feelings of isolation and reduced engagement in stimulating activities. This lack of social interaction and mental stimulation can further contribute to cognitive decline.

In terms of addressing cognitive decline and improving cognitive abilities, engaging in regular mental exercises and social activities is crucial. Activities like Tai Chi classes, dancing, attending religious gatherings, or participating in community events can help keep the mind sharp and promote social interaction. Additionally, maintaining physical activity through exercises like swimming, cycling, walking, gardening, or housework also plays a significant role in overall well-being.

It’s essential to tailor exercises and activities based on each patient’s preferences and capabilities. Encouraging patients to spend time outdoors, get sunlight exposure, and engage in activities that keep them physically and mentally active can significantly benefit their cognitive and physical health. However, when patients show reluctance or decreased motivation to engage in physical activities, it’s important to address these barriers and find alternative ways to keep them moving and active to prevent further decline in mobility and cognitive function.

1Twenty80: What role do proper lighting, non-slip flooring, and clutter-free pathways play in creating a safe and accessible home environment for older adults?

Dr. Seenikatty:

As we age, various sensory impairments, such as hearing loss, visual impairment, and reduced sensory feedback, become increasingly prominent. These impairments are not only crucial for muscle strength, joint mobility, and balance but also play a vital role in navigating daily activities. For instance, even simple tasks like standing on one leg can become challenging when vision is impaired, leading to instability and potential falls.

Visual impairments, such as cataracts or glaucoma, can significantly reduce visual acuity, especially in low-light conditions. This can affect activities like driving at night, where visibility is compromised. Older adults may struggle to navigate in low-light environments or when their vision is obstructed. Interestingly, some individuals, like the patient who planned for potential visual impairment in the future, recognize the importance of vision and the impact it has on daily life.

Moreover, sensory impairments, including hearing loss and reduced tactile feedback, can further complicate mobility and safety. For instance, individuals with hearing impairments may miss auditory cues, making it challenging to respond to warnings or signals in their environment. Similarly, reduced sensation in the feet can lead to difficulties in detecting slippery surfaces or obstacles, increasing the risk of falls.

Creating well-lit environments and minimising clutter can significantly improve safety for older adults with sensory impairments. Additionally, technologies like lighting control systems or assistive devices for hearing and tactile feedback can enhance mobility and reduce the risk of accidents. Overall, addressing sensory impairments and optimising environmental conditions are crucial steps in promoting safe and independent living for older adults.

1Twenty80: Are there financial assistance programs or resources available to help older adults afford home modifications that improve mobility and independence?

Dr. Seenikatty:

Malaysians are known for their generosity, often stepping forward to offer assistance when needed. I’ve personally facilitated requests for aid on behalf of pensioners, whether it’s for walking aids post-events like strokes, hospital admissions, or amputations, or for wheelchairs. Additionally, ex-servicemen can find support through avenues like the Ministry of Defence or associations specifically for retired army servicemen, which are known to be quite supportive.

For Muslims, organisations that have Zakat programmes can be beneficial, as they are often forthcoming with aid upon application. Furthermore, Malaysia boasts numerous NGOs that are open to providing assistance, making it possible for individuals in need to receive the support they require.