Geriatric /Parental Care
WHAT ARE OLD AGE RELATED PROBLEMS?
With increased life spans the concept of old age itself has undergone a change. However, people who live beyond sixty years of age or so are commonly known as aged or elderly. Old age is still an inevitable physiological process, which cannot be postponed indefinitely. One has to perceive both physical and socio-psychological aspects of the life of the aged to understand life conditions of elderly. Parents abusing children, husbands abusing wives and older persons being abused and neglected by spouses, daughters-in-law, sons, brothers and other members of the family and relatives are quite common.
With better health care facilities, increased incomes and better dietary pattern throughout life, life spans have improved. The life expectancy index which was earlier at 40 years or so has crossed 65 now. As a result more and more people are living beyond the normal retirement age. This problem is much more acute in certain European countries where younger generation is surpassed by the number of aged.
The youngsters do not wish to accept old people as part of their social setup and their life-style at all. Changing priorities of younger generation and replacement of “We” concept by “I” concept have resulted in this age divide.
Old age is bound to catch up with each and every one of us. Our parents living away from us, alone and in a place bereft of the best possible medical care, are a constant source of concern for us. We want to provide the best for them even when we are not personally present to look after them.
Old age is advanced years in the latter period of life. Physiological changes are bound to occur in the body and related to this are the psychosomatic changes. Changes in no particular fixed order will come. Some of these could be:
- Experience vision problems
- Noticeable loss of hearing.
- Appetite loss;
- Difficulty concentrating;
- Loss of interest in life or the ability to enjoy it;
- Feelings of emptiness,
- Sadness, and hopelessness;
- Wishing for death.
DO MY AGED PARENTS LIVING ALONE NEED SPECIAL CARE?
Elderly people are described as a very heterogeneous group comprising several subgroups (robust, frail, demented, and dying people), each requiring a different approach to medical care. The robust group generally needs a full diagnostic work up and treatment, whereas for the frail group the priority is treatment to maximise function.
Being old is an individual’s psychic perception while being labeled old is a social description. Our religious customs and traditions ascribe certain duties and responsibilities towards our parents. The changed family and economic situations have forced people to live away from their parents sometimes in different countries. Older people need specific care for their physical and emotional sustenance.
Old people need affectionate care as much as a small child. They tend to get disturbed over small matters. It is important to provide them physical, financial and emotional security.While financial security can be ensured by providing sufficient means at their disposal through a bank or financial institution- their emotional security can be ensured through personal touch.
WHAT IS OLD AGE ABUSE?
Old age abuse is defined as violation of the physical and psychological integrity of an older person or harming the development of his/her personality and undermining or damaging his/her financial security.
Most of the times old people are dependent on those who abuse them for their physical and financial need and support. Abuse of old people has been on the rise due to property related issues and many an old person has been done to death for this reason alone.
Some cases exemplify the nature of abuse in our society:
- There was this 70 years old widower living with his son. A few years back, his son started demanding transfer of father’s property to his name. When the father refused to comply, he started abusing him physical and verbally and eventually killed him and dumped his body in a canal.
- While in other case one poor widow woman of about 60 years of age lived with he young unemployed son. Due to economic hardship she had to sell her small room and after some time she lost her legs in a road accident. Her son one day discarded her who had become a liability for him.
Elders have nobody to share their grievances. Older persons are least wanted in the social setup of a family or the society at large resulting in loneliness and the death anxiety. Everyone evaluated death negatively, the elderly rated it more positive than others.
Children do not have the time or inclination to care for the old and neglect intentionally or by default due to their own very busy and hectic life schedules. The problem for older persons in all cases may not be lack of money but lack of time by others. The other thing is lack of emotional support from family members. Sense of insecurity and feeling of burden and old age itself was a disease.
Old people are sent away to live separately even when families can taken care of them. This may not be the desire of the children but the desire of old parents to stay in the place of their ancestors- far away from their children. The other problem is older couple being asked to live separately when they had more than one child. While in the case or rotation, the parents stayed with one child for a particular period of time and then moved over to the other child to stay with him for the same period of time.
Death of a spouse in old age causes greatest mental anguish. Many societies still frown upon remarriage of a widow irrespective the age. In old age in any case marriage of a widow / widower is frowned upon. A widow in her old age may be able to absorb herself in household work and care of the children / grand children; it is a major crisis for a widower. His sole link with the family gets broken and he at times finds even normal communication with his children adversely affected.
Women perceive financial dependency and no access to money for their personal needs more so for health problems and buying of medicines as a form of maltreatment. The cause of abuse is because there is no communication between old and young. Parents are abused when he/she got pension and children wanted to take away the money.
HOW DO I TAKE CARE OF MY OLD PARENTS LIVING AWAY FROM ME?
It has been confirmed through various studies that the three basic ingredients of old peoples’ care are:
- Physical security
- Financial security
- Emotional security
Physical security involves body and physical possessions and medical care. One can ensure body security through the involvement of local level (village) administration and relatives residing nearby. Adequate compensation in the form of some indirect benefits can be provided to the care giver.
Alternatively, a young boy or girl from some relatives or poor from the village can be asked to live the aged and their education etc. financed.
Geriatric care is a special field of medicine and many health issues are related to age- osteoporosis being one- in addition to some others listed above. It is imperative that we ensure the following for our parents living separated from us due to any reason:
- Ensure proper physical security.
- Periodic / annual medical check ups.
- Quality medical care when required.
All of these aspects do not require our presence all the time with our parents. We can ensure some of these by arranging for a good service provider for this. You may contact punjabihospitality.com to arrange for required care at minimal cost.
Financial security is relatively easy to arrange. One could place a certain sum in a bank to be withdrawn in parts each month. Going to the bank may pose a problem in case the bank is located at a relatively longer distance. There have been instances when the local caregiver has exploited this to cheat the old people, especially uneducated ones, by withdrawing large amounts.
You could contact punjabihospitality.com to arrange for this.
Emotional care on the other hand requires sensitivity and care as per the situation. You could plan to do this through the following:
- Telephone calls at regular intervals.
- Arranging personal visits by a caregiver on a fixed date and time. This could be fixed to arrange delivery of cash and other personal needs, medical check up and coordinate personal security and well being.
- Arranging delivery of gifts in the form of clothes, sweets or other material comforts.
- Arranging visits to religious places on special occasions accompanied by a caregiver.
- Arranging visits to the place of residence of the children.
- Arranging old parent’s involvement in some social cause or an activity sponsored by you. This will be a huge morale / prestige booster for the parent.
You could contact punjabihospitality.com to arrange for this.
WHAT STEPS CAN I TAKE TO ENSURE WELL BEING OF MY PARENTS WHEN THEY VISIT US?
Many a times visit of old people and / or their stay with the children becomes a traumatic experience for both parties. Inadvertently the sensitivities of both are affected resulting in tension and strained relations. The problems of parents and their children are peculiar and most of the times both parties tend to view these through “tinted glasses” of old prejudices.
Old parents especially from a village and semi / illiterate background tend to view the behaviour of their children / grand children living in urban centres or foreign lands as incomprehensible. While the old have all the time, the children due to their work schedules have little time except on week ends. You could take following steps to avoid misunderstandings:
- Explain to your parents the finer points of economics of an urban/foreign life where every member has to work to support the family.
- Try and involve the elder person in some activity to keep him / her busy. This could be in the form of a religious group or a meeting of similar age people belonging to your ethnic background or any commercial activity.
- Explain the finer points of local laws to the old to avoid any mishaps.
- Explain the finer points of traveling in the new area- costs and routes etc.
- Seek their active involvement and advice on issues concerning your / your children’s lives.
- Find other people of your ethnic back ground with parents staying with them. Arrange a group of such old people to meet on a daily basis in some place to spend time together.
- Involve your children to care for your parents by sharing their daily experiences at school/work place. This will improve inter personal relations and ensure better understanding.
- Alternatively you may arrange a travel plan for them to show various places in your place of living.
In case your parents are not too old, you may involve them in helping you out in your work in business or at home. They have to be taken in to confidence about your plan without seeming to be coercive in this.
You have to keep in mind that your suggestions have to be explained to your parents to avoid any misunderstanding. An open and frank discussion is always welcomed by the old- after all they are your parents and the also want you to be happy.
WHAT STEPS CAN I TAKE TO ENSURE QUALITY MEDICAL CARE FOR MY PARENTS LIVING AWAY FROM ME?
We at punjabihospitality.com are well poised to arrange for the best care for your old parents. We provide the following services for the aged:
- Periodic visits to check on general well being.
- Coordinate with local police and administration about security.
- Delivery of cash; gifts and other valuable etc.
- Arranging special functions for the aged and ensuring a good time for all participants especially your parents.
- Arranging religious and other tours and visits alone or with an attendant.
- Arranging annual or as required medical check ups.
- Arranging ambulance service and other medical care in an emergency.
- Arranging home care –medical check up and nursing.
- Arranging house repair, renovation and other maintenance.
- Provide round the clock / night time security, as required.
- Providing an attendant to the old during their visits to relatives or other places.
- Arranging hospitalization, providing regular health status on line and by telephone to you.
Our staff is available round the clock to provide care at odd times and our tie-ups with the best hospitals in the region ensure the best medical care – which many times may make the difference between life and death. Specific medical tests for the old are required annually and we arrange the same.
REST ASSURED WE SHALL ENSURE CARE OF YOUR PARENTS LIKE OUR OWN.
WHAT STEPS CAN I TAKE TO AVOID ABUSE OR MALTREATMENT?
Most of the times old age abuse is related to financial dependence on others. Some countries have adopted laws to ensure the care of the aged from government funds or through retirement plans. Even if you are not in a regular job, plan early enough to ensure suitable income in your old age.
You may take the required steps well in time. ECONOMIC SECURITY
Start taking steps well in time to invest part of your earnings in secured plans/insurance plans. This will ensure adequate income for you after you have retired from service. Ensure that the investments are reviewed periodically and adequate safeguards exist so that you do not lose your savings to some fly – by- night- operator. Consult your tax planner in this or to be safe invest in government secured debentures- in this the return may be less but your investment is safe.
POST RETIREMENT ACCOMMODATION
In the event of your retirement, the employer-provided accommodation will have to be vacated. You must select a place of residence depending on your needs and arrange to get suitable house well in time. The place selected must cater to the following:
- Adequate quality medical facilities in most important specialties in or around the place of residence- or in easy reach.
- Sufficient facilities to cater to your post retirement social, cultural and religious needs.
- Availability of post retirement job in case you wish to look for one.
- Access to your friends, relatives and other social support systems that you may require.
- Not too high cost of living- or one that meets the availability of funds with you.
- Reasonable maintenance cost for the accommodation.
- Adequate facilities in terms of old age peoples groups etc for support and company in case you lose your spouse.
You may not get all the listed terms in a place but try and find some place close enough. In case you have inherited property, assess the same for your needs and plan accordingly.
EXECUTE AND REGISTER A WILL
You must register your will well in time to obviate any problems for your spouse or your children in case of sudden demise. Ensure adequate funds for your spouse to cater to his / her needs.
Do not succumb to emotional blackmail of your children to invest your savings for some scheme of theirs. In case you plan to do so draw up legal documents to safeguard your interest. It will save you from major problems at a later stage. IT MAY BE BETTER TO KEEP YOUR FUNDS INTACT TO ENSURE YOUR FINANCIAL SECURITY. Do not pledge your house or other resources to provide legal guarantee for somebody.
In the event of your children wanting to stay with you after your retirement clarify al terms well in time to avoid any unpleasantness later. Explain your reasons for the same to all parties involved.
Inform the local police, your housing society or other authorities about your shifting to the area. Establish a routine of regular meetings with others in the area and join some creative work group involved in social or religious charity work. This will ensure that others keep checking on you and are available in case of need.
Ensure proper security measure at your residence and do not allow any unknown persons to enter your house uninvited. Keep a list of local service providers and preferably call the same person in case of any repair work. Select a house as per your needs and have adequate security set up installed before moving in. AT NO STAGE ALLOW STRANGERS ACCESS TO YOUR HOUSE ESPECIALLY AT ODD HOURS. Keep your neighbours and friends informed about your schedules and plans and request them to check on you from time to time. You can reciprocate this, thus ensuring a community policing set up.
Develop a buddy system with a friend outside your home.
EMOTIONAL SECURITY- It is practical not to expect too much from your children and relatives in terms of company and care. A detached approach helps you overcome negative situations easily. Once you have ensured your financial and physical security it is easy to create an atmosphere of contentment around you.
Join a social, religious or professional association to give shape to your dreams of the past for which you did not have the time due to professional commitments. You may join a group of persons in social or charity work to get satisfaction and contribute to the society.
Do not ignore your limitations and try to overextend yourself. Keep in touch with old friends and relatives even if you move. You may ask them for regular visits.
IN ANY CASE DO NOT GIVE UP ON LIFE. YOU MAY TAKE UP A SECOND CARREER OR ANY OTHER ACTIVITY TO REMAIN FULLY OCCUPIED. ALTERNATIVELY, TAKE YOUR SPOUSE OR PARTNER ON A TOUR OF PLACES OF INTEREST. REMEMBER YOUR LIFE IS IN YOUR HANDS MAKE THE MOST OF IT.
WHAT STEPS CAN I TAKE TO RETAIN A POSITIVE AND HEALTHY ATTITUDE IN OLD AGE?
It is important to maintain a healthy profile and age is no criteria to avoid this. In old age in any case it becomes more important to be healthy more so if you are staying alone. Some simple tips can help you remain fit irrespective of age.
- Select and maintain a dietary pattern of mostly fresh fruits, vegetables and plant foods and no / less coffee, tea, sugar, red meat, butter or salt.
- Maintain a lean body mass and avoid overeating and excess body fat.
- Avoid processed or fried foods.
- Have a total daily calorie intake of 1,500 to 2,000 calories only.
- Lifelong exercise especially walking- take your spouse along and enjoy each other’s company.
- Keep busy- find some work lifelong-do not over stress or physically tire yourself.
- Enjoy pleasurable and fun activities within a group or with your spouse / partner.
- Have plenty of rest and sleep.
- No smoking- direct or even passive smoking.
- Join some community / religious service / charity purely for keeping busy.
- Maintain lifelong connective relationships / friendships- sharing and caring for others and being cared for in return.
- REMEMBER-“HEALTH IS NORMAL & SICKNESS IS ABNORMAL”.
Adopt positive value from others around you or from other cultures and apply these values in your life. You can add years to your life and life to your years.
WHAT CAN I DO TO DELAY THE EFFECTS OF AGING ON MY BODY?
Everybody wants to look and feel younger right throughout their lives. You can look and feel young by taking some actions in routine.
As you grow older, your bones lose density. Exercise, especially weight bearing exercises like jogging, hiking, stair climbing and weight lifting build up your bone density. Exercise regular and take enough calcium through milk and leafy green vegetables to beat osteoporosis.
Since muscle mass decreases as you age, you can beat that through exercise. Exercise builds muscle and makes you healthier overall. You’d feel younger too.
- Adequate rest and sleep
Your body repairs itself when you sleep. Cells regenerate faster at night. While you are in the deep cycles of sleep, your body tissues are rebuilt and repaired after the wear and tear they have undergone throughout the day. Too little sleep might make you age faster. If you have problems sleeping, prepare for bed 30 minutes before your bedtime with a long soak in a warm bath scented with lavender oil. Avoiding coffee or anything caffeine after dark will help in getting good sleep.
- Consume sufficient water
You must drink 8 to 10 large glasses of water everyday. 60% of your body mass is water and you take all efforts to maintain the balance. This will help in flushing away the toxins and your body to stay healthy.
- Care for your skin.
That is the best thing you can do for your skin. The sun’s UV rays damage your skin, causing it to age prematurely. Also inadequate water in the body also has ill effects on the skin. Use a sun screen lotion on your skin while moving out doors during the day. Avoid direct sun light as it may also cause skin cancer.
Cleanse your skin twice daily to get rid of toxins on the surface of your skin. Then apply moisturizer to plump up the surface layers of your skin and to seal in the moisture. Most moisturizers have ingredients with anti-aging properties.
- Take a well balanced diet.
A balanced diet helps you in remaining healthy and disease free. Antioxidants neutralize the free radicals that would damage the cells in your body, aging you more quickly. Vitamins A, C and E are antioxidants as are glutathione and superoxide dismutase. Taking fruits, vegetables and oils rich in antioxidants would help slow down the deterioration of your body’s cells.
IN OLD AGE HOW DO I PROTECT MY BONES FROM DAMAGE? ARE MEN ALSO AFFECTED BY OSTEOPOROSIS?
50% women and around 25% men over 50 years of age are likely to have an osteoporosis related fracture in his / her lifetime. Porous bones or Osteoporosis affects men and women both- though the affect in men may not be as severe. The ill effects of bone loss like easily shattered limbs or a humped back can be avoided by eating properly and regular exercise.
A younger person’s bone have the inherent capacity to self repair by creating more cells than the numbers lost due to normal wear and tear. That is why fractures heal faster in the young. Around menopause this capacity is greatly reduced in women due to certain physiological changes in the body. As a result the bone density starts falling. This change also affects some men.
A DEXA scan is a test for measuring the bone density of an individual. It is a painless low radiation X-Ray which gives out a number called the T-Score. Essentially this is the process of comparison of the individuals bone density with that of an average person of 20-30 years of age. This comparison with the peak age score gives us the level of bone loss in the individual.
Bones are living tissues and contain nerves, blood vessels and bone marrow. Bone marrow helps in creating new blood cells. Bones are under a constant process of destruction and repair. Without this repair and reconstruction/reinforcement work of weak spots, we would keep on breaking bones regularly with no relief. The level of this process of rebuilding and reform is well within our means to control.
We can ensure healthy bones by:
- Take 2-3 helpings of dairy products daily.
- Regular exercise.
- Use supplements of vitamin d and calcium daily.
- Monitor bone density with DEXA scan.
- Undergo regular medical check ups.
CAN I DELAY THE EFFECTS OF AGING ON MY BODY?
Age has to catch up with all of us and its effects also can not be avoided. We can take some steps to feel and look younger. Some steps that you can take to delay the signs of old age are:
- REGULAR EXERCISE
Regular exercise provides multiple benefits to the body. On one hand it helps in controlling disease causing situations like cholesterol and blood sugar levels, while also improving bone density. As we grow older, our bones start losing their capacity to regenerate tissue thus reduced bone density. Exercises like walking, jogging, stair climbing and weight lifting etc. help in building bone density. Regular exercise, use of enough dairy products with calcium supplement and consumption of leafy vegetables helps in beating osteoporosis.
Age also impacts on our muscle mass and we can beat that through exercise. Exercise makes us feel and look younger.
- ENOUGH SLEEP
Sleep is the process of body repair and regeneration of cells. The wear and tear of body tissues during various activities throughout the day are reversed/repaired during the deep sleep period. Inadequate sleep will make you look older.
If you have any problem in going to sleep prepare for bed at least 30 minutes before bedtime; do not watch any emotionally disturbing programme on television before sleep; have a warm water bath scented with oil of your liking; have a glass of warm milk and avoid tea/coffee before bedtime.
REMEMBER GOOD SLEEP IS THE BEST REMEDY TO AVOID AGING.
60% of our body mass contains water. It is essential for us to drink at least 8-10 glasses of water everyday. Water not only flushes toxins from our body but also makes our skin look soft and younger. This is the best remedy to beat age.
- BLOCK SUN RAYS
Sun rays contain many skin harming components. UV rays damage skin; cause early / premature aging and cause skin cancer. It is imperative to protect your skin from direct sun. Use sun protection lotions and creams and adequately cover your body while moving in the sun.
- SKIN CARE
Use of good quality skin care products as moisturizers is essential. These help in sealing your skin and saving / sealing the moisture in the skin. Skin cleaning to rid it of toxins is required before going to bed. Moisturizers help in retaining a healthy look.
- HEALTHY DIET
Use of green vegetables, fresh fruits, oils rich in anti oxidants help in slowing down the ill effects of age. Vitamin supplements as per advice of your physician are necessary. Anti oxidants help in neutralizing the free radicals that would have damaged your body cells. In any case a balanced diet is essential to control cholesterol and avoid heart disease. Avoid red meat and use omega 3 rich supplements like fish.
- NO SMOKING
Smoking and tobacco use cause a direct adverse effect on our body. Smoking causes cancer, coronary artery disease and greatly reduces our immunity to disease. Even passive smoking (indirect smoke inhalation by being in the presence of a smoker) affects us.
Maintaining a healthy body and mental outlook is well within our own hands and positive thoughts, meditation; reduced stress levels help in remaining young and beating the old age.
HOW SHOULD I PLAN MY EXERCISE SCHEDULE IN OLD AGE?
Planning your exercise is very important since it can get you the maximum benefits of exercise. Consult your physician before starting your exercise. You may be advised to take a treadmill test. It is a test to decide what your body is capable of or rather not capable of. A treadmill test will help you decide on how much you should exert and how you should build your stamina.
Figure out your target heart rate
In order to figure out what your target heart rate should be, you can use a simple formula. Subtract your age from 220- for example, if you are 58 years old, your target heart rate should be 162 (220-58) per hour. Wearing a pulse watch can help you stay at a steady pace. During exercise your peak heart rate should invariably not cross your target heart rate.
There are 3 things that have to be kept in mind while deciding your exercise schedule:
- Intensity of exercise.
- Duration of exercise.
- Frequency of exercise.
Whenever you start any exercise schedule it is best to start at the bottom of the ladder and work up wards. You may begin walking at 6 KMPH for three times a week. After this you should increase any of the three (intensity / duration / frequency) by 10% every week till you reach your optimal level. Thus you could walk for 15 minutes from second week and increase your speed of walking to 7 KMPH in the third week and so on. This way you will not be doing too much too soon.
A regular cool down is essential after exercise to avoid damage to your muscles.
STEP BY STEP
- CONSULT YOUR PHYSICIAN BEFORE STARTING YOUR EXERCISE SCHEDULE.
- PREFERABLY UNDEGO A TREADMILL TEST.
- CALCULATE YOUR PEAK HEART RATE.
- INCREASE YOUR EXERCISE PATTERN GRADUALLY-10% EACH WEEK.
- DO NOT WALK ON UNEVEN SURFACE OR A BROKEN FOOT PATH.
- WALK IN A FAMILIAR AREA AND NOT IN POOR LIGHTING AND AFTER DARK.
- BE AWARE OF YOUR EXERCISE- DO NOT USE DISTRACTIONS LIKE HEAD PHONES ETC.
- ALWAYS WEAR BRIGHT CLOTHES SO THAT YOU ARE NOTICEABLE.
- PREFERABLY EXERCISE WITH A PARTNER.
HOW DO I IMPROVE MY QUALITY OF LIFE DURING OLD AGE?
We are never prepared for old age though it is part of our lives. Enhancing the quality of life in old age is well within our means. It involves may features of life per se which includes body, mind and soul.
To achieve optimal results follow these simple guidelines:
- Monitoring your health through regular check ups is essential. This not only aids in early detection of diseases like Coronary Artery Disease (Heart Disease) and cancer but also helps in proper treatment.
- Regular exercise is a must to ensure good health. With age the process of muscle weakening starts and strength building exercises help in avoiding arthritis and joint pains. Also bones lose strength due to osteoporosis and fractures are common in the elderly. Being bed ridden due to a fracture increases weight and adds to the pressure on the already weak bones. Regular exercise helps in avoiding related problems.
- Healthy diet with proper nutrients is a must in old age. It is not quantity but quality that matters. Include a bowl of fruits in your meals daily; eat some nuts and oilseeds; and start drinking some vegetable juice daily. Small meals are better than 3 large meals. Do not stretch the capacity of your stomach.
- Include daily reading as part of your schedule. Develop a reading habit as per your taste. Better still learn some new skills- use of computers, cooking (especially for those who have lost their spouse) are good options. Reading also helps in diverting your attention from worries and negative thoughts.
- Ensure safety at home- slippery bathroom floors, stairs without railing and loose electric circuits can cause avoidable injury. Does not clutter up your living space- discard what is not required.
- Use proper clothes and shoes. Tight fitting shoes and clothes can result in skin allergies; warts and cuts.
- Develop a busy schedule- join some interesting activity with your spouse and / or some friends. Look forward to each day.
- Settle your outstanding issues with others. Create healthy atmosphere for stress free life.
- Join / learn YOGA and breathing exercises. These will help in maintaining a healthy outlook.
- Do not expect too much from your contacts. Remember expectation leads to frustration and disappointment.
Prepare to be graceful in old age- avoid disputes and stress.
WHAT IS THE IMPORTANCE OF GOOD DIET IN OLD AGE?
Nutrition remains important throughout life. Many chronic diseases that develop late in life, such as osteoporosis, can be influenced by earlier poor habits. Insufficient exercise and calcium intake, especially during adolescence and early adulthood, can significantly increase the risk of osteoporosis, a disease that causes bones to become brittle and crack or break easily.
But good nutrition in the later years still can help lessen the effects of diseases prevalent among older people or improve the quality of life in people who have such diseases. They include osteoporosis, obesity, high blood pressure, diabetes, heart disease, certain cancers, gastrointestinal problems, and chronic undernutrition.
Studies show that a good diet in later years helps both in reducing the risk of these diseases and in managing the diseases’ signs and symptoms. This contributes to a higher quality of life, enabling older people to maintain their independence by continuing to perform basic daily activities, such as bathing, dressing and eating.
Poor nutrition, on the other hand, can prolong recovery from illnesses, increase the costs and incidence of institutionalization, and lead to a poorer quality of life.
WHAT ARE THE PROBLEMS IN MAINTAINING A GOOD DIET IN OLD AGE BEING A WIDOW / WIDOWER?
Newly widowed people, are less likely to enjoy mealtimes, less likely to report good appetites, and less likely to report good eating behaviors than their married counterparts. Nearly 85 percent of widowed people undergo weight change during the two years following a spouse’s death, as compared with 30 percent of married subjects. The widowed group is likely to lose 7.6 pounds (3.4 kilograms) of weight on an average.
Most of the women enjoy cooking and eating when they are married, but as widows, they find those activities “a chore,” especially since there is no one to appreciate their cooking efforts.
For many widowed men who had generally left the cooking to their wives, the problem may extend even further: They may not know how to cook and prepare foods. Instead, they may snack or eat out a lot, both of which may lead people to eat too much fat and cholesterol and not get enough vitamins and minerals.
Whether it happens at age 65 or 85, older people eventually face one or more problems that interfere with their ability to eat well.
Social isolation is a common one. Older people who find themselves single after many years of living with another person may find it difficult to be alone, especially at mealtimes. They may become depressed and lose interest in preparing or eating regular meals, or they may eat only sparingly.
At the same time, many older people, because of chronic medical problems, may require special diets: for example, a low-fat, low-cholesterol diet for heart disease, a low-sodium diet for high blood pressure, or a low-calorie diet for weight reduction. Special diets often require extra effort, but older people especially single may instead settle for foods that are quick and easy to prepare, such as frozen dinners, canned foods, lunch meats, and others that may provide too many calories, or contain too much fat and sodium for their needs. Some people may go overboard on their special diets, overly restricting foods that may be more beneficial than detrimental to their health.
WHAT IS THE EFFECT OF DISEASE AND THEIR FINANCIAL CONDITION ON EATING HABITS OF OLD PEOPLE?
Some older people may overly restrict foods important to good health because of chewing difficulties and gastrointestinal disturbances, such as constipation, diarrhea and heartburn. Because missing teeth and poorly fitting dentures make it hard to chew, older people may forego fresh fruits and vegetables, which are important sources of vitamins, minerals and fiber. Or they may avoid dairy products, believing they cause gas or constipation. By doing so, they miss out on important sources of calcium, protein and some vitamins.
Adverse reactions from medications can cause older people to avoid certain foods. Some medications alter the sense of taste, which can adversely affect appetite. This adds to the problem of naturally diminishing senses of taste and smell, common as people age.
Other medical problems, such as arthritis, stroke or Alzheimer’s disease, can interfere with good nutrition. It may be difficult, if not impossible, for example, for people with arthritis or who have had a stroke to cook, shop, or even lift a fork to eat. Dementia associated with Alzheimer’s and other diseases may cause them to eat poorly or forget to eat altogether.
Lack of money is a particular problem among older people. Lack of money may lead older people to scrimp on important food purchases–for example, perishable items like fresh fruits, vegetables and meat–because of higher costs and fear of waste. They may avoid cooking or baking foods because recipes for these foods usually yield large quantities.
Financial problems also may cause older people to delay medical and dental treatments that could correct problems that interfere with good nutrition.
WHAT CAN I DO TO ENSURE THAT MY WIDOWED MOTHER / FATHER LIVING AWAY FROM ME EATS A GOOD DIET REGULARLY?
Along with regular medical check ups you can ensure consultation with a dietician to explain the specific dietary requirements in old age. Arrangements can be made to procure the necessary food items for them on regular basis and arrange for a refrigerator / storage facility to avoid deterioration of food items.
You could also:
- Occasionally telephone to enquire of your parent.
- Asking relatives / other Samaritans in the area to check on them.
- In case the aged parent is alone and suffering from some ailment impacting their ability to prepare food have him / her shifted to an old age home under good care.
Whatever an older person’s living situation, proper medical and dental treatment is important for treating medical problems, such as gastrointestinal distress and chewing difficulties that interfere with good nutrition. If a medication seems to ruin an older person’s taste and appetite, a switch to another drug may help.
A review of basic diet principles may help improve nutrition. Explaining to older people the importance of good nutrition in the later years may motivate them to make a greater effort to select nutritious foods.
WHAT IS IDEAL AND A WELL-BALANCED DIET?
Ideal diet is one that contains all the essential nutrients – proteins, fats, carbohydrates, vitamins and minerals. A well balanced diet must contain all these in correct proportions and adequate amounts. Proteins, fats and carbohydrates provide the energy required for various activities. Vitamins and minerals play an important role in the regulation of several essential metabolic processes in the body.
IN OLD AGE WHAT IS THE AFFECT OF QUALITY AND QUANTITY OF FOOD THAT I TAKE?
The quality of food is more important than the quantity. Adequate quantity with required essential nutrients depending on the age, sex, level of physical activity and height and weight of the individual is required. A trained dietician can select and advise you about your specific needs and get a diet plan especially developed for you during your visit to a hospital for your annual medical check up. Elders can plan their diet so that it is nutritious, easily available and digestible.
The quantity of food intake reduces with age due to reduced metabolism. Physical activity would also get reduced in old people. An average reduction of 8% is recommended for each 10 years period from 55 to 75 years. Assistance of a dietician should invariably be taken.
Quality diet for the elderly implies that 12-14% of calories for body should be from proteins. Proteins are a source of essential amino acids and the recommended allowance is 1gm per kg body weight. Older people tend to follow different measures due to loss of appetite, poor digestion and tendency to prepare easy to cook food items which invariably are carbohydrates.
Another aspect of quality of food is the fat content therein. Fat / oils are energy sources and improve the food taste also. Vegetable oils that are rich in essential fatty acids should form almost half the total fat intake for the elderly. Saturated fats like butter, unrefined oils etc tend to increase the risk of coronary artery disease because of increased cholesterol.
GOOD DIET MUST CONTAIN WHICH ESSENTIAL MINERALS AND VITAMINS?
In old age body starts losing body minerals. Also dietary fibre, menopause, alcohol intake, sickness, drugs and inadequate exercise affect the mineral absorption by the body. There are 2 basic minerals that directly affect our health:
Calcium provides strength to our bones and elderly people start losing calcium and their bones become brittle. This is called osteoporosis and is more common in women after menopause. 400 mg pe day is the recommended intake of calcium and green leafy vegetables, milk, spinach, sea foods, fenugreek leaves and drumsticks are the ideal source for calcium.
deficiency of iron leads to anemia and diet for the elderly must provide sufficient quantity of this essential mineral. Green and leafy vegetables are cheaper than other vegetables, available year round and are the best source of iron. Older people must include some variety of greens in their daily diet. Wheat floor, jaggery and dates are some other foods rich in iron. 30 mg per day is recommended daily iron intake for the old.
Vitamins are involved in the utilisation of major nutrients like protein, carbohydrate and fat in the body. They cannot be made in adequate quantities by the human body. The only source of vitamins is the food that we take. The vitamins required by the body are:
Vitamin A, D, E, K, C (ascorbic acid) and Vit B Complex (Thiamin -B1, Riboflavin, Niacin, Pyridoxine-B6, Biotin, Folate, Cobalamins- B12).
CONSTIPATION IS THE MOST COMMON AILMENT IN OLD AGE- HOW DO I PREVENT THIS?
The decreased metabolism reduces the digestive process in old age. This effects the passage of food through the intestine resulting in constipation. The elderly require sufficient fibre or roughage in their diet to avoid constipation. This fibre is the indigestible carbohydrate present in the food. Rough fibre is not well-tolerated by the intestine in old people. But, the tender fibre of vegetables, fruits and whole-grain cereals will encourage normal bowel movements.
The elderly tend to use harmful laxatives and mineral oils. This should be substituted by a fibre-rich diet and adequate fluid intake. Some good sources of Dietary Fibre are: Wheat, Italian Millet, Horsegram, Green leafy Vegetables, Plantain Stem, Drumstick, Bittergourd, fruits like Dates, Figs, Guava, Wood Apple and Sweet Lime.
SHOULD I SWITCH TO VEGETARIAN FOOD IN OLD AGE?
Food is a matter of choice and does not necessarily change with age. Some items of food may however, have to avoided or their intake reduced in old age. The choice for adopting vegetarian food habits may depend on several factors and some of these could be:
- Religious preferences.
- Cultural preferences of the family.
- Personal preferences.
- Individual tastes.
- Health reasons.
- Economic constraints.
Even in vegetarians there are different food habits existing:
- Some who do not eat meat of some animals (beef / rabbit) or some organ (brain / liver etc.)
- Some eat only fish and dairy products.
- Some eat eggs and use milk but do not eat meat / fish / eggs.
- Those who do not eat meat or any animal product.
- Some eat only fruits and vegetables.
The trend the world over is more towards vegetarian foods these days.
The different advantages of vegetarian foods are:
- Easy chew ability thus more suited for the old who have lost their teeth.
- Some religious sentiments.
- Feeling among the old that vegetarian foods are easy to digest.
- Low cost as compared to non-vegetarian food items.
- No need to cook and resultant retention of nutrients that are lost during cooking.
- Less fat content and reduced cholesterol levels.
Vegetarians need to take adequate quantities of soybeans, groundnuts, lentils and other food items to ensure adequate quantity of vitamins and proteins.
Non vegetarian foods are rich in animal fats and have certain other advantages also:
- They are an ideal source for the protein of high biological value. Vitamin B Complex and B12 are available only in non-vegetarian foods and not in plant foods.
- Small fish are a rich source of calcium.
- Egg white is easily digestible and a good source of protein- especially for the old.
People suffering from obesity, high BP, Heart Disease (Coronary Artery Disease), high cholesterol levels should refrain from using more of non- vegetarian food items especially red meats. Egg white and most varieties of fish contain less fat and provide a good source of vitamins, minerals and proteins.
It is an individual choice to use vegetarian or non-vegetarian food but it is important to get adequate quantity and quality of either category that one takes.
WHAT SHOULD BE MY IDEAL DIETARY PATTERN IN OLD AGE?
The quality of diet is more important than the quantity. For the elderly diet must be nutritious and wholesome while containing carbohydrates, proteins, fats, minerals and vitamins. Dietary fiber must form sufficient quantity in diet of the aged. 1.5 to 2 litres of water (8-10 glasses) also must be consumed by them. Vegetarian or non-vegetarian food is personal preference but the food should be easily digested and chewed.
There is no IDEAL DIET but following portions are recommended:
|EARLY MORNING||1 cup of tea / coffee or a glass of lemon juice.|
|BREAKFAST||Chapatties -2 and lentils ¾ cup OR Bread- 4 slices; AND Egg white- 1 or Fruit-1|
|MID MORNING||Milk- ¾ cup OR buttermilk-1 cup OR Soup-1cup OR Fruit juice-1 glass OR Vegetable Salad- 1 serving.|
|LUNCH||Chapatties-3 OR Rice (cooked)-1.5 cups; AND Lentils- ½ cup OR Chicken Curry with 2 pieces OR fish Curry with 1 piece; AND Green vegetables (cooked)- ¾ cup; AND Curd- ½ cup OR Buttermilk- 1 Cup|
|EVENING TEA||Tea OR Coffee- 1 cup; AND Biscuits- 2; And Fruit-1.|
|DINNER||Chapatties-2 OR Cooked Rice- 1.5 Cup; AND Lentils- ½ cup OR Chicken Curry with 2 pieces OR fish Curry with 1 piece; AND Green vegetables (cooked)- ¾ cup; AND Curd- ½ cup OR Buttermilk- 1 Cup|
|BED TIME||Hot / lukewarm Milk- 1 Cup.|
|MEASUREMENTS- 1Cup- 200 Ml|
It may be better to get a planned diet chart as per age and any disease like Diabetes, CAD (Heart Disease), High / Low BP, Obesity or any other disease, from a trained dietician while visiting a hospital for an annual medical check up.
WHAT DIET SHOULD BE CONSUMED BY AN AGED PERSON WHO HAS LOST SOME OR MOST OF HIS / HER TEETH?
In old age loss of teeth is natural but use of artificial dentures should be resorted to in old age. Without artificial dentures one may have to shift to liquid or semi-liquid diet with lesser nutritional value. An aged person with genuine difficulty of not being able to use artificial dentures may use food in easy to chew form by using:
- Finely chopped cooked vegetables.
- Processing food items through a blender.
- Milk and other dairy products like cheese etc.
- Soft raw fruits like banana, papaya, cooked apples etc.
- Fruit juices without filtering out the fiber content.
- Well cooked and minced meat / fish etc.
- Finely chopped raw vegetables.
- Ice-creams, jellies and other puddings- ONLY FOR A PERSON WHO IS NOT A DIABETIC.
WHAT IS THE RECOMMENDED CALORIE INTAKE FOR THE ELDERLY?
RECOMMENDED DAILY INTAKE FOR PEOPLE ABOVE 60 YEARS OF AGE
|1.||CALORIES (K Cal)||1800||1400|
WHAT IS THE ENERGY CONTENT OF MILK AND MILK PRODUCTS?
ENERGY CONTENT OF MILK AND CURD- COW’S MILK / BUFFALO’S MILK / CURD– HALF CUP OR SKIMMED MILK / BUTTER MILK- ONE CUP
10 Gms FAT PROVIDES 30 K Cal ENERGY AND IS CONTAINED IN –
|4.||HYDROGENATED OILS||2 Tsps|
WHAT IS THE ENERGY CONTENT OF NON-VEGETARIAN FOOD ITEMS?
ENERGY, PROTEIN & FAT CONTENT OF NON- VEGETARIAN ITEMS
|Sr. No.||ITEM &QUANTITY||FAT CONTENT||PROTEIN||ENERGY|
|1.||CHICKEN-75 Gm||1-14 Gm||7-19 Gm||35 K Cal|
|2.||LIVER 75 Gm||1-14 Gm||7-19 Gm||35 K Cal|
|3.||MEAT 45 Gm||1-14 Gm||7-19 Gm||35 K Cal|
|4.||CRAB 150Gm||1-14 Gm||7-19 Gm||35 K Cal|
|5.||FISH 70 Gm||1-14 Gm||7-19 Gm||35 K Cal|
|6.||EGG 50 Gm||1-14 Gm||7-19 Gm||35 K Cal|
|7.||PRAWNS 100Gm||1-14 Gm||7-19 Gm||35 K Cal|
WHAT IS THE ENERGY CONTENT OF COMMON FRUITS?
40 K Cal ENERGY AND 10 Gm CARBOHYDRATE IS PROVIDED BY
|Sr. No.||TYPE OF FRUIT||QUANTITY ( MEDIUM SIZE FRUIT)|
|3.||GOOSEBERRY||4 – 5|
WHAT IS THE ENERGY CONTENT OF COOKED VEGATABLES?
ENERGY / CARBOHYDRATE CONTENT OF COOKED VEGETABLES
|MEDIUM ENERGY LEVELS –(ENERGY-30 TO 40 K Cal & Carbohydrates-5 Gm)|
|6.||MINT LEAVES||½ Cup|
|8.||LADY’S FINGER||½ Cup|
|HIGH ENERGY LEVELS –(ENERGY-50 TO 60 K Cal & Carbohydrates-5 to 10 Gm)|
|3.||SWEET POTATO||½ Cup|
|6.||FIELD BEANS||½ Cup|
IN OLD AGE WHAT CAN I DO TO LOSE WEIGHT?
In old age reduced metabolism leads to difficulty in losing weight. It is imperative to plan your weight loss schedule in consultation with your physician. Some of the measures that you can take are:
- Intake of food should be reduced according to the advice of the nutritionist, dietician or doctor. But in general about 1000 calories per day is sufficient for the elderly.
- Regular physical exercise will help in keeping fit.
- More of fibre-rich foods should be eaten.
- Intake of fat and sugar should be cut down.
- One should take plenty of liquids.
- Fresh fruits and vegetables are good, keeping in mind that in certain cases such as diabetes, one cannot have fruits rich in sugar.
- Consumption of alcohol should be cut down.
It is necessary to note that even small weight loss results in reduced risk of disease. While it may not be possible to reach your ideal body weight, every kilo / pound of weight lost is good.