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Be conservative with your sick elderly folk

Back in 2013, Kenya was estimated to have about 1.8 million people in their 60s. With improving socio-economic status, our life expectancy is expected to rise. The number of elderly people in Kenya is expected to double by 2050. We’ll increasingly be caring for the elderly, or geriatrics in medical terms. You shouldn’t get surprised if you find yourself bearing the health responsibility of your own elderly folk, or getting to a geriatric age yourself and needing care.

Geriatrics have unique health needs. They require a delicate balance that maintains them in good health, without being over-interventional. Being minimalist with their care is good enough, doing too much can tip them over the edge. This approach has recently been underlined by recent observations in some US geriatric centres. Elderly patients who got admitted in hospitals for various reasons ended up worse than when they came in. Some left in a completely debilitated state and could no longer care for themselves. Others didn’t fare too well, they succumbed to hospital-related complications shortly after their hospital discharge. That wouldn’t have happened if they didn’t get admitted in the first place.

So what happened to these geriatrics? They came in with some condition that necessitated a hospital admission. But they found over-enthusiastic doctors who went beyond basic care and simply over-treated them. Take the example of an old lady who came in with a hip fracture. Instead of fixing just what the matter was, the doctors thoroughly searched for other silent conditions that she may have harbored. She ended up with multiple specialists seeing her, with each of them beefing up her interventions. She stayed longer and longer in the hospital, was fed somewhat inappropriately, became more and more dependent and eventually succumbed to a hospital acquired infection. Had her fracture been fixed, and been out pronto, she may have fared better.

The recurring theme is to avoid over-treating the elderly. For starters, resist from rushing your elderly folk to the doctors whenever an itch or a simple ache occurs. If there is a good reason to get them to the hospital, their stay there should be as short as possible. Only allow the primary problem to be sorted, the rest can be left alone. Don’t be swayed by an over-enthusiastic medical team. They may mean well, but most of their efforts might leave your folk worse off. If caring for yourself as a geriatric, take control of what gets dome to you. You don’t want to spend the rest of your days in a miserable hospital bed.

A geriatric physician has summed it up nicely. The elderly sick should have minimalist medical interventions. They should be out of hospitals as soon as they come in, and integrated back into their community to enjoy the rest of their days. Being conservative with geriatrics should be the norm.

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