Care of Elderly
CARE OF ELDERLY
“Each patient carries his own doctor within him. He comes to us not knowing that truth. We are at our best when we give the doctor who resides within each patient the chance to go to work.” Albert Schweitzer
Prevention of osteoporosis and Hip fractures
Mrs Paroma Mitra just turned seventy two three days back. She considered herself reasonably fit and in fact needed to be, as her husband had a stroke recently and was bedridden. However that night , while proceeding to the bathroom she slipped on the water lying on the floor. After the fall she could get not getup an had severe hip pain. Somehow she managed to to alert her servant who fortunately had not departed till then. She was taken to the hospital where she was diagnosed to have a osteoporosis hip fracture.
Osteoporosis is a condition where bones become brittle resulting in reduced bone strength and increased risk of fracture. It has been established that the incidence of osteoporosis increases with age and by 80 years of age 100 percent women have osteoporosis. The danger of osteoporosis is directly related to the risk of developing fracture of the spine, wrist and most serious of all, hip fractures.
A hip fracture occurring in an elderly leads to death in upto 30 percent of patients within one year. Of the survivors only 37 percent regain normal mobility and walking ability
It is therefore essential to detect osteoporosis in the elderly at the earliest and take suitable preventive measures so that hip fractures do not occur .
At the age of 65 years all women should undergo DEXA scan(dual energy xray absorptiometry)to detect osteoporosis.
Below 65 years of age DEXA scan is indicated in patients with thyroid disorders, hyperparathyroidism, chronic liver or kidney disease as they have high incidence of Osteoporosis. It may also be indicated in individuals who are chronic smokers, alcoholics, caffeine use, low physical activity, and use of certain medications.
Preventing osteoporosis progression
Currently a class of drugs called biphosphonates(allendronate) given daily(5mg) orweekly(75mg) taken orally in empty stomach half hour before breakfast with a glass of water, continued upto two years reduces hip fractures by 49 percent and spine fracture by 48 percent.other medications used are calcitonin, oestrogen, parathyroid hormone, strontium ran elate.
Preventing patient falls
Elderly patients tend to have an increased risk of falls which often leads to fractures. If the risk factors which lead to falls in the elderly can be detected and removed the risk of osteoporosis fractures decreases.
The risk factors for increased falls are medications such as antidepressants and benzodiazepene , gait impairment due to previous stroke, poor vision due to cataract and retinopathy and home hazards.
Falls can be prevented by reducing or discontinuing medications that cause drowsiness and postural hypotension. Regular exercise improves balance, mobility. Steps should be taken to correct visual impairment and have adequate night lighting. Correct home hazards by using shoes rather than slippers, avoiding carpets, not using highly polished floor tiles , wiping water spills in bathrooms and kitchen, controlling pets to avoid collisions .
OSTEOARTHRITIS OF KNEE AND TOTAL KNEE REPLACEMENT SURGERY
Many of my patients get confused by the two terms osteoporosis and osteoarthritisas they resemble each other. However whereas osteoporosis is a disease of the bones osteoarthritis is a disease of joints specifically joint cartilage which undergoes degeneration with age.
Osteoarthritis is common after fifty years of age and leads to pain in hips or knees on weight bearing. Later the pain becomes continuous and the individual has constant unremitting pain.
The greatest advancement in treatment of osteoarthritis knee has been total knee replacement surgery where an artificial joint is placed where the previous joint existed. After the surgery the individual is able to walk pain free . She is able to carry out domestic activities as well as moderate outdoor activities.
The frequently asked question of a patient before TKR is whether it will be successful ? The in knee replacement surgery is of premature failure due to loosening of the artificial joint . While a well performed TKR should last for 15 to 20 years a poorly done TKR can loosen (fail) in two years. While selecting a competent surgeon for your TKR look for someone who has trained in a reputed institution , the volume of surgery he performs(low volume surgeons operate infrequently while high volume surgeons delegate)and personal philosophy(whether using evidence based protocols).