Health and Wellbeing in Late Life : Perspectives and Narratives From India

This open access book takes a multidisciplinary approach to provide a holistic understanding of late old age, and situates the aged person within the context of family, caregivers, clinical and other institutions. All through the book, the author discusses preparedness for an aging individual as well as the society in the Indian context. The book highlights inevitable but mostly neglected health issues like depression, dementia, fall, and frailty and provides detailed analyses of solutions that are practicable in low resource settings. It also brings up intergenerational differences and harmony in the context of holistic care of older Indians. Alongside clinical perspectives, the book uses narratives of elderly patients to dwell on the myriad of problems and issues that constitute old age healthcare. Demonstrating cases that range from the most influential to the most underprivileged elderly in India, the book enlightens multiple caregivers--doctors, nurses, and professional caregivers as well as family members--about the dynamic approach required in dealing with complex issues related to late old age. The narratives make the book relatable and interesting to non-academic readers, with important lessons for gerontological and geriatric caregiving. It is also of use to older adults in preparing for active aging Foreword 6 Prologue 8 Acknowledgements 13 Contents 14 List of Figures 17 List of Tables 18 About the Author 19 Chapter 1: Understanding Frailty: The Science and Beyond 20 1.1 Active Ageing and Life Course 22 1.2 Managing Frailty: A Holistic Approach 25 1.3 Preparation for the Penultimate Phase of Life 30 1.4 Primary/Secondary Frailty and Family Distress 33 1.5 A Wake-Up Call for Older Adults and the Society 36 References 37 Chapter 2: Living with Failing Memory: A Caregiver’s Perspective 40 2.1 Lack of Acceptance in Early Stage of Dementia 40 2.2 Multimodal Diagnosis of Cognitive Impairment 42 2.3 Handling Caregiver Stress with Additional Complications 45 2.4 Downhill Course and Discussion About Advance Directive 47 2.5 Lonely Couple and Their Fight Against Dementia 48 2.6 Abuse of an Older Adult with Cognitive Impairment 50 2.7 Situation of Poor Older Indian 52 References 53 Chapter 3: Panorama of Cancer 56 3.1 Cancer: An Unpredictable Melody 56 3.2 Non-specific Symptoms in Elderly May Be Signs of Cancer 57 3.3 The Varied Prognosis of Ca Prostate 60 3.4 Bias in Professional Opinion and Management of the Disease 62 3.5 Rapidly Spreading Tumour and Its Consequences 66 3.6 The Life Course Perspective and the Penultimate Phase 67 3.7 Alarm Signs of Early Cancer 70 3.8 Comprehensive Geriatric Assessment: The Best Tool to Assess Octogenarian Preoperatively 71 3.9 Functionality Matters More than the Calendar Age 73 3.10 Routine Screening in Late Life 74 3.10.1 In One of Our Conversations 74 3.11 The Care Provider on Decision-Making Process 76 3.12 The Big Decision 78 References 79 Chapter 4: Meaningful Engagement: An Option or Not 82 4.1 Difficulties in Visiting Tertiary Care Public Hospital 82 4.2 Evolution of First Geriatric Clinic in North India 82 4.3 Challenges of Multimorbidity and Polypharmacy in Older Adults 83 4.4 Intergenerational Solidarity: A Fantastic Way of Meaningful Engagement 86 4.5 Situation of Primary Care Physician in Metropolitan Cities 87 4.6 Staring Second Innings 88 4.7 Situational Challenges in Late Life 89 4.8 Ill Effects of Space and Time Restriction 91 References 92 Chapter 5: Constipation: More than Just “A Symptom” 94 5.1 The Uncomfortable Conversation 94 5.2 A Syndrome with Multifactorial Risk Factors 95 5.3 The Emotion of Motion 98 5.4 Dismissive Attitude Towards Constipation of Physicians 102 5.5 A Comprehensive Approach to Constipation 105 5.6 Frailty, Immobility and Constipation in a Long-Term Care Facility 107 5.7 Dealing with Constipation as an End-of-Life Issue 108 References 110 Chapter 6: Fall: A Geriatric Syndrome with Endless Agony 112 6.1 Falling: A Casual Approach and Its Consequences 112 6.2 Managing Consequences Without Knowing the Cause 114 6.3 Fall Prevention Clinics for Older Adults 115 6.4 Fall-Related Complications and Treatment Expenses 116 6.5 Fall: A Preventable Agony for Individual 117 6.6 Syncope and Its Implications 119 6.7 Deleterious Effects of Fall 119 6.8 Post-Hip Surgery vs Conservative Management 122 6.9 The Divine Relationship of a Daughter and Father 124 References 126 Chapter 7: Stroke, Premorbid Status and Resilience 128 7.1 Delirium: Family Support, Love and Care 128 7.2 Stroke and Risk Factors 132 7.3 Importance of Family Support 133 7.4 The Virtue of Joint Family 135 7.5 The Gravity of Problems Alter with Changing Support System 138 7.6 Stroke in a Healthy Octogenarian, from Rural India 139 7.7 The Pivotal Role of Rehabilitation 142 References 145 Chapter 8: Discussion About Sexual Health: Is It Age Inappropriate? 148 8.1 Sexual Health of Older Adults 148 8.2 Importance of Detailed History of Both the Partners 149 8.3 Scarcity of Data 153 8.4 Anxiety and Depression: A Spoiler Vitality 154 8.5 Lack of Awareness About Safe Sex 155 8.6 Love Is Beyond Age 156 8.7 Sexuality Among Cognitively Impaired Gentlemen 157 8.7.1 Andropause: Judicious Management 159 8.8 Necessity to Discuss Sexual Health 163 References 164 Chapter 9: To Treat or Not to Treat 166 9.1 Managing Terminally Ill Patients with Situational Challenges 166 9.1.1 Discussing DNR: Need and Importance 169 9.2 Creating Awareness About DNR and Passive Euthanasia 172 9.3 Sentiment Versus Science 175 9.4 Scenario for DNR: Public Versus Private Hospitals 176 9.4.1 Can Doctors Be Wrong? 179 9.4.2 Continuing Discussion About DNR in Society 180 References 181 Chapter 10: Successful Ageing: An Opportunity and Responsibility for All 183 10.1 Individualistic Way of Achieving Successful Ageing 183 10.1.1 Aspiration Index and Active Ageing 185 10.1.2 Conscientiousness and New Possibilities 189 10.1.3 Blue Zone of the Earth: The Life Lessons 191 10.2 Spirituality and Successful Ageing 193 10.3 Adopting with Random Events 194 10.4 Preparation Is Not Similar for Rural Elderly 195 10.5 Regular Physical Activity and Healthy Diet: Needs Behavioural Motivation (Fig. 10.2) 196 10.6 Lifelong Learning for Subjective Wellbeing 202 10.7 To My Doctor and Paramedic Friends 205 10.8 To My Beloved Senior Citizens and Their Family Members 206 References 209 This open access book takes a multidisciplinary approach to provide a holistic understanding of late old age, and situates the aged person within the context of family, caregivers, clinical and other institutions. All through the book, the author discusses preparedness for an aging individual as well as the society in the Indian context. The book highlights inevitable but mostly neglected health issues like depression, dementia, fall, and frailty and provides detailed analyses of solutions that are practicable in low resource settings. It also brings up intergenerational differences and harmony in the context of holistic care of older Indians. Alongside clinical perspectives, the book uses narratives of elderly patients to dwell on the myriad of problems and issues that constitute old age healthcare. Demonstrating cases that range from the most influential to the most underprivileged elderly in India, the book enlightens multiple caregivers--doctors, nurses, and professional caregivers, but also family members--about the dynamic approach required in dealing with complex issues related to late old age. The narratives make the book relatable and interesting to non-academic readers, with important lessons for gerontological and geriatric caregiving. It is also of use to older adults in preparing for active aging. -- Provided by publisher Front Matter ....Pages i-xxv Understanding Frailty: The Science and Beyond (Prasun Chatterjee)....Pages 1-20 Living with Failing Memory: A Caregiver’s Perspective (Prasun Chatterjee)....Pages 21-36 Panorama of Cancer (Prasun Chatterjee)....Pages 37-62 Meaningful Engagement: An Option or Not (Prasun Chatterjee)....Pages 63-74 Constipation: More than Just “A Symptom” (Prasun Chatterjee)....Pages 75-92 Fall: A Geriatric Syndrome with Endless Agony (Prasun Chatterjee)....Pages 93-108 Stroke, Premorbid Status and Resilience (Prasun Chatterjee)....Pages 109-128 Discussion About Sexual Health: Is It Age Inappropriate? (Prasun Chatterjee)....Pages 129-146 To Treat or Not to Treat (Prasun Chatterjee)....Pages 147-163 Successful Ageing: An Opportunity and Responsibility for All (Prasun Chatterjee)....Pages 165-195