TLC plus minimum drugs for the elderly

Lucky are the elderly who live with family or have ready family support at hand in our contemporary world. It is a fact, and a hard reality of our times that this desirable ideal is on the wane as more and more our modern ‘civilisation’ is inclined to park its senior citizens in homes or residences for assisted living. In the richer countries there are high end ones, which are of course very expensive and not accessible to the large majority of those who are in most need of similar facilities. Every so often there are stories that surface about the sub-standard conditions in homes for the elderly, with cases of abuse that go unreported, and that make for harrowing reading.

So the advice that is going around for quite some time now is that planning for one’s old age must begin early in adult life, especially as life expectancy has improved significantly across a majority of countries which believe in living in peace – which prefer to ‘live and let live’ rather than engage in mutually assured destruction – MAD – arising out of a MADness going back to the dark ages. Such planning must perforce include saving for the rainy day – 5 to 10% of one’s income from the start being one estimate -, and ensuring that one has a roof over one’s head, even if it be – by force of circumstances – that of an old age home, a not improbable scenario. Equally and side by side, it is in the interest of the future senior citizen that s/he reaches that stage of life in the best possible physical and mental condition possible.

This is to a large extent within the individual’s own capacity, and control, as opposed to the social aspect, for which there is no guarantee, what with families going nuclear and children if any likely to be scattered around the globe or not staying under the parental roof anymore. When the World Health Organisation at its inception came up with its definition of health as being ‘not merely the absence of disease, but a state of complete physical, mental and social well-being’ (italics added), little did it foresee that within less than half a century the evolution of societies across much of the world – with the rest inevitably to follow sooner than later – would be such that social alienation and isolation would come to be a dominating feature.

Not only old age per se but this social transformation as well is associated with several problems, the medical ones probably being central to the context. In fact, the likelihood of illness and disability increases as one ages. Even if there is no disease, the natural decline of hearing, eyesight, mobility and sense of balance can be quite troublesome and prevent one from having a smooth aging. If on top of that one is affected by disease, the situation of course gets complicated.

Inevitably, this issue of how one will age is a frequent topic of conversation among senior citizens and those who are approaching that status. With all my friends when this issue comes up, we are categorical that we are not afraid of death; what we are worried about is what kind of life, or rather living, will precede it – especially as regards the period that will immediately precede death, the dying process as it were. We all wish, or pray, that it will not be unbearably painful, and that we will not suffer chronic conditions that would leave us crippled or bedridden, and thus be a burden to our children or others. And the uncertainty and total lack of any possible control over such a scenario is a matter of great concern among us.

Based on this realization, we try to keep as fit as possible by regular, if possible daily exercise, of which every account in the medical literature underscores walking as the ideal sort for not only senior citizens, but all ages. My advice is therefore: get going everybody, whatever your age, and the sooner the better for your later life. Combined with appropriate consumption of food and drink and adequate socialising, along with a sane work pattern in the earning of one’s living, this can ensure one’s passage towards the ‘third age’ without much hassle.

If the good habits continue, even if one ends up in an old home, one will be in a better position to cope – especially if one gets a regular dose of TLC: tender loving care. In fact, I was puzzled when I first saw TLC as part of the prescription in a patient’s medical file when I was training in the U.K. And I understood by the by why it was practically a constant item of prescription when the elderly used to be sent to the hospital by their GPs. They lived mostly alone, husband and wife or widowed; home help was practically unknown, unlike what obtains say here in Mauritius.

And most of them would come with several small medicine bottles. Apart from medicines for any ailment they would be suffering from, such as heart disease or diabetes, invariably they would have a plethora of other drugs: for constipation, sleeping pills, tranquilisers, pain killers, supplements such as vitamins, etc – what we call polypharmacy. It was no surprise that they were often confused about which drugs to take and when, and they often missed or mixed up. For that matter, the drugs themselves can cause confusion. And I must say that I find the same situation locally too, with elderly people carting loads of medicines in their bags and facing a similar dilemma about their use – or misuse.

So I was not surprised when a few days back I came across articles in the New York Times about drug prescriptions for the elderly there. One of them was titled ‘Sharp Rise Reported in Older Americans’ Use of Multiple Psychotropic Drugs’, which pointed out that ‘A new analysis, based on data from doctors’ office visits, suggests that inappropriate prescribing to older people is more common than previously thought,’ and that ‘the number of retirement-age Americans taking at least three psychiatric drugs more than doubled between 2004 and 2013, even though almost half of them had no mental health diagnosis on record’. The concern about overprescribing to older people was that they ‘are more susceptible to common side effects of psychotropic drugs, such as dizziness and confusion’.’

‘When Retirement Comes With a Daily Dose of Cannabis’ deals with a major problem in the management of some specific medical conditions in the elderly which fail to respond to the usual prescription medicines. One such condition is neuropathy, an affection of nerves in the elderly which causes acute, disabling pain and which does not respond to the usual treatment. Others are cancer pain and the associated vomiting and nausea caused by chemotherapy, muscle spasms associated with the paralysing lesion called multiple sclerosis, some forms of dementia, and Parkinson’s disease.

For such people, ‘it (cannabis) is a last resort when nothing else helps’, and in fact, the author notes that ‘from retirement communities to nursing homes, older Americans are increasingly turning to marijuana for relief from aches and pains. Many have embraced it as an alternative to powerful drugs like morphine, saying that marijuana is less addictive, with fewer side effects.’ Who are we to gainsay the personal experience of these sufferers? – such as that of 98-year old Ruth, who got immense relief from her devastating neuropathic pain that allowed her to pass peacefully after a few weeks of much needed pain-free living.

It may be noted that marijuana, although banned by federal law, has been approved for medical use in 29 states, including New York, on the basis among others that accumulating scientific evidence has shown its effectiveness in treating the medical conditions mentioned above. Although many regulatory, legal and ethical issues remain to be sorted out in this regard, clearly there is a need to adopt a more rational and flexible approach rather than a simplistic ‘yes or no’ line which denies deserving patients the great relief that can give them some quality of life for their remaining days on Earth, which are numbered. And which may well lead to less polypharmacy, thus sparing the elderly of many an unnecessary complication.

When it comes to the elderly, therefore — that is, us all in due course! – best is TLC, which may also cut down on the polypharmacy, and minimum drugs based on sound scientific evidence and a more humane, pragmatic approach.

RN Gopee