Common Geriatric Problems in day-to-day Homoeopathic Practice

Geriatrics is the branch of medicine that deals with the diseases of old age. The study of physical and psychological changes that occur in old age is called “gerontology”. At present, there few such specialty in India though 20 per cent of doctor visits, 30 per cent of hospital days and 50 per cent of bed-ridden days relate to the elderly. In 1947, when India became independent, the average life span of an Indian was around 32 years. Now it has gone beyond sixty years. The elderly population in India which was 7.7 crore, as per Census 2001, is projected to be around 9.5 crore in 2011. it is projected to further go up to 17.3 crore in 2026. Rise in the share of elderly in total population poses multiple challenges. These challenges, like for the younger generation, who can utilize the vast repository of knowledge that our elderly possess. Simultaneously, our senior citizens too have to think of ways to creatively and usefully occupy themselves.3 , 1, 2

Social problems like Poverty, Loneliness, Dependency, Isolation, Elder abuse, Generation Gap are common. 2/3rd of Indian elderly live in rural areas. Geriatric problems are related to socio-economic status, health and living status One-third was reported to be living below the poverty line, Overall 75% of the economically dependent elderly are supported by their children and grandchildren. Chronic interfamily verbal abuse are the most common, followed by financial abuse, physical abuse, and neglect by adult children, daughters-in-law, spouses, and sons-in-law. Per capita costs for acute and long-term health care services are beyond reach.2,1
The following are few of the health problems that are observed in day to day practice - 88% visual impairment, 40% joint disorders like Osteoarthritis - Falling is a very common and often, a serious problem for older persons as it results in injuries such as broken bones and cuts, and the need for hospital care. 18.7% neurological complaints, 17.4% Cardio Vascular Diseases, 16.1% Respiratory disorders, 13.3% skin, 9% Gastro intestinal disorders, 8.5% psychiatric problems, 8.2% Hearing problems and 3.5 % bladder control problems are found in 1 out of 3 people over the age of 65.. 1.7 million deaths in this age group are due to chronic diseases, 36.3% were due to heart disease, 22.5% to cancer, and 8.2% to cerebro vascular diseases, Lung cancer has the second highest incidence in men at all older ages and in women aged 55 to 75.Colon cancer is the third most common cancer in men aged 55.1
Psychological problems commonly observed are dementia, anxiety, depression, fear, somatoform disorders, psychosis, sexual problems like sexual dysfunction, substance abuse and sleep problems like loss of deepest levels of non-REM sleep, more daytime napping among the elderly, sleep apnea. The common cause of these problems are retirement, loss of personal identity, disruption of daily routines, death of a spouse, family members, or friends, changes in social and financial circumstances. Alzheimer's disease plus vascular dementia are common. Alzheimer's disease is the most common type and it accounts for about 2/3 of cases of established dementia. The incidence of seizures increases throughout the course of dementia. Hallucinations, delusions, or paranoia occurs in about 25% of patients with dementia.

Management:
In the treatment of Geriatrics, Homoeopathic system has an edge over the conventional medicinal system. According to Dr Hahnemann, physician should clearly perceive what is to be cured in diseases; and to achieve this in Geriatrics, history and physical examination sometimes needs to be modified. Because a complete history may not be obtainable, elderly patients may present with many nonspecific symptoms making it difficult to undertake the case taking. Hearing or vision loss, common in the elderly, can also interfere with the case taking. Elderly patients may under-report symptoms (E.g.: dyspnea, hearing or vision loss, problems with memory, incontinence, gait disturbance, constipation, dizziness, falls), which they consider a part of normal aging. As a physician we may need to focus more on the physical examination to elicit objective symptoms. Elderly patients may have difficulty recalling all past illnesses, hospitalizations, operations, and drug use, have to obtain these data from family member, aide or medical records. Past medical history when reviewing the physician should ask the patient about diseases that used to be more common, past psychiatric care, including psychotherapy, institutionalization, and electroconvulsive therapy and the use of psychoactive drugs or antidepressants. Drug history & Nutrition history are also important.
Common Homoeopathic remedies indicated 4:

O - Old age, senility
ambr. ant-c. arn. ars. AUR. BAR-C. caps. carb-an. carb-v. chin. Con. fl-ac. hydr. KALI-C. LACH. LYC. nit-ac. OP. phos. sanic. sars. Sec. sel. seneg. sil. squil. sul-ac. sulph. sumb. syph. tub. verat.
Phatak S R Repertory

GENERALS - OLD AGE - old people
Abies-n. acet-ac. Acon. Agar. Agn. All-s. Aloe Alum. alumn. Am-c. am-m. AMBR. Ammc. Anac. Ant-c. ant-t. apis Arg-n. Arn. Ars. ars-s-f. AUR. bapt. BAR-C. Bar-m. Bry. calc. Calc-p. camph. cann-i. caps. Carb-an. Carb-v. carc. Caust. Cham. chin. chinin-s. cic. cit-v. COCA cocc. Colch. Con. crot-h. cupr. dig. Fl-ac. gali. gamb. gins. Graph. ham. Hydr. hydrog. hyos. Iod. Irid-met. Iris kali-ar. kali-bi. KALI-C. kreos. LACH. LYC. mag-f. merc. Mill. nat-c. Nat-m. nat-s. Nit-ac. nux-m. nux-v. OP. orch. Ov. perh. ph-ac. Phos. puls. rhus-t. ruta sabad. sabal sanic. sarcol-ac. sars. SEC. SEL. Seneg. sep. Sil. sul-ac. Sulph. sumb. Syph. ter. TEUCR. thiosin. thuj. tub. Verat. zinc.
Synthesis 8.1 V (Radar 10.0)
The following are 1ST and 2nd graded remedies for Dementia (Boericke) 3 Agar ,3 Anac ,3 Bell ,3 Hyos ,3 Lil-t 3 Nat-sal ,3 Ph-ac ,3 Phos ,3 Pic-ac ,3 Verat ,2 Apisin ,2 Calc, 2 Calc-p ,2 Cann-i ,2 Con ,2 Ign ,2 Merc ,2 Op,2 Sulph ,2 Hell
MIND - DEMENTIA - senilis
agn. alum. Ambr. anac. ant-c. arg-met. aur. Aur-i. aza. bapt. bar-act. Bar-c. bell. bry. calc-p. carc. Con. Crot-h. Cupr. gaert. ign. lach. lil-t. nat-i. nat-m. nux-v. phos. plb. puls. sec. sep. sulph.
Synthesis 8.1 V (Radar 10.0)

A small study on 49 Geriatrics cases was done, in this study Literates were 19 and Illiterates were 30. Day to day activity in them is as follows 1) very good:3,2) good:17, 3)no activity:29, psychological problems Anxiety 9,Fear 7, Depression 16, Somatoform disorders 6, Dementia 2 , Psychosis 2 and sleep problems 7, Physical problems were as follows urinary problems like stress incontinence, constipation, falling tendency, injuries, memory loss, pain multiple joints more so knee joints, low back pain, visual impairment, impaired hearing, shortness of breath, flatulence , irritable bowels, etc along with Hypertension and Diabetic in majority of cases .In majority of cases they are more concerned about loneliness, visual impairment , lack of vital heat and sleep.Remedies used are shown in the table.
******full text is avaiable in Asian journal of Homoeopathy,vol.5no 2(15) May 2011-july 2011