Geriatric – A One Stop Solution For The Aged

Dr Kusum K Doshi is practicing in a speciality field of medicine known as ‘gerontology,’ a specialized field of medicine’ for treatment and caring of the old.

Geriatrics is a well developed field of medicine abroad but is just setting its foot in India. As we have the second largest population of senior citizens
after Japan, geriatrics should soon become a mainstream line of medical facility.

For Dr Doshi becoming a geriatric practitioner has been an evolution as a doctor over a span of sixty years.

Dr Doshi did her MBBS in 1956 from Nair Hospital at Mumbai and started practicing at Ville Parle, Mumbai. Interestingly her education progressed as her patients progressed in life. Eg. she did her DGO when a set of her young patients got married and would prefer a lady Gynecologist. Then as their babies came she armed herself with a DCH, a post graduation as a children specialist . Soon she got her FCGP, Fellow of College of General Practice, so that she could treat her patients in totality of all age as a family doctor.

Few decades later she saw her patients going through the ‘Empty Nest Syndrome’ as their children settled in different states and countries, in presuit of their carriers.
She thought, ‘how can I help them?’. The answer came in Dr Doshi doing a post graduation , in Geriatric Medicine in 2006 from ‘Indian Medical Association’

Dr Doshi has answered a number of questions for us to understand the basics of ‘geriatrics’, the over all care of senior citizens.

Q.What is Geriatrics as per your observation?
Ans. Geriatrics is a branch of medicine or social science dealing with the health and care of old people. Geriatrician is a doctor who practices it.
To begin with people above the age of 60 are clasified as senior citizens, above 80 are super senior citizens and those above 100 years are called centurions.
Age related changes take place in all the systems of the body like heart, kidneys, brain etc; so here we study the age related functional changes.

Q.What are the signs of aging?
A. Co-morbid conditions, that is aging, generally starts setting in at about 50 years. At 50 one disease enters our body. At 60 we get two diseases and then at 70 three.
Generally there are eight age related changes in our body during this interaction phase. Since age related changes take place in all the systems of the body, it is important to have regular health follow ups. Co-ordination and management of treatments is required on long term basis.

Q. What is the role of a Geriatrician ?
A. A geriatrician first dose geriatric assessment to find out what the problem is. As the age related changes are inter related, geriatric assessment has to be done to pin point the problem and act accordingly. Often vague and inconclusive symptoms which at times show up may be due to acidity, gas, kidney problem, pollution , etc. Instead of going to different doctors for different symptoms these patients have to be seen, heard and understood in totality. Here comes the importance of a geriatrician. The doctor has to use all his skills and patience to extract the medical history, even when no proper history is available .
In many cases assisted living is required where patients need continuous care and monitoring while at home.

Q. What is the difference between treatment and monitoring?
A. Treatment is treating a specific disease e.g. Diabetes , heart condition , etc., by a family physician. Monitoring is making sure that this treatment is taken properly. It also includes non-medical domain aiming to improve functional capacity and quality of life.

Q. What do you mean by Geriatric Assistance or assisted living?
A. Geriatric assistance is multi dimensional, multi disciplinary including functional, physical, cognitive mental health, socio-economical, cultural and educative obscure recognition of any abnormality. Like we see that the medicine prescribed to the patients is cost efficient. We provide phycological support and try to create an accident prevention situations. When i visit my patients home I supervise the furniture placement. I advise that it should not change frequently and ask the family to create an elder friendly home.We coordinate with the chemist and pathologist if required arrange ambulance service , etc. In other words we provide ’at home medical services’.

Q. Are there any other factors you assist?
A. Some non medical factors like financial ignorance and stress related factors also play important role. Solving sudoku, cross words, playing bridge and joining Clubs for senior citizens and participating in there activities is de stressing at this age.Some times as age sets in people tend to become more and more spiritual; but one has to be monitored against spiritual intoxication e.g.visiting temples several times a day; for it can harmful to health. Check list on medicines and mental assistance help with day to day activities.

Talk Therapy too is very important in this stage. Let me tell you about this man who got a wrong number call at five in the evening. As the person on the other side was about to disconnect this old man requested “please do not disconnect. Please talk to me as no one has spoken to me since morning”. To overcome this plight of loneliness up to some extent me and my team speak to such patients, enquiring about their day to day activity.
Extensive prescription is another issue which requires close monitoring e.g my friends daughters mother-in-law took this medicine. Can I also?
Phycological and intergeneration personality problem too are vital. Like a daughter in law not permitting the mother-inlaw to talk to the doctor and interfering.

Q. How do you manage all this?
A. To provide a one spot solution, to promote a sense of an over all well being for our patients, I have established a medicare plan for senior citizens named ‘At Home medicare Services’. Here we work as a team. Our team coordinates with the chemist for home delivery of medicines, pathologist, suppliers of sick bed requisites, ambulance services , etc. Pathological reports and abnormalities are reported to relatives settled abroad.

Q. You are into geriatrics for last 11 years. What have you achieved and observed?
A. I as a doctor have gained a lot of job satisfaction. But one thing worries me. Initially when I started my practice more old people came to me. Now over the years the number of patients coming to my clinic has gone down. Meaning they have become more home bound. This could be due to couple of practical reasons like the roads are constantly dug up, so the fear of falls and fracture keep them house bond. Autos refusing to go and lack of finances are also reasons.
On one hand with life expectancy going up, the no of senior citizens in our country is increasing and on the other hand family structure is becoming smaller. So geriatrics is the answer to our emerging world of the wise elders.

PS: Dr Kusum Doshi can be contacted on : +91 7045535316 / 022-26145316

An interview with Dr. Kusum K Doshi
By Beena Parmar  for ‘Record My Will’.