From replacing joints to heart valves — Indians are increasingly going for medical interventions even at advanced ages to improve their quality of life. With people living longer, physicians and healthcare systems are looking at healthy ageing by managing chronic conditions, preventing complications, and intervening to ensure that people remain physically and mentally active.
Be it the government’s flagship Ayushman Bharat scheme being expanded to cover the elderly or the country’s insurance regulator doing away with the 65-year restriction for purchasing a policy — health of the elderly was brought to the fore in 2024.
Loss of muscles, balance and conditions like Parkinson’s means falls and fractures is a big concern for the elderly. Add to that age-related osteoporosis — a condition that causes bones to become brittle and weak — and the risk of bone breaks shoots up. “Around 15 per cent of people over the age of 60 fall every year — one per cent of these falls can lead to hospitalisation. Falls can be really life-threatening. However, when a person falls from a standing height and breaks their bone, it’s a sign that they have osteoporosis. It can get so bad that some may break their bones while turning in their bed,” says Dr Rajesh Malhotra, orthopaedician at Delhi’s Indraprastha Apollo hospital and former head of AIIMS trauma centre.
Osteoporosis can be age-related but it can also be linked to the use of certain medicines such as anti-epilepsy drugs, diuretics, cancer medicines and chemotherapy, even smoking. Kidney or liver disease is known to cause osteoporosis. “It’s a silent disease — people lose more of their bone without a single symptom. The first fracture is the first symptom of the disease,” explains Dr Malhotra.
While osteoporosis may be the underlying condition, hip fractures are a big cause of concern in the elderly. “Hip fracture is a sign of not just failing bones but of a failing body. Even in the US, 25 per cent of those who suffer a hip fracture die within a year. When it comes to India, 40 per cent die. Also, Indians fracture their hips a decade earlier than Western counterparts,” he says, adding that the aim is to operate on it as quickly as possible.
The wear and tear of joints can also lead to hip fractures. “A large majority of patients with hip fractures also have a bad knee — and the hip break tends to be on the same side as the bad knee. I tell my patients, even if they do not want to undergo a joint replacement surgery, they should use a stick or walker, otherwise they would fall and break their hips. While people are living longer, the last decade of life can be bad, with many ignoring their health. It is heartening to see more and more people getting the joint replacement surgeries that they need. Even if one is 100 years old, if they are otherwise fit and can afford it, they should get their replacement surgeries. It immensely improves their quality of life and keeps them mobile, helping keep their bones healthy. A majority of those who get operated on regret that they wasted so much time,” says Dr Malhotra, who now operates on three persons over the age of 80 years every week.
How to prevent falls? First, take all prescribed medicines to keep chronic conditions such as diabetes and hypertension in check. Second, ensure adequate nutrition because people tend to eat less as they age and get malnourished. The thinner you are, the likelier you are to get a fracture. Third, improve Vitamin D levels. “We have an epidemic of Vitamin D deficiency, which increases the risk of fractures. Even in a sunny country like ours there is Vitamin D deficiency because we don’t step out in the sun between 10 am and 3 pm when it’s made. We keep our neck and upper trunk that absorb the maximum Vitamin D covered, we are dark-skinned. When it comes to the elderly the lack of fat under the skin also has an impact — the sun actually converts the cholesterol to Vitamin D,” says Dr Malhotra.
Correcting eye sight and hearing aids and wearing proper footwear can prevent falls significantly. Someone who takes more than four medicines or someone who has to stop walking in order to speak is at a higher risk of falls. Someone who takes more than 12 seconds to get up from their chair, walk 6 metres, turn around, come back and sit, is also more likely to fall.
If you have had a fall from standing height that resulted in a fracture, get diagnosed for the condition. Post-menopausal women and men above the age of 50 years at a higher risk of osteoporosis may get Dexa scan to check bone density once in two years — once a year if they are undergoing osteoporosis treatment or have other conditions that lead to bone loss.
Coronary artery disease is the biggest challenge when it comes to heart health of people over the age of 60 years. “Most elderly people ignore their health but that can lead to more problems. It is essential that they keep all their chronic conditions like diabetes, hypertension in check, take their medicines, remain active and more importantly sleep properly,” saysDr Rakesh Yadav, professor of cardiology at All-India Institute of Medical Sciences (AIIMS), Delhi.
He says regular tests to check blood pressure, sugar, cholesterol, haemoglobin levels can help but there is no need for any other test. “If there is no chest pain or shortness of breath, there is no need for any specialised tests. If people have the symptoms, they should consult their doctors,” he advises.
Dr VK Bahl, principal director of cardiac sciences at Max Hospitals and former head of cardio-thoracic centre at AIIMS, says that with people living longer, the absolute number of people with coronary heart disease and heart failure is on the rise. Minimally invasive procedures have encouraged the elderly to opt for them. “With percutaneous valve replacement — a minimally invasive procedure to replace damaged valves — people are going for surgeries even at older ages because their chest doesn’t have to be opened up. They are also undergoing procedures such as ablation (minimally invasive procedure to destroy abnormal tissue) for irregular heart rhythm,” he says.
When it comes to the brain, vascular conditions such as strokes and neurodegenerative conditions like dementia are a cause for concern. “While most risk factors for stroke have remained the same, over the years, air pollution has emerged as the fifth most common risk factor in south Asian countries. After Covid-19, there has also been an increase in neuro-cognitive disorders such as dementia. Whether there is a definite co-relation is yet to be seen, research is still under way,” said Dr MV Padma Shrivastava, chairperson of neurology at Paras Health-Gurugram and former HOD of neurology at AIIMS.
“We are also seeing a peculiar constellation of autoimmune disorders in the last few years that may be linked to Covid-19 as well. These respond to immune modulators. People may think an autoimmune condition is primarily psychiatric but it may lead to changes in memory and higher mental functions. It can lead to changes in food behaviours, preferences, sleep pattern, problem solving among others.”
It is essential to diagnose and treat conditions such as dementia early on. Dr Padma says that people with dementia forget that they have forgotten things. “It is something that they will not be able to notice but family members will. Someone who is good with words will start groping around for them. Serial steps that a person could do without thinking at all will take longer to do. There are changes in the personality — say, someone starts craving sweets when they have hated it all their life or someone who always reads newspapers stops reading it. These are red flags and the person should be taken to a doctor immediately,” she says.
The increasing elderly population may present challenges but an awareness of healthy ageing and right practices can turn them into opportunities for ensuring longevity that can be productive as well.
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Anonna Dutt is a Principal Correspondent who writes primarily on health at the Indian Express. She reports on myriad topics ranging from the growing burden of non-communicable diseases such as diabetes and hypertension to the problems with pervasive infectious conditions. She reported on the government’s management of the Covid-19 pandemic and closely followed the vaccination programme. Her stories have resulted in the city government investing in high-end tests for the poor and acknowledging errors in their official reports. Dutt also takes a keen interest in the country’s space programme and has written on key missions like Chandrayaan 2 and 3, Aditya L1, and Gaganyaan. She was among the first batch of eleven media fellows with RBM Partnership to End Malaria. She was also selected to participate in the short-term programme on early childhood reporting at Columbia University’s Dart Centre. Dutt has a Bachelor’s Degree from the Symbiosis Institute of Media and Communication, Pune and a PG Diploma from the Asian College of Journalism, Chennai. She started her reporting career with the Hindustan Times. When not at work, she tries to appease the Duolingo owl with her French skills and sometimes takes to the dance floor. … Read More
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