In an interview with Nation, Consultant Geriatrician with Special Interest in Rehabilitation and Parkinson’s Disease,
Dr. Chandana Kanakaratne throws light upon the corpus of Geriatric Medicine in which ‘age’ has no meaning but ‘ageing’ has.

Q:What is the mandate of Geriatric Medicine which is relatively new to the Lankan setting?
Geriatric Medicine deals with ageing population addressing their medical, psychological and functional issues. The rate of declining of body systems with ageing depends on many things: diseases one acquires, dietary habits, lifestyle and economic well-being. Someone at the age of 60 may have depleted systems whereas a person in the 80s could be very fit and healthy. So this is why there is no ‘cut-off age’ in Geriatric Medicine.

Dr. Chandana Kanakaratne
Dr. Chandana Kanakaratne

Back in England I used to ask my patients who were 70 or 90 years old as to how much they would feel and most would say that they felt 30 years younger! This is why numerical value has no meaning in geriatric care but the ageing and associated phenomena linked with the process.

There are many reasons why ageing associated conditions require specialized attention which is fulfilled by this branch of medicine. When a certain stress is induced, there could be multiple
complications affecting several systems within the body. Younger a person is, greater the chances for the body to overcome the primary problem as well as other problems associated with it. However, in an older person, although we may address the primary problem, the person may not fully recover as the body system declines with age. This is where a holistic approach is required to treat the patient rather than the disease per se. It is a multi-disciplinary approach which is committed to help a patient regain the quality of life and independence for which special skills are required.

Q: How established is Geriatric Medicine in England where you had a long practice?
It started emerging as specialized branch of medicine in England in the early 1940s even before their National Health Service was setup. This was in response to so many older people stranded in nursing homes without proper medical attention. Since then, this discipline has evolved with so many challenges for clinicians as well as older people alike. Today it has developed to an extent of having over 1200 Geriatric Specialists for 60 million people over there!

Q: How important is it to popularize this branch of medicine in a country like ours with a rapidly growing ageing population?
Developing countries like ours will be more burdened as what is called ‘population ageing’ is taking place much more rapidly now than it had in developed countries in the past. Developing countries would take a shorter period of time to gain similar percentage increase in older population observed in developed countries in the past. Third world countries need to be prepared for this challenge. Although there are certain diseases more prevalent in older people, that does not necessarily mean that all old people will end there. Understanding the expectations of the older people and restoring their hope, quality of life and independence is the ultimate role of geriatric medicine. In a setting where population ageing is alarmingly rapid, it is important to understand the strength of this discipline so that misconceptions related to old age could be dispelled to help the older population appropriately.

There are several ageing-specific issues such as dementia, delirium, falls, instability, immobility, nutrition issues, palliative and end of life care issues which Geriatric Medicine seeks to address. Therefore the ‘detective mind’ of geriatric specialists is becoming increasingly important.

Q: What challenges do you perceive in the delivery of geriatric medicine here?
I think the first thing to overcome is the attitude – how others perceive older people and how older people perceive themselves. Both parties could be burdened by ‘old age’ when actually their quality of life could be improved through geriatric care. Lack of awareness of this specialty is another challenge to overcome. The cost factor too is a challenge which the health delivery system has to negotiate when setting up geriatric services. Such services should cater to both in house and outpatients, branching out to the community so that a holistic approach could be adopted in the delivery of care.

Q: Finally, what is the role family or care givers play here?
It should be a win-win situation for the patient and the family. What an older person can do and cannot do should be assessed and ‘can dos’ should be optimized. This helps to alleviate the burden on the caregiver as well. Professional training for caregivers and professional advice for family is imperative to that a tailored service is possible to optimize a person’s independence and quality of life.