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Don't break those bones
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Tomorrow is the Day of the Elderly. Dr. K. S. SUNIL says that a fracture is Enemy No. 1 for senior citizens. He tells us how to fight that.
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IT IS common knowledge that the elderly are more prone to fractures, often with disastrous consequences. A hip fracture can lay up an elderly person for life. The elderly break their bones more commonly because their bones tend to be comparatively fragile and they have an increased propensity to fall. The commonest sites of fracture in the elderly are at the hip, spine and the wrist.
What matters to the elderly is not adding years to life but life to years!
A hip fracture means that the patient cannot walk unless the fracture is repaired, either by nailing or by replacement of the broken bone with an artificial hip. This has to be followed by weeks of rehabilitation, which requires a high degree of motivation on the part of the patient and the relatives to be successful. Often, coexisting illnesses make this process extremely difficult. Conditions like heart disease, chronic lung disease, depression, stroke etc. makes rehabilitation difficult and sometimes impossible. Unsuccessful rehabilitation would result in the patient being bedridden for life. Studies have shown that at the end of one year after a hip fracture 12-24 per cent of the victims do not survive. The spine is another common site for fractures. Injury can result from a fall on the buttocks such as would occur if one's foot were to slip forward. The bones that form the spine can get compressed or dislocated and can press on the spinal column or nerves in that region causing severe pain and even paralysis of the legs. Sometimes, the resulting deformity of the spine can also cause difficulty in breathing. Another common location of fracture is the wrist, which occurs when one falls on an outstretched hand.
Our bones tend to become less dense as we grow old. They are constantly being repaired and remodelled to meet the contingencies of stress and damage that they are subjected to. For this, old bone must be destroyed and removed and replaced by new bone. In youth there is a balance between the two, so that the bone mass remains more or less constant. With ageing, the rebuilding activity gradually declines and this leads to reduction in bone mass. This happens to all of us to a greater or lesser extent as we age. When this process is severe, we call the condition osteoporosis. Women are much more susceptible to this condition. Women have a lower bone mass to begin with and as age advances, the bone mass declines. Added to this there is the jeopardy that women face at menopause, when there occurs a decline of female hormones. The female hormones are important for maintenance of bone mass. With their decline there occurs a somewhat rapid decline in bone mass leaving rather weak bones, which are further subjected to the ravages of old age.
Thirty five percent of postmenopausal women develop osteoporosis. As many as forty percent of women over eighty years of age go on to develop fractures.
In men, fractures increase exponentially with age. Tobacco and caffeine use, alcoholism, small build, sedentary lifestyle and inadequate calcium and Vitamin D intake are risk factors for development of osteoporosis in both men and women.
It is best to prevent bones from becoming weak. This can best be accomplished by taking a diet rich in calcium right from middle age itself. Contrary to the popular belief, this does not increase the chances for formation of kidney stones. Milk is one of best sources for dietary calcium but should be taken skimmed to decrease cholesterol intake. In the elderly, the calcium requirement goes up to about a gram and a half per day. It is virtually impossible to make this up from diet alone and calcium supplementation in the form of pills becomes essential.
Another simple way to maintain the strength of bones is exercise. The more one walks, the better it is for the bones. When bones are stressed, the body responds by making the bones stronger. Avoiding smoking, excess alcohol and caffeine helps. Hormone replacement in postmenopausal women is a very effective way of preventing osteoporosis. However, this cannot be universally recommended because of other side effects. The other aspect of prevention is addressing the issue of falls. This should be accomplished without trying to confine the elderly to bed, which can be counterproductive, but by improving strength and balance with appropriate exercises. All remediable risk factors should be corrected such as improving vision with glasses or surgery as appropriate, improving hearing with hearing aids etc. Certain simple measure such as avoiding intake of beverages and other liquids for a few hours before bedtime would reduce the need for going to the bathroom at night. It is at night when the lighting is poor and the patient sleepy that accidents often occur.
Modification of the home environment for the elderly is important. Furniture should be stable and unobtrusive. Firm seats helps one to get up more easily. Floors should not be slippery and should preferably be carpeted. Special attention should be given to the bathroom- the commonest site for accidents. Lighting of the rooms and bathroom is very important. Bright but glare-free lamps are ideal. A little care can make a big difference to the older person. We owe it to them.
(The author is Chief, Department of Geriatrics, Amrita Institute of Medical Sciences, Kochi E-mail: sunilks@aimshospital.org.
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