Health Matters

Health Matters
Health Matters

Blood Pressure

Keeping one’s blood pressure under control is one of the important measures for well being. The usual definition for high blood pressure or hypertension is a blood pressure reading which is persistently above 140/90 mm.Hg. Usually it does not have any symptoms and thus it may remain silent and detected only on routine medical check-up.

 

Hypertension is a risk factor for Stroke, Heart diseases, e.g. Coronary heart disease and Heart failure, and Kidney diseases.

 

There are some general precautions one can take to control hypertension, e.g. weight reduction if overweight, reduced salt intake, regular exercise, stopping smoking, reduced alcohol intake, etc.

 

Advice from one’s family practitioner is essential for proper management of hypertension.

 

Blood Cholesterol

 

Cholesterol rich deposits can get deposited in the arteries supplying one’s heart, brain and other organs. This causes narrowing of the arteries, which may result in Coronary artery disease or Stroke. Blood tests can measure the level of total cholesterol as well as its components; LDL(‘’bad’’ cholesterol), HDL(‘’good’’ cholesterol) and Triglycerides, another fatty substance in the blood. It is the increased level of LDL or total cholesterol and high triglycerides are to be watched for. It can be lowered by dietary measures or drugs.

 

Advice from one’s family practitioner is warranted. Information leaflets are available from various sources, e.g. British Heart Foundation, Stroke Association, Age Concern, etc.

 

Diabetes

This is diagnosed by measuring one’s blood sugar levels. It can remain silent for sometime and develop symptoms later like, increased frequency of micturition, increased thirst, lethargy, weight loss or sometimes weight gain.

 

Fasting blood sugar should be between 4-6 mmol/litre. Higher than 7 mmol/litre is suggestive of diabetes and needs further opinion. Diabetes needs proper medical attention and the patient should follow the advice strictly to avoid various complications associated with this disease.

 

Heart rate and rhythmn

 

Normally one’s heart rate and pulse rate ranges between 60-75 beats per minute and the rhythm is regular. One may however get occasional irregular beats or missed beats, but if if the rhythm is fast or irregular or one gets palpitations, further attention is required. One of the abnormalities of rate and rhythm is called Atrial fibrillation which is a risk factor for Transient cerebral ischaemic attacks (mini- strokes) and full fledged stroke, as well as other vascular and heart problems. The incidence of Atrial fibrillation increases with age.

 

Heart rates lower than 40 beats per minute also needs further investigations. Electrocardiogram is the first line of investigation, to be followed on by others as required.

 

Stroke

It is a focal neurological deficit due to vascular lesion in the brain. It is rapid onset and commonly manifests as Hemiplegia i.e. weakness of one half of the body, although the disability can be of variable degree.

 

The incidence of stroke increases with age. It is a major cause of mortality and disability.

 

It is commonly caused by thrombo embolic infarction, intracranial haemorrhage or subarachnoid haemorrhage.

 

Usual risk factors are;-

Hypertension, High cholesterol, Smoking, Diabetes mellitus, Age, Obesity, Atrial fibrillation, and Family history.

 

Once stroke develops, it requires urgent medical attention during the acute stage and followed by rehabilitation.

 

Transient ischaemic attack (TIA)

 

This is commonly known as ‘’Mini-strokes’’. It consists of focal neurological deficits lasting for less than 24 hours, followed by complete recovery. This may be recurrent and lead to full fledged stroke. Hence it needs prompt medical attention and setting up of therapeutic regime to prevent recurrence and development of full fledged stroke.

 

Falls

 

Falls can be major problems in the elderly. They can be spontaneous or accidental.

 

Spontaneous falls may be caused by disturbance in the maintenance of posture and balance due to various factors. One of the results of ageing process is a disturbance in gait, characterised by more sway, shorter pace and flexed posture, all of which can predispose to falls.

 

There may be environmental hazards, e.g. loose rugs, poor lighting on stairs, slippery floors in bathrooms, etc. causing falls.

 

Systemic illnesses can also present as falls in the elderly.

 

A fall may therefore represent a serious unexpected disease process or a minor precipitating problem on the background of a precarious home or external environment.

 

Falls can result in bony injuries, e.g fractures of hips, femur, wrists, tibia and fibula etc.

 

Where do falls occur?

 

Falls are more common at homes, and may be related to frailty.

 

Falls occurring outside the homes are more likely in fitter people and are accidental.

 

They can also occur in institutional settings, in bedrooms, bathrooms, or during transfers from bed to chair, to toilet seats or bath.

 

Assessment of falls

 

Falls need to be properly assessed and hence need to be brought to medical attention. It can be done in either primary care setting or secondary care, depending on individual cases and circumstances.

 

Preventative measures

 

Moderate exercise regimes to improve muscle strength and balance.

 

Proper lighting on staircases, halls and bedrooms.

 

Avoid clutter of furnitures and loose rugs at home.

 

Non slip bathroom floors

 

Bath aids to help getting into and out of the bath, especially for frail and disabled persons

 

Use of walking stick or frame after proper assessment to help with maintaining balance.

 

Regular review of medications, because some may cause disturbances of balance mechanisms.

 

Multidisciplinary management

 

A single fall in an otherwise fit person may need only first aid or whatever treatment is required. However this may need further follow up.

 

Repeated falls, specially associated with bony injuries or other complications, require multidisciplinary management, e.g. medical, nursing, remedial therapists, social worker, etc.

 

Dementia

 

It is a progressive disease that affects the functioning of one’s brain. Its incidence rises after the age of 75.It is estimated that currently there are over 570,700 people living with Dementia in England and the number is projected to double in the next 30 years.

 

One can get a bit forgetful at any age. As one gets older, the brain is not as agile and the memory is not as good as it used to be. If however it starts to affect one’s daily life and its activities, it should be taken as a matter of concern.

 

There are two types of Dementia

 

Alzheimer’s disease – the most common type

 

Vascular dementia – which can start following a stroke or more slowly following a series of mini-strokes ( Transient ischaemic attacks)

 

Features of Dementia

 

  • Forgetfulness and short term memory loss, e.g. being unable to find right words for things, forgetting what you did or were told a short while ago.
  • Difficulty in following what people are saying or understanding simple instructions or retaining new information
  • Changes in personality and behaviour

 

Can the risk of Dementia be reduced?

Measures worth trying

 

  • Brain training – by doing quizzes, puzzles, crosswords, Sudoku against the clock, Nintendo DS Brain training programmes.
  • Maintain a healthy life style
  • Enjoy an active life with plenty of outside interests that exercise your mind and body.

 

Once you are concerned, contact the family practitioner, who can do the initial checks and if necessary refer to specialist services for further advice and management. Alzheimer’s Society can offer help and information. Carers also need help, support and information.

 

Incontinence

 

Incontinence of urine or faeces, i.e. lack of control in passing urine or opening bowels, is a symptom that not only causes embarrassment and social isolation, but may become a cause for institutionalisation.

 

Urinary incontinence is more common than faecal incontinence. Prevalence increases with age and 5% of the elderly in the community can be expected to have urinary incontinence.

 

Causes

Urinary incontinence can happen due to two main groups of causes;-

 

  1. Pathologies affecting urinary bladder and urethra, and their neurological control, e.g. Urinary tract infection, Detrusor instability, Diabetes with peripheral neuropathy, fistula, Stroke, Spinal injuries, Multiple sclerosis, Parkinsonism, Dementia, etc
  2. Physical and mental disabilities preventing easy and timely access to toilet facilities.

 

Commonest cause is instability of bladder muscle (detrusor instability).

 

One must seek medical help at the earliest stage of having the symptoms.

Management:-

 

Proper assessment with history, physical examination and clinical investigations as required should be undertaken.

 

Treatment and advice will depend upon the cause identified. There are some medications available for managing detrusorinstability.

 

Incontinence nurse advisors can help with the long term management and also advise about any equipment needed to manage the incontinence.

 

Some self-help measures can also be undertaken.

 

Timed voiding is widely advocated. One should void before the bladder has filled to a volume when an uninhibited contraction would occur. A chart should be kept of the times of incontinence for a few days to determine the frequency of incontinence. The timed intervals between voiding must be shorter than the intervals between recorded episodes of incontinence.

 

Avoid drinking any fluids at late hours of evening; it helps to prevent nocturnal frequency and incontinence at night.

 

Osteoporosis

 

It means loss of bone density and is common with ageing. When bones become very weak, they can fracture with minor injury or a fall.

 

Osteoporosis affecting the vertebrae can cause vertebral collapse and compression fractures, causing back pain, and shortening of the height. It also causes flexed posture, which affects balance and predisposes to falls.

 

Bone health is mostly genetically influenced, but it can be affected through life by diet and life style.

 

Hence, to minimise the risk of Osteoporosis, one should :-

 

  • Eat a healthy diet, with plenty of fruits and vegetables, and calcium rich foods like milk and dairy products
  • Vitamin D is particularly important and is found in oily fish and also produced in your skin on exposure to sunlight
  • Keep yourself physically active and do regular weight bearing exercises like brisk walking, dancing, etc.
  • Do not drink excess of alcohol and do not smoke

Medications are available for managing Osteoporosis. G.P. and Specialist advice is advisable for proper assessment.

 

Osteoarthritis

 

This is the commonest type of arthritis and signs and symptoms usually start at the age of 50 and 60 onwards. It is due to the damage of joint cartilages which is not properly repaired and gives rise to joint pains and stiffness. It commonly affects the back and weight bearing joints, e.g. knees and hips. It also affects the fingers and toes. It is commoner in women than men and seems to run in families.

Life style advice as mentioned earlier can prevent development of osteoarthritis, specially important being watching your weight.

 

Physiotherapy is quite helpful in the management of osteoarthritis. In advanced stages, joint replacements are quite helpful. Specialist advice is recommended; hence one needs to consult the Family practitioner when symptoms start to develop.

 

Tips to keep healthy

 

  1. Take regular exercise
  2. Stop smoking
  3. Eat healthy diet, e.g. five portions of fruit and vegetables daily, less of fatty foods, fibre-rich foods, at least twice weekly oily fish. Drink plenty of fluids every day, it keeps the skin moist and hydrated
  4. Less of salt intake
  5. Avoid obesity
  6. Drink only within safe limits of alcohol
  7. Care of the skin, specially during hot weather and exposure to the sun
  8. If worried about any lumps, bumps, or change in the colour of the skin, consult your GP
  9. Get your BP and Cholesterol checked regularly
  10. Keep warm during winter months
  11. Get your Flu- jab and Pneumonia vaccine regularly as advised by your GP
  12. Have your eyesight tested at least every two years, and every year after the age of seventy
Translate »