Dr. Harshad Gordhandas

Hello. I’m Dr Rajiva Gupta. I’m a senior consultant in internal medicine at Ashok Vihar and Fortis Hospital, Shalimar Park. My special areas of interest are diabetes and care of the elderly.

Now talking about care for the elderly, the branch of medicine that deals with the care of the elders is called Geriatrics anthology. The elderly patients present peculiar problems. They present not just discreet conditions, but with discreet syndromes. A syndrome is a constellation of symptoms and signs. In common, they are called the geriatric syndromes. The common geriatric syndromes are false, impaired cognition, deficiencies in a hearing, difficulty in vision, delirium. These syndromes are important because we have to investigate several different causes. For example, if the patient falls, it is not necessary that he may be having weakness in his legs. It is highly possible that the patient will be suffering from an acute infection or from some electrolyte imbalance or from CVA or cardiovascular problem. The patient is having disorientation, he is not oriented, he may have necessarily, he may be having, that he is having infection of the brain, he could as well be having electrolyte imbalance or any infection or a cardio-vascular problem. It means that the syndromes present, similar syndromes present with different types of illness in the elderly. The reason is that the physiological reserves of the elderly are just on the borderline and any acute insult that results in these syndromes. The approach to geriatric patients is slightly different from the way we approach people of other age.

So there are two components, one is the Curative component and another is comfort, or the palliative. That depends much on the functional ability of the patient. So if you have got an elderly person, above 80 years, he does regular exercise, enjoys his life, goes out for walks, the treatment of any condition in such a patient would be on the lines the management is done for a younger or a middle aged patient. Whereas, on the other end, if the patient is 70 years or 75 years, and he suffers from a problem, he is immobile, confined to bed, he is not able to take care of his own daily needs. For such patient, the aim would be to have a comfort care. So, the treatment of the elderly has to be individualized and surprisingly, there are not many guidelines which are available for treatment of elderly in different, for different medical conditions. SO the treatment for each individual has to be individualized, considering his individual circumstances. For example, if we take a very common problem like sugar, and we call that, there is a parameter called the Glycosylated hemoglobin, so we say that glycosylated hemoglobin for a normal should be less than 7% or less than 6.5 %. Bit for the elderly, because they may be having other illnesses, they may be having kidney disease or may be living alone in the house, they may not be able to take care, so in such patients, we will not go in for a very strict control, we’ll go in for a modest control, where the range may be say, around 8 or 8.5.

As physicians, we need to be aware that the number of elderly people is increasing, we need to be aware about their special needs, we have to give time once they come to our clinic and we have to define their problems and treat them accordingly.

I will be most willing and happy to answer to any questions, which can be approached through the lybrate website or they can seek consultation by telephone or physical consultation.

Gastroesophageal reflux disease, or GERD, as it is commonly known is a digestive disorder that is caused primarily due to intestinal distress. GERD is caused in the muscle that lies between the oesophagus and the stomach, when the acid is produced in the stomach, it starts to flow backwards. For patients suffering from GERD, the acids flow back into the oesophagus instead of the stomach, causing symptoms like severe heartburn, chest pain and nausea, amongst others. So what does one do to deal with GERD? Here's a brief list!

• Obesity: Being overweight and obese are two of the most important factors that contribute to discomfort in GERD patients. Working towards a healthier weight is a sure shot way of dealing with this ailment.
• Alcohol and Smoking: The muscle ring that can be found between the stomach and the oesophagus relaxes with the intake of alcohol or with smoking, which prevents it from closing to stop the stomach's juices from reaching the oesophagus. So, giving up both substances would be a good idea if you are a GERD patient.
• Go Gluten Free: Adopting a gluten free diet can help you cut out ingredients including grains and dairy products that contain more protein than what your digestive tracts can handle.
• Other Dietary Measures: In order to handle GERD effectively, you will need to remove or reduce chocolate, fatty food, spicy food, and even oily and fried food from your diet. You may need the help of food with extra fibre, like fruit so that it can pass through the digestive tract faster.
• Smaller and Well Timed Meals: Eating meals regularly and dividing them into smaller meals that can be digested quickly and more efficiently is one of the best ways of dealing with GERD to prevent the onset of backward flowing of stomach acids.
• Exercise: Ensuring that you do not take a nap or lie down right after a meal and putting in a small amount of exercise everyday will also help in doing away with the uncomfortable and painful symptoms of this disease.

Making lifestyle changes is one of the best ways to deal with GERD. Yet, it would be best to see a doctor regarding severe cases where the symptoms do not abate and medication may be required. If you wish to discuss about any specific problem, you can consult a Gastroenterologist.