helplessness and hopelessness and considers
himself as unfit to live. The depressives may frankly express
suicidal ideation and reject treatment even for their physical
problems like cataract. Out of loss of interest and
despair, some of them become tearful. There is a gradual loss
of weight due to poor intake of food. Such persons should
be identified since treatment is rewarding in these patients.
Memory failure is common in the aged. It is generally benign
and is associated with ageing, when it is occasional and only
for details or for names which later, the individual is able
to recall. On the other hand, memory failure may be progressive.
The person is unable to recall the major events even. He may
fail to identify the place and the persons and likely to lose
himself on the streets or even within his house. This memory
failure gradually leads to other difficulties and this should
be recognised as beginning of a serious brain disease, dementia.
Some elderly people suffer from ideas of being persecuted
and that their food is poisoned etc. They may have hallucinations
of voices or vision. Owing to suspicious nature, they have
difficulties in adjustment and may lodge complaints with the
police. These disturbances occur in 'late paraphrenia' in
the elderly. The delirious states are characterised by incoherent
talk, hallucination and disorganised behaviour. Place, people
around are identified wrongly. They may not know the time,
day or date. Although this is generally due to the brain disease,
such episodes can result from the conditions like fever, acute
constipation, retention of urine, bronchitis or from taking
drugs, starvation, vitamin deficiencies, persistent vomiting.
The cataract operation or acute psychological stress can lead
to such delirious states. In many instances, they are reversible
by treating the precipitating cause. However, in some they
can be the beginning of the dementia.
Many elderlies are in the habit of self-medication.
They suffer from symptoms from such prolonged administration
of drugs. They may be taking medicines for constipation, cough,
sleep and for depression both prescribed and unprescribed.
This is to be enquired into by the MPHWs.
Early detection of cancer carries with it
a possibility of complete cure in some cases. Even in advanced
cases of cancer, management is possible and in many terminal
cases, measures to control pain and to make life tolerable
are possible. Patients are to be enquired about the following:
Change in bowel or bladder habits, such as persistent constipation,
recent onset of diarrhoea and difficulty in voiding urine
or urinary incontinence, bleeding or bloody discharge in urine,
in motion or in the vomit or while coughing; any ulcer or
a sore that fails to heal, especially on the tongue, in the
mouth, on the skin; progressive loss of weight and loss of
appetite and difficulty in swallowing; a persistent cough
or change in the voice; a lump in the breast (in women) or
any mass appearing in the body. The women may be advised to
periodically examine their breasts for lump and also to report
on any bloody discharge per vagina. Research all over the
world has proved that certain behaviours predispose to or
cause cancer. Cigarette smoking, chewing tobacco cause cancer
of the lung and cheeks and tongue respectively. Similarly
the excess of chilli powder in the diet can produce cancer.
Suitable advice is to be given on stopping smoking, chewing
tobacco and use of chilli powders. A family history of cancer
also indicates the liability of the person to this disease.
The elderly people in view of their physiology
are unable to metabolise drugs and to excrete them as efficiently
as the youngsters. For example, a drug like Diazepam takes
20 hours to get metabolised and excreted in a twenty year
old individual. On