Ageing is a global phenomenon. The world’s population is ageing due to increasing life spans and decreasing birth rates. There are nearly 104 million elderly persons in India, both the share and size of elderly population is increasing over time. The life expectancy at birth in Kerala is 71.8 years and 77.8 years for males and females respectively, the highest in India. It is also noteworthy that Kerala is aging faster than the rest of India. As more and more of us live longer and healthier lives, we need to plan well as we grow older, and work toward the kind of health care system we'll need in the future.

To address this greying population in Kerala, Jubilee Mission Medical College has a unique Geriatric Department with a team of dedicated health care personnel - Geriatricians, Geriatric skilled Nurses, Physiotherapists, Nutritionists, etc. Where necessary, specialists from various other departments in the hospital also participate in the medical and rehabilitative care of the patients.

The traditional ancient culture with joint families and common land holding laid stress on showing respect and providing care for the elderly. But modernization, migration of younger generation towards greener pastures, lack of sufficient support resources in the family, economic hardship and break-up of joint family system have exposed the elderly to emotional, physical and financial insecurity.

Why Geriatrics?

"Old age is not a disease". Besides the diseases that affect older people, various other issues influence the downfall of the health of the old people and here comes the relevance of geriatric medicine. It differs from Internal Medicine in the focus of the treatment. As people age, they become more heterogeneous, meaning that they become more and more different, sometimes strikingly so, with respect to their health and medical needs. Different organs age at different rates in the same person. Some 70 year old's walk without support, some cannot. A husband may be actively walking but suffer from memory loss, whereas the wife may be wheelchair bound, but have a clear mind.

As we grow older, our bodies are increasingly more susceptible to any stress or, such as an infection, trauma, and the effects of medications. For example, let's consider the effects of an annoying case of the common cold. A younger person may feel run down and achy, have little appetite, and sleep poorly. Most over-the-counter cold remedies can help him. The same viral illness and these same effects can cause far more havoc in an older person. A 75-year-old may present with c/o of not taking food, increased tiredness which may be easily mistaken for age related problems. A poor appetite can result in significant dehydration and cause dizziness or even a fall, especially if the person is taking medications for high blood pressure. Just a day or two lying in bed and not walking much will make an older person noticeably weaker, again increasing the risk of falls. Many over-the-counter cold medications can cause confusion in addition to constipation in them.

Older patients often have multiple illnesses and would be consulting multiple specialists. The treatment for one problem might even make another condition worse since elderly patients are more prone to suffer from adverse effects of drugs. This is an excellent example of how the expertise of a geriatrician can help prevent drug related interactions that at times may be deleterious.

Diseases may show up in older adults in very unusual ways. The crushing chest pain and feeling of impending doom so commonly thought of as the symptoms of a heart attack are rarely present in an older patient. Instead, an older person may have a stomach ache and feel nauseous or simply feel extremely tired. Therefore, the medical history of older patients may not be completely reliable and often a corroborative history from other members need to be considered.

Older patients often visit their physician for a worsening of a chronic condition. This is, at times quite a challenge as these patients are already on various medication regimens for multiple illnesses.

So how do geriatricians do it? Instead of treating each of the many medical conditions separately in older patients, a geriatrician focuses specifically on those conditions that affect a patient’s functional abilities. Trained to treat medically complicated elderly patients, they use a global approach that encompasses aggressive disease prevention and address the social aspects of illness.

The role of the geriatrician, therefore, is to coordinate and guide a team of professionals not only for the clinical management of acute and chronic disease, but also to optimize and maintain functional status, in a concerted effort to keep the patient out of the hospital and living independently and safely at home for as long as possible.

Geriatric Home Care Services

This is a special and unique service of our Department, first of its kind in Thrissur. With the advancement of Medicine and technology, health care has shifted completely to hospitals. Gone are the days when the family doctor visited the home of a sick patient. However, long queues at the counters, cross consultations to multiple doctors make a hospital visit difficult for older patients who often are accompanied only by their equally old spouses. With our home care services, your loved one can stay in the comfort of their own familiar home while still receiving assistance, ensuring their safety, health, and happiness.

Geriatric Home Care services are for those who have a good functional status and aims to bring the patient back to his / her previous level of activity. While investigating, diagnosing and treating specific diseases, the focus is always on the preservation of function and improving the quality of life. The Geriatrician addresses the patient's psychological, social and environmental issues as well as his/her medical problems and also frequently works with the family or caregivers who are assisting the elderly. Geriatric care different from palliative care which is comfort care for those who have less chances of recovery and whose expected life is about a year or less.

With our newly introduced Tele care facility, the patient can consult the doctor assisted or unassisted through the use of a smart phone. Interdisciplinary consultations can be provided at the homes

Future Plans

1. Specialty clinics : Clinics specifically focused on Geriatric syndromes is the boon of every Geriatric service. Clinics to assess for risk of falls in the older patient, Cognitive assessment / memory clinics, Frailty clinics, Bone health / Osteoporosis clinics help detect problem in the older person before it surfaces. We are set to start our Memory clinic in the coming year.
2. Orthopaedic peri-op assessment : Most of the elderly admitted under Orthopaedics undergo a myriad of medical complications. A liaison with the Orthopaedics would help in prevention of complications in the peri operative period, so that the perioperative period is smooth and their hospital stay reduced.
3. Post graduate- MD Geriatrics : An MCI approved MD Geriatrics is lacking in most parts of the country. We hope to roll out the first batch of MD Geriatrics in the next few years and hope to develop one of the best center in Post Graduate training
4. Outreach support to peripheral institutes : Through our Tele-home care service, we hope to liaise with and train other centers engaged in care of the elderly in providing care to those who cannot be shifted to tertiary hospitals.
5. Research : Having just formed a separate Department in December 2018, the current focus of the Department has been to set up the Department and ward and take care of acutely ill patients. There is an increased need for research into elderly care. With an active Research wing – JCMR we are aimed to break barriers in the research field.
6. Elderly Day care centre : An elderly day care centre would be a huge solace for the families of those persons living with dementia. In the present-day scenario, where both the spouses are working members, it is difficult to arrange a trusted caregiver to attend to the needs of the person with dementia. Left with no option, these families are forced to give up jobs, institutionalize their loved one, or worse, lock them up in the safe confines of their homes. A Day care center, where they can be dropped off safely and engaged in meaningful activities would not only ensure active participation among those with cognitive impairment but also would be a big relief for the family who does not have to constantly worry regarding the safety of their loved one.

Faculty

Our Services

Geriatric Medicine Out-Patient Clinics - 09:00 AM to 01:00 PM – Monday to Friday, 2nd floor, St. Thomas Block, Gate no 5, JMMC.

• Comprehensive geriatric assessment of the elderly
• Fall risk detection
• Screening for common geriatric syndromes
• Optimized medical treatment - both inpatient and outpatient according to the age, medical status and patient opinion
• Investigations appropriate for the elderly and tailored to the particular patient
• Life style advice including diet and exercise programs
• Counseling to family members and caregivers on care of the elderly
• Sub specialty referral where required
• Interdisciplinary inpatient care wherever required
• Cross consultations from allied specialties when requested
• Regular follow up to reduce functional decline in the patient
• Geriatric home care services with Tele medicine support
• Geriatric Executive Health Care package
• Support to old age homes