DR.RAJEEV- on Ayurvedic Geriatrics

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Ayurvedic Approach to Geriatrics

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1 Dr.B. RAJEEV Scope of Ayurveda In GERIATRIC HEALTH CARE

Scope of Ayurveda In GERIATRIC HEALTH CARE :

Scope of Ayurveda In GERIATRIC HEALTH CARE Dr B Rajeev MD (Ay), PhD (Psych ) Hon. Consultant ,Dept of Holistic Medicine, Amrita Inst. of Medical Sciences: Sr. Consultant AyurVAID: HOSPITALS Consultant, Ayus Arogya Kendra,Perumbavoor

Geriatric health care:

3 Geriatric health care Introduction The task assumed is to examine and analyze those concepts that involve Geriatrics in an attempt to discover The nature of each of these concepts and how they are to be classified The relations between them- especially to those of matter and energy, the human body and in particular the central nervous system. Scope of Geriatric-Health Care in Ayurveda Dialogues & Recommendations are discussed.

Objective of Geriatrics:

4 Objective of Geriatrics “ Anayaasena Maranam Vina Dhainyaena Jeevitham ” The objective of geriatric medicine which is in tune with the Indian philosophy is essentially . “ Longer life with lesser disease and painless death ” that is, a self sufficient life followed by a peaceful death.

Aim of geriatric medicine:

5 Aim of geriatric medicine Maintenance of health in old age by high levels of engagement and avoidance of disease Early detection and appropriate treatment of disease Maintenance of maximum independence consistent with irreversible disease and disability Sympathetic care and support during terminal illness

Gerontology:

6 Gerontology The study of physical and psychological changes that occur in old age is called “ gerontology ” . The word geriatric has also a close link with the Sanskrit word ' Geeryathi ‘ which means degeneration Geriatrics is the branch of general medicine (Kaya Chikitsa) concerned with clinical, preventive, medical, psychological and social aspects of health& illness in the elderly. The old age is commonly defined as the age of retirement. In our country it is fixed at 60 years and above.

Brief history of Geriatrics:

7 Brief history of Geriatrics Deerghayu mantra sangraha in Atharva Veda. In Srimath Bhagavata & Valmiki Ramayana references highlighting Jara Brahma purana- Factors accelarating ageing and measures to control it. Samhita kala – Acharyas have given elaborate explaination about Jara, Jarajanya vikaras and their chikitsa Hippocrates (400BC) described various common clinical manifestations of later life Aristotle offered theory of ageing based on loss of heat The word geriatrics was coined by Ignatz L. Nascher,considered as the father of modern geriatrics and Majory Warren as the Mother The 1 st Geriatric service (modern medicine) was started in U.K in 1947.;But in Ayurveda it is a 5000 year old well planned therapy

Geriatric population:

8 Geriatric population 1980- 5.3% 2000- 7.7% 2025- 13.3% ( 1.2 billion ) 71% - Developing World 70 million population in India-2001 177 million population -2025 40% below poverty line 73% illiterate

Contd…:

9 Contd … Dramatic increases in aging population from 1996 to projected 2025 Age 60 – 64 1996: 70 million 2025: 100 + million Age 80+ 1996: 30 million 2025: 80 million

Theory of aging:

10 Theory of aging Somatic mutation theory Autoimmune theory Hayflick ’ s theory of aging

Problems of Geriatric age group:

11 Problems of Geriatric age group Health problems 1.Joint problems 2.Impairment of special senses 3. Cardio vascular disease 4.Hypothermia 5.Cancer, Prostate enlargement, Diabetes& 6. Accidental falls Psychological problems 1. Emotional problems 2. Suicidal tendency 3. Senile dementia, Alzheimer ’ disease Social problems Poverty, Loneliness, Dependency, Isolation, Elder abuse, Generation Gap

Risk considerations in Geriatric age group:

12 Risk considerations in Geriatric age group Prone for infections Prone for injuries Prone to psychological problems Prone for degenerative problems Increased risk for morbidity Increased risk for disability Increased risk for mortality

Common manifestations:

13 Common manifestations Infection Fluid & electrolyte imbalance Malnutrition HTN ,DM , Dyslipidaemia Dizziness &blackouts Falls & fractures Painful joint diseases Immobility Incontinence or retention Confusional states Dementia & other neurodegenerative diseases CVA, AF, Heart failure APD Anemia

Present scenario in India:

14 Present scenario in India Cataract &Visual impairment- 88% Arthritis &locomotion disorder-40% CVD &HT – 18% Neurological problems- 18% Respiratory problems including Chronic bronchitis- 16% GIT problems- 9% Psychiatric problems- 9% Loss of Hearing – 8%

Medical care & Management for the old:

15 Medical care & Management for the old It is common knowledge that in the light of demographic and social developments in the years to come our society will have to rise to the enormous challenge of medical care for the old, sick and needy. Level of managements being Preventive geriatrics Specific management for medical conditions Rehabilitation

Preventive Geriatrics:

16 Preventive Geriatrics Primordial prevention Pre geriatric care Primary prevention Health education Exercise, Yoga,& Athma vidya Secondary prevention Annual medical check-up Early detection ( Universal approach, Selective approach) Treatment

Contd….:

17 Contd … . Tertiary prevention Counseling and Rehabilitation Welfare activities (Sanjay Niradhar Yojana, Vridhashrama) Chiropody services Improving quality of life Cultural programme Old age club Meals-on wheel service Home help Old age home

Geriatric rehabilitation:

18 Geriatric rehabilitation In order to shorten long-time nursing periods for old people in need of medical care 1.preventive treatment and 2.medical rehabilitation must be the main priority of all measures Geriatric rehabilitation is subdivided into Prophylactic rehabilitation General rehabilitation and Target-specific rehabilitation. On the whole, it has to be reckoned that older people need a distinctly longer period of recuperation, in which the clinical picture rather than the age is the decisive factor of a successful rehabilitation

Concept of Geriatrics in Ayurveda:

19 Concept of Geriatrics in Ayurveda Geriatrics in Ayurveda: AYURVEDA gives top priority to geriatrics. Acharyas like Caraka and Vagbhata named the very first chapters of their Samhitagranthas, Deerghamjivitiyam & Ayushkamiyam respectively wherein the measures to be adopted so as to gain a longer and healthier life were enumerated. This unusual presentation itself proves beyond any doubt that the viable and vibrant concepts of geriatrics were incorporated into Ayurvedic Shatras much ahead of time.

Contd….:

20 Contd … . Concept of age “ Shareeraendriya satwa atma samyogo dharee jivitham Nithyagaschanubandhascha paryayir Ayur uchyatae ” Components of Ayu are Shareera, Indriya, Satwa and Atma. Since Atma is a supreme entity immune to the cycle of birth, death and disease, the other 3 componenets of Ayu along with the Vikrutis fall within the scope of geriatrics.

Contd….:

21 Contd … . Concept of ageing “ Ayur asmin vidhyathae anena va ayur vindhathi ithi Ayurveda ” ( Ast Sang Su ) Definition of ayurveda itself denotes that it is the knowledge of various aspects of life processes, ageing being one of them.

Contd….:

22 Contd … . Process of ageing “Kalasya parinamena Jara Mrithyu nimmitaja Rogas swabhavika drusta swabhavo nispratikriya” ( Cha Sha 1/115) Ayurveda recognized kala or parinama as the potential causative factor of degenerative disease entities. In this context Parinama being thesequntial events of Baalya, Tarunya, Youvana, Proudha, Vardhikya ie the ageing process Jara being Swabhavabala Pravrutta roga occur due to theKala parinama which itself is considered as the Vyadhi Hetu and is Nishpratikriya.

Contd….:

23 Contd … . Pathophysiological changes happening during ageing Sithilibavanthi mamsani Vimuchyathe sandaya Vidhahyathe rakta Vishyanthade meda Asthasthishu majja na sandhiyathe. Sukram na pravarthathe Oja kshayam upaythyathe Result in glani,sada,nidra,tantra,alasya, nirutsaha,asamartha chesta of sareera & manasa,nasta, smruthi,buddhi chaya etc. ( Cha Chi I/ 2/3 )

Contd….:

24 Contd … . Clinical presentation of Vardhakya Vardhakya is defined as deterioration of dathu,indriya,bala veerya utsaha and appearance of valipalithakhalitya with upadravas such as kasa,swasa etc. Compared to jeernagaram vristamavaseedantha Charaka adds deterioration of paurusha,parakrama,grahana,dharana,smarana vachana,vijnana,and compares to janthudagta kasta

II. Scope of Ayurveda in geriatric health care:

25 II. Scope of Ayurveda in geriatric health care In ayurveda, this is called "Vridhopacharaneeyam". Jara chikitsa is one among the eight branches of Ashtanga Ayurveda and it deals with diseases and conditions associated with old age. Ayurvedic Geriatric procedures are aimed to cure the physical, emotional and behavioral disturbances with the help of well-planned Ayurvedic Chikitsa Procedures.E.g.: Panchakarma ,Rasayana Chikitsa & Vajeekarana Chikitsa Jara Chikitsa is also called Rasayana Chikitsa or rejuvenation therapy, because it aims at revitalizing the body tissues for a youthful being.

Chikitsa yojana:

26 Chikitsa yojana ' Geeryathi ‘ which means degeneration indicates that the constant process of degeneration is an inevitable factor in the old age. According to Ayurveda, human body consists of Sapthadhathu. The dhathus get degenerated due to the body's prolonged structural changes. During old age we cannot enhance the capacity of dhathus, but it can be protected and rejuvenated. Kalaja & Akalaja Jara need to be carefully diagnosed ( eg cognitive pathologies like Alzheimer's disease ?? Akalaja Jara )

Chikitsa Padhati:

27 Chikitsa Padhati Ayurvedic approach is based on Hita charya ( Ahara, Vihara, Manasa ) Dinacharya & Ratricharya, Ritucharya, Sadvrtta Rasayana / Vajeekarana Manasopachara & Achara Rasayana Vyadhi pratyaneeka

Contd….:

28 Contd … . Hita charya ( Ahara, Vihara, Manasa ) Covers a major sphere in the context of Praanapalana as aptly quoted by: “ Nagaree nagarasyaeva radhasyeva radhi yadha Swashareerasya medhavi krityeshu avahito bhavet ” ( Cha Su 5 / 100 ) Commentator Gangadhara on the above verse opines that the measures discussed are especially meant for Jeeva rakshana or sustenance of life by adopting Hita acharas and avoiding Ahita acharas thus striking an equilibrium between the psycho somatic elements

Contd….:

29 Contd … . Dinacharya / Ratricharya - the daily regimens for the maintanance of Ayu, Bala, Pusti & Swasthya eg : daiva poojanam, Abyanga, Nasya. Ritucharya - the seasonal regimens for maintaing the Dosa samya, Dhatu pusti, Indriya & Satwa bala and especially for preventing the seasonal disorders Sadvrtta – includes Dharma acharana for Medha, Satwa, Pusti and Ayu Dharaneeya & Adharaneeya vegas Ahara – (nutritional aspects) Nityopayogi ahara, Hita ahara, Matravat ahara etc

Rasayana – Vajeekarana::

30 Rasayana – Vajeekarana: Sharngadhara notes that with each passing decade the body loses, one by one the following factors ie childhood growth luster and complexion intelligence skin health strength of sight virility& valour discrimination sensory perceptions etc

Contd….:

31 Contd … . Rasayana & Vajeekarana is meant to enhance health and ojas hence re-vitalizing tissues that were worn out or are in the process of wearing out due to factors like diseases and ageing. Rasayana & Vajeekarana chikitsa enhances immune system, arrests ageing, gives luster to the skin, gives youthful energy, nourish blood and body tissues (Sapta dhatus), and eliminate senility and other diseases of old age. To conclude these therapy includes immuno-modulation, antioxidant action( prevents bio-oxidation there by checking age related disorders, auto immune disorders, degenerative disorders), adaptogenic affects and so on. “ Asya prayogat Chayanah suvriddho abhoot punaryuva ” (Cha Chi I / I / 72 )

Vyadhi Pratyaneeka chikitsa:

32 Vyadhi Pratyaneeka chikitsa Wherein the specific chikitsa explained in the Roga Adhikara have to be followed Selection of yogas may be done after considering the factors like Heeyamanadhatu avastha Saukumaratwa Dourbalya Hence mangement may be done using Minimum dosage having maximum efficacy Modifiable Aushada sevanakala and Aushada matra Prescription with minimum adverse effect Adequate supervision of long term medication Therapeutic procedures like Panchakarma to be done after thorough evaluation

Glimpses on Diseases where Panchakarma offers better management options:

33 Glimpses on Diseases where Panchakarma offers better management options Aging / Geriatric – Parkinson ’ s disease Alzheimer ’ s disease Immunological disorders Bronchial Asthma & Allergic disorders Rheumatoid arthritis & other collagen disorders, Joint Disorders Neuro - muscular disorders Skin disorders Gastro – intestinal disorders Psychosomatic diseases – Ulcerative colitis, IBS Psychological disorders – Stress syndromes Anxiety neurosis, Sleep disorders, MSD

Manasopachara / Achara rasayana -:

34 Manasopachara / Achara rasayana - Vardhakya avastha invariabily presents with Psyosomatic afflictions Glani Sada Nidra & Tandra Alasya Nirutsaha Asamarthya chesta of Sareera & manas

Contd….:

35 Contd … . Implementation of Manodosha ousadha sangraha – Dhi, Dhairya & Atmadi vignana Satwavajaya chikitsa Daiva vyapashraya chikitsa

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36

DIALOGUE:

37 DIALOGUE Largely in response to the public ’ s use of Ayurveda practices and products, an emerging dialogue between Ayurveda and conventional medicine appears to be taking place, along with a growing willingness to study Ayurveda and experiment with its inclusion in national geriatric health care policy. This gradual change, which presents an exciting and hopeful prospect for meaningful collaborations, is reflected in an increase in cooperation and opportunities or cooperation between Ayurveda and conventional geriatric health care professionals and institutions. A major challenge facing both Ayurveda and conventional medicine is to foster this emerging dialogue and, by doing so, increase mutual respect and better understanding of one another ’ s expertise, concerns, and contributions.

Contd….:

38 Contd … . Strengthening the dialogue will not only help protect the public from unsafe treatments, but will also expand opportunities to improve geriatric health care. Conferences, workshops, and expert panels are excellent instruments for enhancing communication; participants at such meetings should include Ayurveda, conventional medical & geriatric health care professionals, the public, private and nonprofit sectors. Multidisciplinary meetings offer the opportunity for people from a broad variety of disciplines and interests to build on each others ’ knowledge and experience in discussions about promising research topics and research planning, program development, and policy considerations, and to explore innovative methodological approaches to solving difficult research questions in focused geriatric areas.

Recommendations:

39 Recommendations State agencies should receive increased funding for clinical, basic, and Geriatric health services ’ research on Ayurveda. Parliament and the administration should consider enacting legislative and administrative incentives to stimulate private sector investment in Ayurveda Geriatric health care research that may not be patentable. Central, private and non-profit sectors should support research on Ayurveda geriatric- care modalities and approaches that are designed to improve self-care and behaviors that promote positive health

Contd….:

40 Contd … . Investigators engaged in research on Ayurvedic geriatric health care should ensure that human subjects participating in clinical studies receive the same protection as are required in conventional medical research. Funding should be made available to accredited Ayurvedic and conventional medical institutions to develop programs that examine geriatric health care research questions which stimulate cross institutional collaborations involving faculty and students in research and research training.

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41 Dr. B. Rajeev MD (Ay), MSc. PhD (Psych) @ Chief Physician Ayus Arogya Kendra ; Perumbavoor, @ Sr. Consultant Ayur VAID: HOSPITALS @ Honorary Consultant Amrita Institute of Medical Sciences& Research Centre, AIMS, Kochi, Kerala (Mob.) +91 94475 75905 E-mail: drbrajeev@yahoo.com

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