Guidelines for Ageing with Health, Grace and Dignity SM Tuli, Neena Bhasin, Punya Bhasin
INDEX
Page numbers followed by f refer to figure.
A
Affordable houses 17
Alcohol and drug abuse 70
Alcoholic drinks 37
Allergy 58
due to
drug 58
food 58
Alzheimer's disease 25, 65, 78
American Association of Retired Persons 27
Anxiety 63
Appetite, loss of 65
Arthritis 57
Assisted living 20
services 16
Atal Pension Yojana 32
Attack of confusion, sudden 58
Attention disorders 63
Ayushman Bharat Scheme 62
B
Bariatric surgery 42
Beans 38
Bladder and bowel functions, poor control of 65
Blindness 51
Blood
pressure 2, 49, 55
high 35, 42, 56, 70
low 58
sugar levels 52
vomiting, sudden 58
Body
immunity of 33
tissues 4
Bone
fragility of 4
mass 4
Book reading 26
Brain cells 5, 33
Breakfast, suggested 35
Breathing, sudden difficulty in 58
C
Cancer 49, 56
of mouth-throat 53
save yourself from 53
Cardiovascular system 4
Cataract 2, 4
Cell mediated immunity 55
Chest discomfort, defused 58
Chicken 38
Cholera 72
Cholesterol, levels of bad 42
Comfortable death, assisting for 76
Communicable diseases 72
Communication skills 4
Constipation 4
Coronary artery disease 56, 70
Cortex, grey matter in 5
D
Death
café sessions 74
common cause of 3
doctor-assisted 84
sudden 73
Deep sleep, induction of 82
Delhi Development Authority 19
Dementia 25, 65, 78
Dental problems 2
Depression 63, 64
Depressive disorders 63
De-stress 70
techniques 50
yourself 50
Diabetes 2, 49, 56, 70
product of 51
save yourself from 51, 50
Dialysis 52
Diarrhea 55, 58
Digestive system, slowing of 4
Diminished hearing 4
Dinner 35
Disease, global burden of 3
Drink sufficient water 36
E
Egg 38
for health 38
Elderly abuse 11
Employee Provident Fund 31
End of life 74
Euthanasia 77, 81
subject of 82
Evening tea 36
Exercise
active 46f, 47f, 49f
physical 43
Eye-ailments 59
F
Family for hire 29
Family physician 61
Family support network 5
Fat, small amount of 38
Feeling lonely 27
Fish 38
Food
free 36
pyramids 34f
Foot paths 18
Fruit 36
G
Gene dependent 7
Glaucoma 59
Good food in younger age, invest for 38
Good-food pyramid to ensure health 34f
Government effort to prevent elderly abuse 11
Guru Vishram Ashram 13
H
Hand fullness 23
Happy hormones 56
Happy living 25
Health
insurance 32
is wealth 48
maintenance practices 3
Healthy
life, long-term 35
persons 2
Heart 78
disease 2, 56
Hepatitis 55
Heredity from parents 54
Hippocratic oath 81
HIV-AIDS, infected with 40
Home for seniors 15
Homo sapiens 5
Hormonal changes 4
Hospice movement 79
HPV virus 54
Human animals 5, 67
Human body 54, 69
systems of 51
Hyper-aged-societies 1
I
Immune system 54
Immunity, acquired 55
Infection 72
Intensive care units
multiple tubes in 76f
plugs in 76f
J
Japanese encephalitis 55
Japanese tea ceremony 25
Joint
desiccation of cushions of 4
pains 2
K
Kala azar 72
Kidney 78
disease 51
function of 4
transplant 52
L
Lens of eyes, opacity of 4
Libido 4
Life 76f
Life Insurance Corporation of India 32
Lifestyle ageing and death 72
Lifestyle-related disorders, common 56
Liver 78
function of 4
Living animals, biological system of 67
Living-will 72, 83
Loneliness 23
Lunch 35
Lung 78
air sacs 56
conditions 49
M
Maintenance and Welfare of Parents 18
and Senior Citizens Act 19
Malaria 72
Measles 55
Medical attention in seniors, immediate 58
Medical disorders 44
Medical doctors, learning from journey of 10
Memory loss 4
Meningitis 55
Mercy killing 72, 82
Middle-age, expectations at 8
Milk product 38
Mindfulness 23
Ministry of Loneliness 26
Model Building Bye Laws 17
Modern nuclear family 17
Monetary investment for sunset years 31
Mood swings 63
Muscle mass, start losing bulk of 4
N
National Crime Record Bureau 12
National Pension Scheme 31, 32
National Policy on Senior Citizens 11
Nerves, disease of 52
Neurons, reduction of active 4
Neuropathy 52
Neuropsychiatric disorders 63
Non-Government Organisations 23
Bharti Foundation 24
Cure International India 24
Equitas Development Initiative Trust 24
HelpAge-India 12
Ipas Development Foundation 24
Make A Difference 24
Parinaam Foundation 24
Quality Education and Skills Training QUEST Alliance 24
Room to Read India Trust 24
SEWA Rural 24
SOS Children's Villages of India 24
Nurture and nature 6
Nutrition, eat food for 33
O
Obesity 44, 49, 56, 70
Obstructive disease 56
Oils for cooking, preferred 38
Old age
homes 19
pension 32
Oral cavity 53
Oregon's physician-assisted suicide 81
Organ 4
failures, progressive 78
Oro-dental health 60
Orphanages 18
Osteoarthrosis 2
Osteoporosis 2, 57
P
Palliative medical care 79
Paralysis 52, 65
Parkinsonism 66, 78
Peripheral vascular disease 52
Physical strength, diminution of 4
Pneumococcal influenza 55
Polio 55
Pradhan Mantri Awas Yojana 32
Pradhan Mantri Jan Awas Yojana 17
Prohibited for seniors 45f49f
Prostatism 2
Psychoneurological disorders, age-related 63
Psychosocial stressors 50
Public Provident Fund 31, 71
R
Residential areas, libraries in 26
Residents Welfare Associations 25
Rubella 55
S
Seizures 65
Senior age, less dependant at 38
Senior Citizens Act 18
Senior citizens
balanced diet for 35
food for health for 33
generation of 23
Sensations, loss of 52
Service apartments 16
Severe giddiness 58
Sexual activities 4
Shift workers 67
Shifting onus 78
Skin
rashes, sudden development of 58
wrinkling, extrinsic 4
Sleep, biological clock for 67
Sleeplessness 65
Sleep-wakeup rhythm 69
Smallpox 55
Social functions 6
Speech
disturbance 65
sudden changes in 58
Spiritual care 80
Starch-rich foods 37
Stress 70
post-traumatic 63
psychological 68
Stroke 49, 56, 70
Sugar rich fruits 37
Sun-set years, walking during 9f
Sweating, unexplained severe 58
T
Tension 44, 70
Terminally-ill patients 82
Tetanus 55
Tobacco 52
Trans fats 38
Traumatic brain 82
Tuberculosis 55, 72
U
Unhealthy lifestyles 3
Unit Trust of India 31
V
Vegetative stage 77
Viral infections 72
Vomiting 58
W
Wellness centres 62
Whooping cough 55
World Health Organisation 1
Y
Yoga 44, 70
Youth-full years, during 5
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Chapter Notes

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-fm1Guidelines for Ageing with Health, Grace and Dignity
-fm2
-fm3Guidelines for Ageing with Health, Grace and Dignity
SM Tuli MBBS MS PhD FAMS Senior Consultant Vimhans PrimaMed Super Speciality Hospital New Delhi, India Neena Bhasin MBBS MS Medical Officer Anand Arogya Mandir New Delhi, India Punya Bhasin MA BEd PGT Psychology New Delhi, India Foreword Shridhar Dwivedi
-fm4
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Guidelines for Ageing with Health, Grace and Dignity
First Edition: 2019
9789352705825
Printed at
-fm5Dedicated to
“MOTHER INDIA” and mothers of the world who strive to maintain the fabric of families and nurture the culture in homo sapiens.-fm6
-fm7Foreword
It is a most poignant moment of my life to write few words about the book Guidelines for Ageing with Health, Grace and Dignity penned by my teacher Professor SM Tuli who is not only a teacher of teachers for generations but continues to look after sick and wounded at age past eighty exhorting us to do our best. Through this book, he gives us guidelines how to cope best with important health and related socioeconomic issues in twilight years of one's life. He has given us the essence of his vast clinical experience while dealing with elderly people. The book has (contains) eleven chapters. He has candidly dealt several aspects of ageing starting from realization, family support networking, its abuse, various options regarding their home/shelter, loneliness particularly so for females in case the spouse dies early, steps to mitigate loneliness, mindfulness, financial issues in sunset years, lessons to be learnt from Japan which has world's most elderly people, various food options for elderly, protective steps for de-stressing, diabetes, cancer and blood pressure. Passage on Yoga is something which makes this book invaluable for elderly. Description of psychoneurological disorders is a special feature which assumes significance in view of increasing cases of dementia, Alzheimer's disease, Parkinsonism, etc. As our daily routine has gone haywire and sleep hygiene so faulty, a chapter on ‘Biological Clock of Sleep’ is so timely and relevant for all of us. It would be apt to mention that work on ‘Biological Clock’ has been awarded Nobel Prize of Medicine last year. His suggestions to keep the bedroom screen free/digital free -fm8is very important for all those who wish to enjoy sound sleep and good health.
As our longevity has increased tremendously concurrent with improvement in socioeconomic status and health, it is not uncommon to find the last days spent in intensive care units with tubes all around in nostrils, food pipe, urinary passage and veins punctured at several places with no hope for meaningful life to return. At such times one sometimes thinks very poignantly what the fun of such vegetative life is. Why not have a peaceful end to such existence. Professor Tuli has discussed this aspect of human ordeal in a very humane manner. The suggestions regarding medical and spiritual care is a welcome feature of this book. Taking all these plus points into consideration this book will not only be valuable companion for lay people, but also for students interested in geriatric care who wish to understand the dynamics of ageing, its familial, social and biological aspects.
It would be no exaggeration to say if many of us follow the guiding principles of this book in our early adulthood, the sunset years would be peaceful, productive and gracious indeed.
Shridhar Dwivedi
Senior Consultant Cardiologist
National Heart Institute
Former Dean/Principal
Hamdard Institute of Medical Sciences and Research
New Delhi, India
-fm9Preface
The Guidelines for Ageing with Health, Grace and Dignity, has been compiled by collecting the observations made by the three contributors belonging to three different generations. Dr SM Tuli is an octogenarian having worked in government medical institutions and dealt with the medical issues of senior citizens, the efforts needed from the families and healthcare facilities. Dr Neena Bhasin is mature in age, a medical doctor working in a charity health providing organization. Punya Bhasin belongs to the growing age and is a teacher of psychology for senior classes in a school. All the three contributors have lived their life in generational families—four or three generations living together under the same roof. Dr SM Tuli has put together the observations by reflecting back on his life, past the age of 14 years since 1945. He saw the tremendous devastation caused by the partition of the Indian-subcontinent, turning lacs of people homeless and families lost in transition. The seniors of the surviving families struggled and used their wisdom to gather facilities for food, shelter and clothing, not only for their first relations but also for extended families who tragically had lost everything and left “alone”. The exemplary compassion shown by the seniors did pass on to the next generations influencing their behavior for approximately next 25 years.
We observed amongst our families (both immediate and extended) people following a “healthy lifestyle” reaching senior age in good physical and mental health. Observations were also available regarding persons not so disciplined about the lifestyle and consequently ending up with obesity, diabetes, heart problems and psychoneurological disorders. Unfortunately, however, -fm10all families come across some persons (including medical doctors) developing brain stroke, massive heart attack, cancer, neurological disorders even amongst those observing all facets of a healthy lifestyle. These are shocking cases disturbing the total fabric of families: one wonders whether these cases related to genes, ambience how and where you live, non-apparent stress, destiny or will of God!
The senior one observed the tremendous growth of India from the British-times, to the partition, to the demographic change and challenges faced by the society during the 75 years of post-independence era. The generations struggled and survived with meager resources up to 1965s: thereafter the country observed tremendous increase in the middle-class segment of the society, almost universal education, global job opportunities for workers, blue-collar people, highly specialized professionals. Evolution of information technology gave use inputs for universal style of living, food, education and other facilities. Internet connectivity provided us with an illusion of virtual “global connectivity”, but at the same time created a chasm (gap) between people. How all these developments have affected the real life of senior citizens as perceived by the three generation are presented here.
Later half of 20th century provided us unprecedented achievements which made available effective vaccinations, safe antibiotics, better nutrition, improved hygiene, better medical infrastructure, which brought the demographic change in the India-subcontinent. This write-up aims to suggest simple and practical guidelines for all of us to thrive during youth and reach senior age with health, security, grace and dignity.
SM Tuli
Neena Bhasin
Punya Bhasin
-fm11Acknowledgements
I am thankful to Mr Kundan Kumar, who prepared the type-script; and Mr Amit Kumar for preparing the illustrations. We appreciate the families and people who interacted with us in the hospitals, places of work, and social gathering, thus providing helpful information for this write-up. This is my third book with M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, it speaks for their proficiency to tolerate an author like myself.
-fm12Song of Life
Start with one and
End with one
In this journey, of emotions
Sometimes sorrow & sometimes fun
Like sometimes cloudy & sometimes sun.
For this journey
Each one of us is a part of someone
Thus let us try to help those someones.
Don't you tell this to anyone
As they're going to make it's fun
This is the story of everyone
Try not to hurt anyone
Start with one and end with one.
Composed and written by
Gagan Joshi and SM Tuli
-fm13Virtual and Real Life
Use technology
Not all the time
Find time to love
Your family
Find time for
Ageing parents
When they can no longer
Look after themselves
You will feel blessed
Not have guilt of neglecting your
Parents when
They needed you
To keep going
As a sense of duty
It should be
Daughters too
Not sons always
To realize
Their sense of duty
Who had all the
Times and resources
For children-fm14
They did their duty
With endless love
Surely you can do your
Duty to hold
Their hands!
Composed and written by
Dr Kiran Devendra