Abstract: Geriatrics is the branch of medical science concerned with the prevention and treatment of diseases in older people. Aging is the progressive, universal decline first in functional reserve and subsequently in function that occurs in organisms over time. It varies widely in different individuals. There is no stereotyped aging process common to all; it depends on individual’s life style and genetic factors. In homoeopathy, we are considering every individual as a unique, from this perspective to minimize limitations of old age and to promote comparatively healthy life, homoeopathy deserves its role and significance in a harmless and gentle way.
The word geriatrics is derived from two Greek words – geras means old and iatros means physician, as a whole impact of the word is medical care of the old. Ageing is not a disease condition; however, the risk of developing disease is increased, often dramatically, as a function of age. The biochemical composition of tissues changes with age; physiologic capacity decreases, the ability to maintain homeostasis in adapting to stressors declines, and vulnerability to disease process increases also with age.
Geriatrics is concerned with all aspects of health and disease in the elderly, and with the normal ageing process. Gerontology, however, is concerned primarily with the changes that occur between the attainment of maturity and the death of the individual and with the factors that influence these changes. The incidence, prevalence, and burden of chronic diseases increase with age, and this increased burden of disease is also associated with an increased risk of disability and decreased ability to recover from disability once it occurs. The problems of gerontology may be considered into four major categories.
- Social and economic problems precipitated by the increasing number of elderly people in the population
- Psychological aspects of ageing, which include intellectual performance and personal adjustment
- Physiological basis of ageing, along with pathological deviations and disease processes
- General biological aspects of aging
Aims and objectives: To execute two ultimate therapeutic goals:
- Prevent early ageing, and
- 2. Preserving function as long aspossible and extending lifespan.
Marjory Warren in Britain in the 1930s demonstrated that specific care plans for chronically ill older patients, previously considered to have “irremediable” conditions, could prevent many of the worst consequences of ageing. As people older than 65 came to constitute an increasing proportion of the population in developed nations in the 20th century, it became apparent that specialized physicians dedicated to treating the diseases associated with old age were needed; this need was recognized by the British government after World War II, resulting in improved training in geriatric medicine in that country.
In the mid-20th century a change has occurred in the population structure in developed countries. The proportion of elderly people has been increasing. Between 2000 and 2030, the number of older adults worldwide is expected to increase from 420 to 974 million. At present 59% of older adults live in the developing countries of Africa, Asia, Latin America, the Caribbean, and Oceania. The developing world has the largest absolute number of older adults and is experiencing the largest percentage increase. Persons of 80 years of age only 13% live in the United States; over 40% of those live in Asia. In the late 20th century Japan had the fastest growing elderly population. Geriatrics, the health care of the elderly, is therefore a considerable burden on health services.
Biology of Ageing
Study of ageing (gerontology) is aimed at understanding the cellular and molecular basis of age-related changes and have two ultimate therapeutic goals: preserving function as long as possible and extending life span. Ageing can be described as progressive constriction of homeostatic reserve of every organ system. Many theories are put forward for ageing but cellular senescence is multifactorial, it involves both intrinsic and extrinsic molecular programme of cellular ageing.
Management: Management of the geriatric problems can be handled in namely in three ways:
- Prevention of early ageing and old age diseases and promotion of health.
- Providing medical treatment for the present conditions depending on urgency, nature of diseases (surgical),
moreover patient’s choice and feasibility.
- Counselling the patients and relatives about ageing and other related factors of old age trouble as well as limitations.
Factors those accelerate ageing:
As genetics is revealing the information about premature ageing, family studies may also identify features
of delayed or successful ageing. Twin studies suggest that 30% of the variation in longevity can be attributed
to genetic factors, with the remainder being attributable to environmental and behavioural factors.
- Physical environment: Pollution, Electromagnetic waves, Ozone depletion.
- Chemicals: Food additives, colors, soft drinks, low fiber foods, fast foods.
- Stress due to any illness, physical stress or mental stress in any form, insecurity in any form
namely depression, anxiety, inability to express emotions, living alone, loneliness, absence
of close friends and relatives, lack of regular routine, lack of job satisfaction, having work
more than 40 hrs /week, financial burden, habitual and excessive worries, lack of physical
exercise etc. has significant role in production of free radicals that accelerates Ageing.
Positive factors those retard aging and increase life span:
- Correct balanced food: Dietary habits of taking vegetables and fruits (more than seven items in
daily diet) rich in fibers and vitamin and minerals but low in calories.
- Regular moderate exercise: Heavy exercise may lead to more free radicals that accelerate
- Avoid conflicts, mental worries and persisting anxieties and practice any type of relaxation.
- Happy conjugal and social life, job satisfaction, feeling of personal happiness, satisfaction of
aesthetic needs (practicing or enjoying arts or spiritual life), benevolent works, regular daily
routine, financial planning, optimistic attitude may help to retard ageing.
- Balanced, optimistic and openhearted life style.
Scope of Homeopathy in Geriatrics:
In homeopathy, we are considering every individual as a unique following a dictum ‘we treat the patient that has the disease but not the diseases that the patient has’. Considering the prevalence of chronic diseases and their implications in old age, homeopathy deserves its own space. Moreover, correct homoeopathic medication has no adverse or side effect upon health. In extreme conditions also it may not cure but promotes desirable painless death. So, from this perspective homeopathy occupies its own place with its scope and limitations for Geriatrics.
Principle of Homeopathic Treatment in Geriatrics:
Ageing is the part of the development of sequence of the entire life span, from prenatal growth to senescence. So, factors responsible for accelerating early ageing throughout life (gestation to old age) are to be considered. Principle of treatment should be adopted accordingly. Apart from treatment, attention should be given to the factor that accelerate and retard ageing (stated above).
Our sole aim in relation to geriatrics is as follows:
A. Preventive: To prevent early ageing.
- Treating Chronic diseases, and
- Treating acute diseases
B. Preservative: Preserving function as long as possible and extending llifespan
A. Preventive, to prevent early ageing: Though absolute prevention of ageing is not possible but ‘early ageing’ may be prevented. Homeopathy by default of its principles and philosophy has enormous scope in this aspect.
1. By treating Chronic diseases: In order to prevent early ageing attention should be given to treat chronic diseases to avoid their implications in old age. In younger age every attempt of treatment should be curative but not palliative. To execute curative therapy totality of the symptoms with due consideration to history (Gestational, past, Family, Personal history) from phenomenological point of view is the only means. If a mother suffered from eclampsia, pre-eclampsia during pregnancy may have implications to her offspring’s health. That particular child if not treated accordingly may be a victim of early ageing in a long run. One dose of Thyroidinum in suitable potency may prevent this individual from early ageing if treated judiciously at time. Past history of whooping cough, diphtheria etc. has serious implications for rest of period of life, that accelerate ageing may be easily combated with
Pertussin, Diptherinum respectively. Personal history of abuse of sex leads to premature old age may be treated
with Agnus Castus. Family history of tuberculosis presenting with recurrent cold may points to Tuberculinum, that not only cure the condition but also modify the susceptibility and thereby retard early ageing. Family history of Cancer with past history of repeated inflammatory disorders presenting with mental depression may be recovered
with one or two doses Carcinosin, thereby also preventing early aging.
2. By treating acute diseases: In every case of acute disease treatment should be done strictly according to
the totality, considering causation, location, sensation and characteristics modalities or concomitants if any. Severe acute viral diseases damages DNA and accelerate ageing prematurely. With indicated homoeopathic medicine we can safely treat them almost without sequel. We usually give Bry, Rhus-t, Eup-pas per their modalities and causative
factors, for Fever with pain in limbs.
IN EVERY CASE OF ACUTE DISEASE TREATMENT SHOULD BE DONE STRICTLY ACCORDING TO THE TOTALITY, CONSIDERING CAUSATION, LOCATION, SENSATION AND CHARACTERISTICS MODALITIES OR CONCOMITANTS IF ANY.
Sometimes patient may be recovered with apparent similimum, but sequel remains. In that case medicine was not true similimum, disease course was self limited, and in spite homeopathic treatment ageing accelerated in its own way. Fever with concomitant pain in joints (Location specified) which moves like an arthritis, patient in acute stage, Calc would be the only remedy leaving no sequel and patient may recover. After recovery in acute diseases, in every case patient having significant miasmatic background is to be combated with a suitable anti-psoric in order to modify susceptibility and thereby prevent early ageing process.
B. Preservative: Preserving function as long as possible and extending lifespan.
Absolute prevention of ageing is not possible, as birth, growth, development and ageing are natural phenomena.
Patient of any age group can be treated with homoeopathy with a goal of recovery, if rare, uncommon, peculiar characteristics symptoms points to any one medicine. But in cases where gross pathological changes take place, scope of curative therapy is less. ‘Gerontology’ is the scientific study of the phenomena of ageing, which is meant by the progressive changes that take place in a cell, a tissue, an organ system, a total organism, or a group of organisms with the passage of time. So, as age progresses (after the third decade) some irreversible physiological changes followed by pathological changes take place in every individual that are not curable. So, in this context common
particular symptoms of old age are to be taken into consideration with rare modalities and concomitants if any. Some examples are given below.
Costiveness is a common phenomenon in old age due to inertia, but if it is associated with depression, vertigo and headache Calc-p (usually known as children remedy) would be the only remedy.
Gross mental depression with palpitation, sense of oppression in chest with heart complaints–Aurum. Insomnia after business embarrassment, mostly imaginary – Hyoscyamus. Vertigo with dominating skin symptom may be recovered with Conium. Always fear of sickness, usually a long spells of sickness before dying-Cicuta Having lots of troubles, complaints nothing with inclination not to react-Arnica. Complaints nothing with expression of joy-Opium Taste bitter with clean tongue in aged women-Carb-veg. Natrum Mur.
In chronic bronchitis cough in every winter with asthmatic character and abundant offensive expectoration
in old age is common to many old aged persons ,but if it recurs only in winter and abates in summer we
may think of Phel (Phellandrium aquaticum), it may not cure in all cases but definitely gives relief and
thereby preserving function and prolong life.
Poor reflexes with dreamy state of mind but does not bear presence of others, even the nurses, during stool;
frequent ineffectual desire, which makes her anxious, points to Ambra Grisea. Embarrassing condition due to
enuresis may be helped with Secale Cor. Inability to retain urine- Kali-p.
Baryta carb-geriatric profile: Generally Baryta carb is used in homoeopathy as a medicine of childhood (first and second). It has therapeutic reputation for old age with regard to enlarged prostate and hemorrhoids etc. J.T. Kent asserted very beautifully, “There is an expression here in the text, ‘Want of clear Consciousness.’ If you had read that symptom, first you would not have appreciated it. ‘A want of clear Consciousness’ especially in old age that has been useful. It is not that confusion of mind that we know, to be dizziness. But he is not clear in his intellect. It egins with a feeble state, and it gradually travels toward imbecility.” It is very effective medicine for ‘Stupor’, a marked impairment in consciousness but not complete loss, only reacts to strong stimuli, with both mental and bodily weakness and marked groaning. It is also an effective remedy for Apoplexy having great mental and bodily weakness after eating. So tired that she cannot raise hands; she is too weak to masticate, childishness. On observation reveals dark redness of face, with congestion, circumscribed dark redness of cheeks, cold hands with blue spots. Immovable pupils, looks sleepy with dull red eyes. Redness of conjunctiva with swollen lids. Vision is poor with weakness of sight due to ageing, dim sighted, cannot read.
Deglutition difficulty without any pathological lesion but due to spasm can swallow liquid only with difficulty, solid food gags. A lady of 75 yrs of age complaining of deglutition difficulty (no lesion observed with Barium swallow) with confusion in mental level and imbecility with continuous moaning and was successfully treated with Baryata
Gastralgia with constipation is also an important symptom. Constant urging and frequent emissions of urine. Urine clear on passing soon becomes cloudy. On urinating, burning in urethra. Before urination: urgent desire to urinate. During urination: burning in urethra. After urination: renewed staining, with dribbling of urine. When
appetite improves and thirst lessened, urinary secretions became very considerable.
The word “Geriatrics” relates with the conclusion of life. But before concluding we should be careful about early ageing and do try to prevent it and at the same time to preserve function as long as possible to extend life span. Though homoeopathy will not cure every geriatric case, but with this harmless gentle way of treatment we may prevent early ageing as well try to preserve function for a longer period and thereby extending the life span for
the higher purposes of existence.
1. Allen T.F. — Encyclopedia of Pure Materia Medica, 1879, New-York, Boe & Tafel.
2. Basu Biswajit — An Illustration on Family History, 1st Edn. Kolkata, India, 2000. Published by Dr Shipra
3. Basu Biswajit — An Expedition on Carcinosin,1st Edn., Kolkata, India, 2007. Published by Dr Shipra Basu.
4. Basu Biswajit — Homoeopathic Approach to Bronchial Asthma, Homoeopathic Heritage; Vol 33, No 4, April 2008; B. Jain Pub. Pvt. Ltd. New Delhi.
5. Basu Biswajit — Phenomenological study of Thyroidinum, Homoeopathic Heritage; Vol 33, No 12, December, 2008; B. Jain Publishers Pvt. Ltd. New Delhi.
6. Boger C.M. — Boenninghausen Characteristic & Repertory B.Jain Publishers New Delhi.
7. Boenninghausen Therapeutic Pocket Book. B. Jain Publishers Pvt. Ltd. New Delhi.
8. Clarke J.H — Dictionary of Practical Materia Medica. B. Jain Publishers Pvt. Ltd. New Delhi.
9. Hahnemann. S. — The Chronic Diseases, their Peculiar Nature and Their Homoeopathic cure; B. Jain Publishers Pvt. Ltd., New Delhi. India.
10. Hahnemann. S. — Organon of Medicine; 5th and 6th Edn. translated by Dudgeon, B. Jain Publishers Ltd.,
New Delhi. India.
11. Harrison’s — Principles of Internal Medicine, 17th Edn., International Edn.
12. Hering C. — Guiding Symptoms of Our Materia Medica. B. Jain Publishers Pvt. Ltd. New Delhi.
13. Kent James Tyler — Repertory of the Homoeopathic Materia Medica. B. Jain Publihsers Pvt. Ltd. New Delhi.
14. Knerr C.B. — Repertory of Hering’s Guiding Symptoms of Our Materia Medica. B. Jain Publishers Pvt. Ltd.
15. Phatak S.R. — Concise Repertory of Homeopathic Medicine, B. Jain Publishers Pvt. Ltd. New Delhi.