The rise of healthy aging specialists

Kevin Mwangi* has fond memories of his father. He was present, healthy and dependable. After all, he was young with the strength of an ox. However, Mr Mwangi began to watch his beloved father slow down as he got older until he was eventually bedridden due to muscle loss, a natural aging process.

Noting the need for a specialised doctor and one who would go out of their way to treat his father at home, he was referred to Dr Tasneem Yamani, a geriatrician - a physician who specialises in the care of older adults. Until his death, Dr Yamani provided the medical care his father needed and the support they couldn’t possibly get anywhere else.

“Having a sick older person in the house is not easy. My father needed assistance for daily living and my mother who is also elderly couldn’t take care of her husband as adequately as she wanted. Having Dr Yamani made all the difference as she provided the medical care he required until the day he rested,” Mr Mwangi says.

It is stories like these that bring to light the need for geriatricians.

Dr Yamani is among the few doctors specialising in geriatrics, a field of medicine that focuses on the care of men and women aged above 65 years. She is 15 years old in the medical field, but for seven of these she has been specialising in geriatrics.

Geriatrics focuses on promoting the well-being, functionality and independence of the elderly to maintain their quality of life.

We met her in her brightly coloured office at Apples and Sense in Nairobi.

“A geriatrics doctor is a general practitioner with specialised training in working with older patients. My goal as a geriatrician is to improve the quality of life of an older person, whether it is for six months or six years. Quality over quantity,” Dr Yamani says.

The need for specialised doctors for older patients didn’t cross her mind until she observed the care of her elderly parent. It dawned on her that old age is a sensitive phase of life that is given little thought, yet older people deserve care and comfort to lead healthy and productive lifestyles.

According to her, aging is inevitable but because most of us haven’t anticipated it, they end up less prepared. She says most people have come to accept ill-health as a consequence of old age and therefore overlook symptoms that require medical attention. As a result, elderly people are not accorded the proper care and attention they need.

Mr James Kinuthia, founder of two home care facilities - Fourshifts Home Care and SJ Remedial Homes for the Aged Kenya- believes it’s precisely because most people are unprepared that the society has come to view senior citizens as a burden.

After seeing the wide neglect of the elderly, he decided to set up the facilities that today help families improve their kin’s quality of life.

He says the demand for geriatrics doctors will grow as forecasts show the population aged 65 and above will substantially increase in the next few decades.

Special attention

“Therefore, there’s an urgent need for the society and public health professionals who specialise in care of older patients to address the needs of this growing segment of the population,” he notes.

But what kind of care do geriatrics doctors offer?

Dr Yamani says unlike other adults, the elderly need special attention, which a non-specialised doctor may not have the patience for. A geriatrics specialist is better placed to treat older people than a general practitioner because they’re trained to recognise how illnesses and diseases manifest in this group.

To the untrained, they are presumably competent adults who can seek their healthcare needs.

“But older people are not adults (in the strict sense of the word). They are a unique group facing a unique set of challenges that require special attention,” Dr Yamani explains.

Aging naturally leads to a slowdown of physical processes due to muscle loss. As such, vision and hearing loss, and joint problems will occur. These are normal.

“However, anger, immobility, some loss of cognitive function, urinary incontinence, sleeping problems, loss of interest in hobbies once enjoyed, and forgetfulness among others, are signs that something could be wrong and medical attention is required,” says the doctor who is currently sitting for a Specialised Certificate Exam in Geriatrics from the UK.

Dr Yamani’s first interactions with her clients are through the younger family members requesting for assistance. Most express frustration at the lack of cooperation from their older family members to go to hospital or even communicate when unwell.

She’s quick to say that this is not the case. Older people are “not difficult”. They’re just “misunderstood”.

“People overlook the fact that older people were once independent people who find themselves becoming dependent on others. This is a difficult transition that should be handled appropriately,” advises Dr Yamani.

Depending on the patient, a Comprehensive Geriatrics Assessment is done. This test looks at the history, risk factors and functional status such as the cognitive function, gait and balance, nutrition, hearing and vision of the patient and medication.

Some of the health problems she handles include frailties as older people are prone to falls; medical conditions such as arthritis, heart disease, diabetes, and neurological conditions and mental decline, for instance as symptoms of Alzheimer’s diseases.

“Many thoughts go through their heads as they undergo the various physical, emotional, financial and social changes. We need to understand that older people are transitioning from independence to dependence, unlike children, from dependence to independence. This is hard for them and may result in shutting down,” she explains.

Additionally, they fear hospitals as they’ll be away from what they are familiar with, are worried about being a bother and are concerned about the financial implications of their ill health.

Consequently, Dr Yamani practices homecare when necessary, visiting them where they feel safe. Creating a safe environment is the first step to treating an older person. Her ears, she says, are the most important medical instrument she has.

“Older people want someone who listens to understand them. When you show that you understand, you’re able to engage them. Not only for treatment but also in life,” the mother to two says.

Dr Yamani derives a great deal of satisfaction from her work.

“My work is a work of honour because people allow me to care for their family members. I derive joy from seeing a patient more alive than before I met them,” she says. “In the event of death, knowing that I provided the best possible care the patient and the family needed so that they can be comfortable, happy, and feel loved reminds me why I do this.”

At Fourshifts Home Care and SJ Remedial Homes, not only are their basic needs met, but also their physical, emotional and spiritual needs. As for medical needs, Mr Kinuthia works with clinicians – doctors and nurses - who are friends of the Homes because there’s a dire lack of geriatricians in the country.

Homecare facilities

Why aren’t many doctors taking up geriatrics? There’s a lack of exposure to the field in medical schools. For example, Dr Yamani learnt about it at a conference before deciding to dedicate her life to it. The practice which is time-consuming is also not financially lucrative unlike other specialties. Doctors look at the economic reality and jump over geriatrics.

There’s also the lack of instant results. A surgeon, for example, will see a tumour removed leading to a prolonged life, but a geriatrician, it may take months to see improvement and for most of the patients, death is only a heartbeat away.

“If you don’t have passion, you’ll not be able to do this job effectively,” Dr Yamani reveals.

It is because of this that home care facilities come in to bridge in the gap. Services that meet the unique needs that come with aging are considered. This allows older people to live independently and longer with a high quality of life. Under Mr Kinuthia’s facilities, older persons live in self-contained rooms; have four meals a day, personalised grooming, chaplaincy, exercises and caregivers.

He’s witnessed families leaving their relatives to die. It’s not enough that geriatricians are scarce, but hospitals have become extortion avenues, plunging them into poverty with every doctor’s visit. Many therefore opt to care for their families at home but because they lack training, older persons are neglected, and abuse cases rise and many die.

To help meet the gap, Mr Kinuthia has been offering online training for three months to get as many family caregivers adequately trained. The course which costs Sh30,000 lasts three months and covers the epidemiology, effects and interventions of aging.

The course is also important because home care is still stigmatised with many associating it with abandonment. There’s also a lack of awareness about care transitions which is a major contributing factor to suffering amongst older persons.

It is also costly. For example, average cost of care per month in a home is Sh130,000. Mr Kinuthia charges at least Sh60,000.

Furthermore, not everyone needs to be in a home care facility.

“Home care is advisable for lonely persons (deceased, divorced or abused) and people who need specialised care (e.g., cognitive illnesses or disabled), supplemental care; require assistance in their activities of daily living; retirees looking for active communal life and those with post operation recovery/rehabilitation care needs (e.g., hip replacement, knee replacement) and intergenerational players,” he says.

To make the society more age friendly, “The government can support key players in the care sector, for instance, by incorporating geriatric medicine courses in our tertiary institutions and providing long-term insurance covers,” the 39-year-old Mr Kinuthia offers. “In addition to structuring and streamlining the care sector, there should also be policies that eradicate ageism and older person’s abuse.”

But on a personal note, Mr Mwangi reminds us that “it’s our duty to care for our older parents the same way they cared for us. Caring for them is indeed a blessing. However, the government should find a way to support people financially because being able to support my dad’s healthcare made it possible for him to live comfortable and rest peacefully. Everyone deserves this.”