Medicosnext
(Words by Dr. Neeta Shakya Malla)
Ageing is an inherent and inevitable phenomenon affecting all living beings. In Nepal, where the elderly population comprises a significant proportion of the total populace, it is crucial to recognize the unique challenges and healthcare needs that accompany this demographic shift.
This article sheds light on the often overlooked field of geriatric Otolaryngology, emphasizing the necessity to raise awareness and provide specialized care to address the degenerative changes in the head and neck area, as well as the impact on special senses and overall well-being of the elderly.
Ageing and the Rise of Geriatric Population:
Ageing is a global phenomenon, with developing countries experiencing a substantial increase in the number of older adults compared to developed countries.
In Nepal, the population aged 60 years and above accounts for approximately one tenth of the total population, steadily increasing over the years. This demographic shift poses significant challenges for social and healthcare services as the ageing population continues to rise.
The Multitude Problems in Geriatric Otolaryngology:
Geriatric, is the term we apply to indicate the aged person. Geriatric Otolaryngology encompasses a range of problems resulting from degenerative changes in the head and neck area.
Notably, the decline in the function of special senses, such as hearing and olfaction, along with the prevalence of head and neck malignancies among the elderly, demands increased awareness in the field. Furthermore, the cosmetic changes associated with ageing faces present a formidable challenge due to the growing desire for a youthful appearance in modern society.
ENT Diseases and Their Impact on Geriatric Patients:
As an ENT doctor, I have observed a high prevalence of diseases and conditions in late life that significantly impact the well-being of geriatric patients.
Hearing loss, balance disorders, chronic nasal bleedings, and head and neck malignancies are common issues among older adults. Although most ENT diseases are not life-threatening, they can profoundly affect social interactions and exacerbate existing health problems.
The Growing Need for Geriatric ENT Specialists:
With the geriatric population on the rise, ENT specialists anticipate an increase in older patients seeking treatment in the coming decades.
Research conducted worldwide has shown that more than 180 million people aged 65 and older have hearing loss that interferes with everyday communication. Presbycusis, a form of age-related degenerative hearing loss, is a prevalent condition among the elderly.
While not life-threatening, untreated hearing loss can lead to decreased communication, social isolation, and a decline in cognitive function. Fortunately, the availability of hearing aid devices has significantly improved the quality of life for elderly individuals with presbycusis.
Addressing Common ENT Problems in the Elderly:
Several common ENT problems afflict older adults are often overlooked or underestimated. One such problem is cerumen impaction, a reversible cause of conductive hearing loss.
Risk factors for cerumen impaction include ear canal hair, degenerative changes of the ear canal skin, use of hearing aids, and bony growths like osteoma. Hospital-based earwax removal is the recommended treatment option for impacted wax causing problems for the elderly.
Tinnitus, the perception of ringing or other noises in the ears without external stimuli, is another challenging symptom to treat in otology, especially when the cause is idiopathic.
It can be linked to impaired control of the microcirculation of the inner ear, often associated with poor blood pressure control, vascular diseases, autoimmune disorders, and degenerative neural disorders. Tinnitus can significantly impact a patient’s quality of life, and a multidisciplinary approach involving ENT specialists is essential for effective treatment.
ENT Problems in the Elderly
Ageing also affects the vestibular apparatus, leading to dizziness and imbalance in older individuals. These symptoms increase the risk of falls and other injuries among the elderly.
Peripheral vestibular dysfunction, such as benign paroxysmal positional vertigo, Meniere’s disease, and age-related deterioration of peripheral vestibular function, are frequent causes of vertigo in older patients. A multidisciplinary approach is necessary to manage these symptoms effectively.
The ageing process introduces changes in the nose, both internally and externally, due to variations in mucous patterns, airflow, and inflammatory and infectious stimuli.
Epistaxis (nosebleeds) is a common complaint among elderly patients and can be caused by factors such as dry nose, nasal malignancies, allergies, and infections. Anosmia, the loss of smell sensitivity, is another prevalent pathology in old age, resulting from a decrease in the number of olfactory receptor cells, thinning of the olfactory epithelium, and environmental damage.
Head and neck squamous cell carcinoma (HNSCC), the sixth most common malignancy worldwide, affects a substantial number of individuals over the age of 70. The optimal treatment approach for head and neck malignancies in the elderly depends on various factors, including the site of the tumor, comorbidities, social support, and performance status.
While no established standard of care exists for elderly patients, it is crucial to consider geriatric assessments, treatment outcomes, and potential toxicity. Quality of life takes precedence over the quantity of life when determining the most appropriate treatment modality for elderly patients.
Government Policies
The Government of Nepal has formulated National policies on ageing and problems of elderly addressed at various levels in acts, code and conducts and regulations like Senior Citizen act 2063, Old Age Allowance, Senior citizens treatment Guidelines 2061 and many more.
Due to inadequate trained human resources and fund, effective and efficient implementation of the development plans and policies of government has been very limited.
Conclusion:
The field of geriatric ENT is often underestimated despite the pressing need for specialized care and attention to the unique challenges faced by older individuals. By prioritizing yearly ENT general check-ups for the elderly, we can detect and manage diseases at their earliest stages, minimizing the need for extensive interventions. Additionally, as societal changes disrupt traditional family support systems, it is essential to develop comprehensive policies and healthcare initiatives to address the growing health and well-being needs of the elderly population in Nepal.
In Nepal, traditionally elderly were looked after by the son and daughter in joint families. However due to modernization and migration of the youth seeking green pasteurs, this has significantly threatened the tradition, leading to high levels of impoverishment, homelessness and ill health among the elderly population.
We need to have well versed additional knowledge in the needs of older patient requiring medical, social and psychological aspects. We need to improvise on improving the quality of living of our senior citizens and enhance the society in general.
By enhancing our understanding of the prevalence of ENT diseases and principles of geriatric medicine, we can ensure better care for older patients. Although many ENT diseases in this age group may not be life-threatening, they require dedicated attention and specialized interventions.
