 Welcome to Kalusugan ay Karapatan with another exciting episode today, geriatric issues and senility. Our episode today is about the elderly and how they should be given medical care. But did you know that it is difficult to define the elderly age group precisely? Some people do not want to see, some people do not want to use the word aged or elderly or senile because they may be derogatory or may connot certain incapacities or physical defects or looks that may be contested by older people themselves. That is why I think the appropriate word is older people which is sometimes preferred but is equally imprecise. 60 to 65 is the age often used to describe older people but most people do not need geriatrics expertise in their care until age 70 or 75. Like many people, I know even they are in their 70s or 80s they still look like glamorous, 40s or feel like they are teenagers. That is true, Commissioner Lili. You will be happy to know that overall women live about five years longer than men and this may be because of genetic, biologic and environmental factors. Although there have been changes in women's lifestyle such as increased smoking, increased stress, still these differences in survival rate over the late 20th century has not changed much. Still we need to confront the fact of life that aging is inevitable. The functions of our organs will decline over time and this will be irreversible even in the absence of injury, illness, environmental risk or poor lifestyle choices such as unhealthy diet, lack of exercise, substance abuse, etc. Aging organs are also more susceptible to injury such as intracranial hemorrhage. We need gerontologists, those who study of aging including biologic, sociologic and psychologic changes. It is good we have invited resource persons to shed light about gerontology, geriatrics and other terms related to older persons. Yes, I cannot think of anybody who can make our audience understand better what aging is because she's the director at Institute on Aging National Institutes of Health, UP Manila. Beside that, she's a professor at the University of the Philippines, president of the Philippine College of Geriatric Medicine and director at Institute of Health Policy, NIH, UP Manila. It is my pleasure to introduce a good friend of mine, Shelly de La Vega. Shelly. Hello and thank you for having me here, Chancellor Padilla and Commissioner Dili de Lasliagas. I was the former policy director and the former president of the College of Geriatric Medicine. But still, I'm the incumbent director of the Institute on Aging at the NIH, UP Manila. I also have the privilege and honor to introduce somebody who will compliment Shelly de La Vega's expertise in aging. She's an adult neurologist and her subspecialty is memory disorders. She is the head of the Center for Memory and Cognition of the Philippine General Hospital. She's been a doctor since 1998. Ladies and gentlemen, let us welcome Dr. Vida Michelle Anlakhan. Thank you Chancellor Padilla. Hello, Dr. Lili. Let us now ask Dr. Shelly about the mental and physical abilities of older people. What happens to them at the age of 65 or 70, Dr. Shelly? All right. We have what we call physiologic aging and chronologic aging. Now, chronologic aging happens from birth. In fact, aging is something that we all go through. From the time we are conceived in the womb. So aging really happens from womb to tomb, unfortunately. And there are people whom we know are very healthy, as you mentioned earlier, despite their age. So not all 65-year-olds will be frail and weak and have problems with their memory. Many of them will be very active when we talk about geriatrics and the geriatric age group of 60 and over, we sort of think of them as in three categories. The young old, the middle, and the oldest old. So many of the Filipinos are in the young old category. These are those who are still working, still active, pursuing their careers and very, very much attuned with what is happening in the world. These are usually those age 60 to 70. At age 70 to 80, 85, then they start having chronic degenerative problems manifest as weakness or frailty, which I can explain later on. At the age of 85 and older, we have the more frail older person. These older persons now start to get sick and get hospitalized and really start to get more dependent in their activities of daily living. So they may need a caregiver at this point. But still, like I said, aging is very variable. So we cannot say that all 80-year-olds are this way because I know of patients of mine who still run marathons at the age of 83 and 85. So there are some outliers there in that what we think is a normal curve to describe aging. Is there a way of, you know, it sounded like a very healthy young old person that you were describing. Are there ways of preparing for this so that we will have healthy aging? So healthy aging is a concern of everyone. Like I said, it should start when we are conceived. So to be able to be a healthy older person, I think your mother has to be healthy because when your mother is healthy, the fetus is healthy, you are born healthy. And we need the environment and the health system, a good educational system and possibly behavioral, you know, behavioral and personal choices that would allow you to live a healthy life. So intrinsically, we have the genes that will sort of determine what illnesses we may have, how long we will live, but genes will only take up about 30% of what determines our aging process. Much of it has to do really with your lifestyle, the environment and the health system that surrounds a person. How do we prepare and be healthy and active up till we are 85 years old? I think, like I said, as a young child, we need to really support maternal and child health. And as young adults learn certain habits, hopefully we get rid of certain habits that promote early aging and sicknesses such as smoking, extreme alcohol, intake, risky behaviors. And if we have a good educational system, a good educational system and a health health system that allows universal healthcare, for example, then that will more or less assure us that we are in a good trajectory. May I ask, I don't know if I am suffering from early aging. How would I know that I am not? A lot of people have different parts of their bodies age differently. So we age differently from the person next to us, but even parts of our body can age differently. So you may have aging joints. If you, for example, have been obese most of your life, possibly by the age of 40, you will start experiencing arthritis of your knees and hips. So those are early signs of aging per se, joint problems, hypertension, elevated cholesterol, poor vision, and maybe eventually later on as we discuss failing memory, those may be some of the manifestations of early aging. But maybe you are concerned about premature aging, right? I still remember you. Okay. So there are signs of premature aging and like I said, you can go to your doctor if you are having all of these aches and pains because arthritis pains are the number one health complaints of older persons. So and of course, blood pressure, uncontrolled hypertension, high cholesterol, these are all, you know, things that we can manage early. But Patino, I think inevitably all of us will grow old. So the goal is health aging, but what we fear most is actually if we go into an issue of dementia or senility and I want to turn to Dr. Anlakan to explain to us what is dementia and what is senility. Dementia is when our memories fail enough to the point that our daily activities are already impaired. If you have problems with day-to-day activities like counting, banking, handling your money, keeping track of your medications, traveling from place to place or using appliances, then you may already have significant memory problems versus just getting old. But when we get old, usually our memory is still intact. That is the norm. That is supposed to be the norm. It becomes abnormal if there is already an impact on our daily activities. I forgot my key. I placed it in the refrigerator. I am already experiencing dementia. Unfortunately, Commissioner Lily, it goes beyond that. It goes beyond that. It cannot be just forgetting where we placed our cell phone, our eyeglasses, or our keys because I think all of us will fall in that criteria because we are all guilty of occasionally having those problems. So the defining line is actually functionality. For example, if you are a doctor, you are still able to function very well. Do your clinics, do your rounds. If you're an accountant, you're still able to do all your bookkeeping and accounting. At the end of the day, it's really functionality because if you have impairment, then you really need to see a doctor already so that certain diagnostics have to be made. What's the earliest sign at what age does it set in? There is no actual age, but there is a usual age. Usually it's above 60. Okay. So senior citizens, if they are in doubt or if they feel that they have declined from a previous level of functioning, they should already consult. Sometimes we don't want to wait for the time that you can no longer recognize family members or you cannot recognize people or you cannot do your daily activities. You don't wait for that. The moment you feel that you do have a memory problem and there is an impact in your life, you should consult because initially, we screened for reversible causes. There are reversible causes. Unfortunately, if the workup is all negative, then that's the only time we say that this is neurodegenerative dementia usually of the Alzheimer type which is the most common. And yeah, so we prepare you and your family to deal with this because this is going to take a long time. What's the reversible checklist? The reversible checklist are usually hypothyroidism. A lot of people have had thyroid surgery in the past and then they forget about taking their supplementation for their thyroid hormone. And then sometimes they have infections in the brain, HIV, Neurosophilis, they are still common. We see, we still see them. We also usually use that to check for vascular risk factors. Heart disease, hypertension, diabetes, hypercholesterolemia because the risk factors that give you a heart attack and a stroke are also the risk factors that will give you dementia. Wow. So it pays to control these risk factors and the most important diagnostic for me is either an MRI or a recipe scan of the brain because then you see if you have had strokes, if you bumped your head and then you had a subdural hematoma or brain bleeding. If you have tumors or cysts that can actually affect your memory. So you need a neuroimaging so that you are sure of what diagnosis you're dealing with. In the usual Alzheimer case, what we just see is atrophy. There is shrinkage of the parts of the brain dedicated for memory. Okay, so I have a question like forgetting names of people you've known in the past. Is that an early sign? I mean, I think that's very common. Yes, but is that an early sign of dementia? I also get that question a lot. Unfortunately, people are different. For example, you meet a lot of people every day and then you don't really work with them too long for you to be able to retain their name or their face. And also you compare yourself to your previous level. Have you always been retentive to names and faces? Because if you have been, you should still be now. But if you were never a good person to remember names or correlated with faces, then you have to be more forgiving of yourself now. Especially if you have only limited contact with people, knowing them for a short time, working with them for a short time, then you may really forget that is part of normal aging. If you want to remember, you really have to put effort on it. So I'm hearing, I mean, if I work and invest on healthy aging, can I assure myself, our selves that you will have a lower risk for dementia? Yes. We actually have scoring systems for what are your chances of developing dementia? Recently, there have been a lot of studies on prevention of dementia, highlighting certain things that are modifiable as we get older. I think that's good for us in the relatively intact stage so that we don't cross over to the persons with dementia stage. I think we can still prevent a lot of these modifiable risk factors. Every day, I talk to people. I remember the names because I try my best to remember names easily. But I have a friend. She cannot remember the person she interviewed. Is it because she has no propensity to remember names or is she experiencing early dementia kaya? We don't know. It has to be a consistent problem and you have to gauge her based on her previous level of functioning. So if she's always been like that, then we have to forgive her now. Because she's always been like that. Yes. Some of the tips that we know of can increase your life expectancy or your healthy life expectancy by two years. If you do these things part of which includes eating breakfast, having a good breakfast that they say can increase your life expectancy by two years. Sleeping well, of course, without the help of any sleeping pill. Hopefully seven to eight hours a day. Not smoking. Zero smoking. Moderate alcohol intake. Moderate wine intake or beer or alcohol intake is allowable. And in fact, more people live longer if they take a little bit of alcohol at the time. Of course, we do not want to encourage anyone who has never taken alcohol to start drinking beer or wine just to increase their life expectancy. That's not what we recommend. More education. Keep on studying, learning, learn new things, new skills, meet new people, visit new places. Have a goal. Have a goal in life. Know who you are and what you can contribute to society. I have a very simple question. Mahilig akong kumain ng gulay, pero mahilig din ako magsigar. But because I'm a farmer, address ko na yung healthy lifestyle by being active the whole day and I eat vegetable. So the risk of having high cholesterol might be lower. Simple Filipino asking you, doctora, vulnerable ba ako dyan sa disorder na yan? Dahil karamihan ng ilukano, maabot ng 80, 90, malakos pa rin sila. Pero naninigariliyo, nag-sigar sila. What can you say, doctora? I think more ilukanos do not use tobacco. I think it's a misconception that just because you're ilukano you smoke tobacco. My grandparents from my father's side are ilukanos. They live to be 90 something. But they never smoke. They love to eat bagnet and things made from pork and fried pork. But they ate a lot of ang palaya, in the pinapet. If you look at the benefits of smoking cessation, the benefit is there. Any time you stop, whether you're a 15-year-old or an 80-year-old. So the risk of cancers, chronic obstructive pulmonary disease, heart disease, et cetera, from smoking is quite well though. So I would still recommend smoking cessation anytime. And many of those who live long have actually not smoked. There are epidemiological studies, for example, on blue zones, areas in the world where people live to be 100-year-old. And these people really live active, healthy lifestyles. A mixture of vegetables, a little bit of wine, a lot of physical activity. Being part and active at community or family. So these are some of the main points that contribute to their healthy life expectancy. Because you don't just want to live long, you want to live healthy. May I ask, doctora? I'm very impressed by the Philippine General Hospital program. Philippine General Hospital is the only hospital giving this program? For memory. There are a lot of centers for memory, mostly in private hospitals. Government hospital. Only PGA? There are some in some government hospitals. If one wants to consult with you, how do they... Oh, they can just go? They can visit there? Do you have special arrangement? They need to be referred by physicians? What is your... We actually have an email ad and I get questions from physicians in the province because I lecture a lot from the north to the south and then I get a lot of questions and most of the patients cannot travel to Manila. So I guide some of the physicians on how to handle their patients or how to even diagnose them. So that is a service that we provide. Is it expensive? No, actually it's a free service that we provide. In Philippine General Hospital, we see both service patients and private patients. And we even do memory tests and diagnostics to screen them because proper diagnostic is important. You have to have a proper diagnosis for you to be able to give the proper medication. There are many types of dementia. The usual will be Alzheimer's disease but there is also dementia because a person had a stroke or a person had traumatic brain injury from accidents and we get that a lot. Or sometimes they've had brain surgery or they have other diseases, other dementias from Parkinson's disease or from Lewy body disease. So the medication varies. So we have to identify the proper type. So how is PGH providing this education and promotion? How do we advise the public? How do we advise the public? So we only activated the center recently. Now we're on the data gathering stage. We're trying to get all of the patients to be screened, properly screened and also we do the memory screening. We do lay forums lay fora every now and then so to disseminate information. We also liais with Alzheimer's disease association of the Philippines and we have gone to many provinces. We have trained physicians, nurses and barangay health workers in recognizing people with dementia and how they should be able to consult and the treatment is available, symptomatic treatment. The Department of Health has this kind of program too? I am not aware currently if there is any active problem. Dr. Shelley. The WHO has a mental health MHGAP. They have a training system called MHGAP that came from the WHO. It's now at the level of the barangay health worker and they train barangay health workers on mental health issues which includes dementia but not to the extent of being able to screen at the level of the community. So I think the work that Dr. Anlakan mentioned which includes work from her group in PCH Alzheimer's association also augments this community-based awareness and even screening. So we have community-based? MHGAP, yes is already ongoing. Of course I'm not a spokesperson from the DOH, I'm from the NIH but I am able to meet with them on a regular basis for their programs. What we have recently signed by Secretary Ubyal is the guidelines for the implementation of the primary essential health care packages for all life stages from pregnant to the senior citizens and included in that package which is now an outpatient service delivery package is screening for problems of older persons including screening for memory problems at the community level but of course that needs to be supported by higher level services because if we are able to screen a person for example in the community who has frailty beginning dementia, risk of falling then there has to be someone in the secondary or tertiary levels in the hospital, specialists included who will be able to diagnose completely and manage these patients better. Officially I have a anybody can answer but I see a lot of old people doing crossword puzzles and I and I've asked this from my uncles and aunties they say they just want their mind to be working so and now that Sudoko has come out it's also one that's been popular do they help? And we also have some computer based gains right for maybe I can ask Dr. Anlakan to shed more light on this is it better to mental exercises physical exercise to prevent dementia or cognitive stimulation is always good one of the biggest risk factors for dementia is actually lesser number of years in school lesser number of years in school because the thinking is that the more you learn especially informal education and the more you have lifelong learning like you are open to anything that is new whether it be crossword puzzle or Sudoko or reading it builds up what we call cognitive reserve cognitive reserve are pathways in our brain or in our neurons connect it's like a tree that is very shady with all the branches so this cognitive reserve is something that you build up over the years and if you have very good cognitive reserve when you are already in your relatively elder age then it is something you can fall back on because if you start having the abnormal protein accumulation of Alzheimer's disease you can be relatively resilient meaning you may not have dementia because you built up a very good cognitive network earlier on so any lifelong learning is actually advisable it's never too late to learn anything and I always tell this to my patients especially those who are afraid of gadgets and appliances so I tell them you should try it you should give it a try always learn if you only have time now to learn the violin or to learn how to sing them do it but also physical activity is very important not just for memory but also for maintaining healthy aging anything that improves blood circulation will also prevent dementia so we need to keep moving physical inactivity is one of the risk factors we have international statistics as to what will give us dementia so if we try to reverse it if you look at them then you can prevent dementia number one is the number of years of education so the longer you stay in school the more protected you are and in midlife which is around 45 to 65 years old there are surprises actually avoidance of hypertension or controlling hypertension is a big thing aside from that avoidance of obesity and hearing loss so if you try to correct hearing loss in midlife you may be able to prevent dementia the theory being that if you are shut off from the rest of the world then there is no learning so your cognitive reserve just declines and declines in the later life there are more risk factors for smoking we will have more dementia because of smoking depression if you are socially isolated you don't have a lot of network of friends or family or if you have diabetes then yes these are risk factors for dementia but there are also clinical trials that help elucidate the benefit of physical activity and a multifactorial intervention that was done in Finland I think it's called a finger study so it was a combination of not just healthy diet but physical exercise, intellectual stimulation they did it in such a way that showed that really all of these factors that Dr. Anlakhan mentioned contribute to preventing dementia and improving longer functional ability when it comes to memory and NIH in the U.S. also did a study on physical activity that showed the benefit of physical exercise of course there are some studies that showed that it doesn't affect memory at all but I think physical activity in general will not only improve the circulation of brain but also overall health how is the Philippines compared to other Southeast Asian countries as far as these figures are concerned I would think that Japan is more developed and they take care of the old senior citizens I can see the programs when I was there and the Chinese people are very hard working up to 85 they still carry this sack of corn and they carry it if you pass by the railroad of China 85 years old they are still physically active is sedentary life related to early onset of dementia Filipinos are quite sedentary am I correct relatively yes I think the life expectancy of the Filipino including the healthy life expectancy of the Filipino has improved through the years because when I was still in med school my life expectancy was only about 60-65 now it's 67 and 73 mas lugay ng konte ang lalaki but I think when you look at the global aging index because there is an aging index and whether countries are advanced in helping promote healthy aging I think the Philippines still has a lot to achieve and the laws that protect our senior citizens we have a very good Philippine plan of action for senior citizens that includes 20% discount hopefully there will be some geriatric services and wards in all hospitals but the implementation of this law still has to be has to be accomplished well the social pension is one of the things that we are interested on and we just started giving the social pension of about 500 pesos per month to our very indigent older people of course we wanted to be a little bit higher than that and for more people rights of older persons I think the Philippines in terms of protection from from elder abuse still has to be improved because we still do not have a good organized system for addressing the abused older person but we are also rated with regards to our life expectancy and we have improved but compared to other Asian countries we lag behind Japan we lag behind Singapore we are more or less at par with other Asian countries like Vietnam Myanmar Cambodia remember that for middle income countries such as the Philippines and low middle income countries when we say life expectancy really are talking about maternal and child health reduction in maternal and child mortality is the key to improving life expectancy if we are very well developed such as countries in Europe Singapore and Japan what determines life expectancy is the services healthcare systems that are provided to the adults and middle aged which addresses problems such as hypertension, diabetes, stroke lifestyle diseases I like to ask both of you Chancellor Doctora Doctora we are so much influenced by my advertisement in the television and such claim like taking this herbal product will improve our memory this might give a different signal to the Filipino people and they will be encouraged buying this herbal product to prevent senility for example especially packaged by and marketed by very prominent people beautiful actresses an aging actress in the 60s taking the herbal product can you say something about the effect of this you go first I always get that question a lot unfortunately I think it's human nature to look for shortcuts or things that are beyond within their power they think they are vitamin deficient so they think that they need a lot of vitamin supplementation but actually it's very rare vitamin supplementation may not really be needed only on certain cases and for those really diagnosed to have the deficiencies they don't want to hear about having to exercise or having to eat more vegetables than meat or stopping smoking and avoidance of alcohol large amounts of alcohol they don't want to hear that they want shortcuts pills that they can pop every day to try and prevent if you look at all the advertisements most of them are targeted towards the people who don't have disease at all they are relatively healthy so of course they will say I'm not getting sick but because they're still relatively healthy but unfortunately the studies that support these supplements are very small and that's not how we do data analysis in the university and this is not for policy making also we need stronger evidence than that what we do have are medications for symptomatic improvement if you already have the dementia and it is specific to what type of dementia you have so it's very important that consultation is made that's enlightening were you tempted also to buy some supplements no I love to swim and that's my that's the source of my energy I love to swim so we hear dementia and simility so can you just explain it again to the viewers when you say your senile your what does that really mean ulyanin is that ulyanin yes in the Filipino language it is ulyanin usually we call our elderly people ulyanin if they are very repetitive or they cannot pronounce your name or they cannot recognize you anymore unfortunately we still lag in the awareness level even some of the doctors that I lectured to in the province for aging people to have memory decline but it is not normal I often say it is common but it is not normal it is a disease so this is memory decline that impairs our daily activities already so do we have numbers do we have statistics to tell us what percentage of our population the right statistics I think we have some based on the Delphi technique there was a researcher from the WHO he went around but mostly specialist reports of how many they have seen so this really are selected practitioners and they say that for the general population those with dementia amounts to between 2% to 6% but we don't have a registry 2% to 6% among in the general population but the percentage of dementia increases as people age and Dr. Anlakan can explain that because that is just a general trend that we talk about but we don't have a registry of persons with dementia we would like to have a registry of persons diagnosed with dementia just as I'm sure oncologists would like to have a cancer registry the international data will say that above 65 years old 65 to 70 we have 5% chance of getting dementia and above 85 years old it's approaching 40 to 50% so again it's very common but it is not normal so sometimes I also see a disparity as to when they consult the lower socioeconomic levels will consult when they are already having behavioral problems like the elderly patient would not eat or is very violent or not sleeping or not eating so those are the issues that bring them to the doctor but the relatively high socioeconomic levels those with higher education will come to you when they feel that they already have a memory decline or they are only missing certain things so that early prognosis is always good when they come early because medications work in the early stages in the latter stages unfortunately we can only give medications for better behavior later meaning 65 years old and above later stage of the disease meaning later stage of the disease they have to be assisted already in their everyday activities somebody has to keep track of their medications somebody has to remind them to bathe and sometimes they have to be bathed and dressed appropriately because of course this is because of a memory problem because sometimes they are frail or they are very weak or they have physical disabilities due to arthritis or they shake because of Parkinson's disease or they have hemiplegia they have paralysis due to stroke but these ones are really purely because of a memory problem but remember that there is no cure for dementia it's a little bit confusing about this study that was presented in congress claiming a health research by group of scientists trying to identify the toxin of spiders to cure dementia and I was listening intently and a congressman doctor asked are you sure that is a cure for dementia? cure for dementia it can only reduce the rate at which a person deteriorates but eventually the person will go through all the stages until the person is very dependent on all activities so there is nothing to reverse the condition the reason we give them medications is we want them to be able to hold on to what they can do so if at the moment they can still eat by themselves and bathe themselves then they can hold on to that longer with medication and also the behavior is they are more amiable they are easier to care for if they have medication but that is only as far as we can give what medication for example? we have colonist race inhibitors for memory so those are dunepazil, revastimin and galantamin and we also have NMDA receptor antagonists like memandi certain drugs that we give depends on the patient there is no single formula so we have to look at the patient and evaluate a patient individually and caregiver support is very important because sometimes it's the caregiver that needs more of our help than the patient what I'm getting is healthy lifestyle healthy aging and be active and to be as to be able to function the longest possible we really need more time to discuss the elderly and the aging but I'd like to request our resource speakers now to maybe give a message to our viewers we'll start with Dr. Shelley so in order to be healthy be functional throughout your lifespan do try to take care of yourself eat healthy be active physically be involved in community and with your family and make sure that you have a goal you know why you are here in this world because if you know why you are here and what you can contribute to the world then you will be able to age gracefully and be more healthy for as long as possible I think prevention is so much better than cure we should do everything in our power to try to prevent dementia via the risk factors and prevention strategies that we discussed earlier but also if you think you already have memory decline you should consult whether you are just not sure of yourself or you're doubting it because there might be other reasons why you are having it let us evaluate you and give you a proper diagnosis so you will be guided accordingly our discussion is really very interesting and we are glad that our audience is hearing this maybe for the first time but we have to say goodbye for now let us have the final message for our guests one word live healthy promote lifelong learning we will all face the inevitable in the future it is good that we understand the changes that will occur in our mind and body we should know what to do when we experience geriatric issues and senility I hope those who will care for the older persons have also benefited from this episode we hope that the families or households with older persons have listened to our resource persons so that we so that we can fully understand them and we know how to respond to their needs I hope you have found this episode relevant and live healthy and healthy