On March 20, ’2021, Seniors Today hosted its weekly Health Live webinar series with Dr Roop Gursahani and Dr Rajam K Iyer as they spoke and answered about Palliative Care for Neurological Conditions. Dr Noor Gill captures the takeaways from the session.
This was the second in the Seniors Today series of Health Live sessions focusing on Palliative Care for Senior Citizens. Leading neurologist and epileptologist Dr Roop Gursahani joined leading Palliative Care and chest specialist Dr Rajam Iyer to answer questions from Seniors Today readers on Palliative Care for Neurological Conditions – What can we Know and Do More Together. Dr Roop Gursahani is a Consultant Neurologist and Epileptologist, at the PD Hinduja National Hospital, Mahim and Hinduja Healthcare Surgical, Khar, Mumbai. He is trained at GMC, Nagpur and GMC and Sir JJ Hospital in Mumbai. Dr Rajam K Iyer is a leading Chest Specialist and Palliative Care Physician. She is attached to the Bhatia and Hinduja Hospitals in Mumbai.
Here are the takeaways from the session:
- India is slowly becoming a greying nation and by the year 2050, there will be a sharp rise in the people between the age groups of 60-80-year-olds.
- Studies show that people above the age of 65 years usually suffer from one or two, if not more chronic illnesses, of which neurological conditions are high on the cards for senior citizens.
- Palliative care includes not just end of life or terminal care measures- which are of course a part of palliative care. It also includes making the journey comfortable, from the diagnosis to the end of life and also address health related suffering not just for the patient but for their family and close relatives.
- Palliative care is of importance in patients with neurological conditions because:-
- These conditions affect the patients for a long period of time.
- They live with a high symptom burden for a prolonged duration of time.
- The suffering that the patient and their family undergo is not just physical but also emotional, psychological, social and financial.
- Common neurological conditions that in Dr Gursahani’s personal experience have been difficult for the patient and their family and have required palliative care are:-
- Patients with paralytic strokes, especially the ones that reoccur and deteriorate the patient’s condition
- Head injuries
- Spinal cord injuries
- Cancers of the nervous system
- Cancers from outside the nervous system but metastasising to it, are amongst some of the many other neurological conditions that require palliative care.
- With chronic and terminal illnesses, the family is usually put on the spot and asked to make the decisions, even though they are serious medical decisions that should not be made without having and gaining full knowledge of the situation. And this is a situation where a doctor’s practical training in palliative care can come handy.
- In case you’re a senior citizen worried about falling sick – ageing is inevitable and age is just a number. It all depends on how well you look after your body. And the most important factor is exercise.
Even for dementia, there have been studies which have come to the conclusion that the brain circuitry that underlies walking is the same brain circuitry that is used in memory and thinking- so, if you can walk briskly for 30 minutes every day, you are good. You can always get in more exercise, there is no restriction on that. Under proper supervision you can even do weights, tai chi and yoga. Other lifestyle changes and modifications such as keeping your weight under control, avoiding smoking, consuming alcohol within acceptable limits, having a positive attitude – all these things go together and have a positive influence.
In terms of medical attention- you need to have easy and quick access to a general physician or a family physician in your neighbourhood who knows your health and other conditions and medical history. Also see that you get regular checkups. Keep touching base with your doctor every six months to get a preventive checkup.
- Sometimes a patient who is severely sick, comes into the ICU and the patient is not conscious or in a sound state of mind to make decisions for himself and the family also does not know or is unaware of the patient’s wishes, then the doctors and the medical staff are duty bound to do everything.
In this case, and to avoid being caught up in such a situation, you need to put these directions down on paper and identify 3 people who will be easily accessible and also depending on their willingness to support you, put them down in a sequence of availability, accessibility and priority and have them sign your wishes. They have to be there at the time to be able to guide the doctors as to what the patient wanted and did not want.
You need to document your wishes and you need to identify people who will ensure that your wishes are carried out.
- The wishes are the “living will”
- The three individuals are the “health care proxies”
- The whole thing coming together is called the “advanced medical directive”
- “The 36 Hour Day” is a book Dr Gursahani recommends for family members and caregivers for individuals suffering from dementia.
- Some things you need to keep in mind before you take a patient with a chronic or a terminal illness home:-
- The first thing you need to understand is the need of the patient and the family
- If the family and the patient will be able to cope with taking care of the patient
- Hiring help- skilled or unskilled
- Size of the house
- Accessibility to the hospital and a doctor or the family GP in case of any emergencies
- Family dynamics
- The family GP needs to be informed of the patient’s conditions and the goals of their palliative care
- The GP is also given a whole algorithm of how to control difficult conditions and situations that might arise- to empower him with the knowledge of what to do in case an unlikely event arises.
- The Indian Association of Palliative Care, on their website, has city-wise doctors enlisted on their site where you can find palliative care practitioners and centres. www.palliativecare.in
There are a lot of private centres and facilities for patients with dementia- these include in care services, out care patients and home care facilities.
- Parkinsonism is another neurological condition where palliative care has a role to play. 85-90% of Parkinsonism is the standard form which is called the idiopathic form which is also called the Parkinson disease which responds to medications for a fairly long time. In today’s day and age, medical professionals believe that an individual with Parkinson’s disease should be able to live almost their entire life. Things will however be difficult in the end but they can be managed and the patient be made more comfortable.
But there is about 10-15% of the population who has what is called the Parkinson plus syndromes. In individuals who have Parkinson plus syndromes, includes other degenerative changes in the brain apart from the Parkinsonism. Very often these patients have dementia, behavioural symptoms, etc. For such conditions there are specialists who specialises in movement disorders.
If you have any questions for Dr Roop Gursahani and Dr Rajam K Iyer on Living Wills and Palliative Care in general, please write to firstname.lastname@example.org. Dr Gursahani and Dr Iyer can be reached for a tele-consult via Hinduja Hospital (https://www.hindujahospital.com/). Dr Iyer is also reachable via Bhatia Hospital at https://www.bhatiahospital.org/