Same Problems are Worldwide for Indigent Elderly

Age-related diseases and physical changes are expected as people get older, but diseases can be more intense and difficult to manage if the patients are poor.

"A huge similarity exists in health care around the world in aging populations who are indigent," explains Dr. James N. Kvale, a professor in the department of family practice and community medicine at The University of Texas-Houston Medical School.

"Whether it is the East Side of Houston or the rural areas of India, the problems of nutrition and access to health care are the same," he says. "On the East Side of Houston alone, at least 20 percent of those over 65 years of age are at or below the poverty level," he points out.

Dr. Kvale and the other UT-Houston geriatricians cannot solve all the problems but they have worked hard to develop home care in the Acres Home and Settegast communities. Patients who are not able to get to the health center are identified and are seen at home. The medical residents have one to two patients they follow and are responsible for maintaining a relationship, whether it is in the clinic setting or home setting. Before this home care program was created, the instruction that the residents received was only hospital-based.

As director of the Geriatric Fellowship Program in the department, Dr. Kvale has been instrumental in developing a curriculum and clinical experience that educates family physicians in caring for old people. He sees patients in two Harris County Hospital District health centers, Aldine and Settegast, as he mentors medical students, residents and fellows and teaches them to care for this aging population.

A primary focus of the health care in the geriatric program is the management of chronic disease including diabetes and its complications, carotid artery disease, stroke, arthritis, and malnutrition. Other problems with the elderly are repeated falls, hip fractures, incontinence, and dementia.

"Obesity is also a problem among many patients, who do not realize that a consequence of this weight gain is rapidly deteriorating joints, such as the hips, knees and ankles, because of the weight the legs must carry," observes Dr. Kvale.

Health concerns of the elderly patients include: medications and what each one is supposed to be doing; joint aches and pains and `why do I have them'; and `why do I wake up in the middle of the night short of breath?'

Among male patients, concerns about sexual dysfunction are common. "I explain to the men that this problem begins in the late 50s, sometimes earlier, depending on what diseases they have and what medications they take. Diseases that have the most impact are diabetes and prostate cancer," says Dr. Kvale.

The main concern of women is social support. An elderly woman may be living alone and not have any family in the community. Families bring in elderly members and ask questions about available sources of help. Social workers at the health centers can be helpful with these concerns.

For all people who are aging, Dr. Kvale has three healthy hints: eat a balanced diet including fruits, vegetables, some meat, breads and pasta, beans and lentils; do some form of exercise every day; and stay connected to other people whether it is family, friends or church.

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©2006 Texas Medical Center

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