Geriatrics: Taking a specialised and holistic view of senior care
By Arunima Rajan
In an interview with Arunima Rajan, Dr Aarthi Kannan, Consultant Geriatrician who leads the geriatric clinic at PD Hinduja Hospital in Mumbai, says ageing is a profoundly personal experience, yet it is often treated as a series of medical events to be managed.
Imagine a 74-year-old stroke survivor who lives alone, having lost both her husband and child. She suffers from multiple comorbidities - diabetes, kidney issues, and a recurring urinary tract infection. Attending regular consultations is difficult, and coordinated long-term care seems out of reach. Instead, she relies on hospitalisation every few months, simply because it allows access to multiple specialists in one setting. On the other hand, healthy older adults are eagerly looking for a doctor to guide them on aging well and living with independence. This is precisely the kind of gap that geriatric clinics are designed to fill. P.D. Hinduja Hospital in Mumbai recently launched a specialised geriatric clinic to address this gap.
“People often don’t understand what a geriatric clinic is because the terminology is unfamiliar,” says Dr. Aarthi Kannan, Geriatrician, who heads the newly launched Geriatric Clinic at PD Hinduja Hospital in Mumbai. “Just like paediatrics once had to be explained, geriatrics is at that early stage of awareness. To simplify it for our patients, we use the tagline in our hospital: “Geriatric Clinic: Complete Specialised Senior Care.”
“In a typical consultation, time is limited. We want to do everything - but we must prioritise what matters most to the patient,” Dr. Aarthi explains. “A comprehensive geriatric assessment (CGA) is valuable, but it is not always necessary during the first visit.”
What is a geriatric clinic?
Dr. Aarthi explains that a geriatric clinic functions as an integrated service that manages the various needs of older patients. “Each speciality has its focus and brings immense value. Cardiologists take care of heart-related issues. The nephrologist looks after the kidneys. The diabetologist or endocrinologist manages diabetes, thyroid and hormone issues. The surgeon addresses surgical problems. More often than not, these multiple medications can interact poorly. So much so that approximately one in every six emergency room visits in the US is related to medication. We don’t have these statistics for India, but it would be reasonable to assume the rates are similar. If 16 per cent of ER visits in those aged 65 and above could be medication-related, it means we have the potential to address something very preventable. Emergency rooms visits can be expensive, distressful and disruptive - if we can prevent them, why not?
She recounts a case where a patient with heart failure was on fluid and salt restriction. A general practitioner prescribed Isabgol for constipation, which requires a high water intake. The result? The patient loses appetite and more importantly, exceeds fluid limits, leading to complications like a heart failure flare up, landing them in the hospital again. “Even safe and well-intended medications can lead to these issues when the patient has multiple issues warranting multiple medications,” she notes. “For the patient, the cumulative effect can be dangerous. And preventable.”
Though ageing is a profoundly personal experience, it is often treated as a series of medical events to be managed. Moreover, elderly patients can have a decline in their function after each hospital admission. Every step down can be permanent. We don’t want that. We want to minimise it and be proactive. In every treatment that we give our older adults, let us always remember that independence is what every older adult desires.”
For optimal outcomes, geriatricians work closely with a geriatric physiotherapist, social worker, a pharmacologist or clinical pharmacist, and a geriatric outpatient nurse.
Rising UTIs
Dr. Aarthi also notes a rise in multi-drug-resistant urinary infections, especially among elderly women. “Simple hygiene practices, like wiping front to back or avoiding communal jet sprays or hand sprays in public washrooms, can make a big difference,” she says. “Post-menopausal women are particularly vulnerable due to physiological changes. Education, early diagnosis, and cautious, medically supervised use of cranberry supplements (in patients who can safely take them) and antibiotics are key.”
Elder-friendly spaces and care
“Hospitals must be designed to be elder-friendly - just as they should be for pregnant women or people with disabilities,” says Dr. Aarthi. She points out common challenges: vision, hearing, mobility, safety in toilets, slippery floors, and confusing layouts. “We must rethink the elderly patient’s entire journey - from leaving home to reaching the consultation room.”
“Teleconsultations have transformed care delivery,” she adds. “In many cases, I can evaluate the patient remotely while a caregiver brings the reports. This flexibility significantly reduces the burden on elderly patients.”
Start low, go slow
So, what is her guiding principle? “The core principle of geriatrics is: start low, go slow. Whether it is medication or exercise, we begin with small steps and scale gradually. With older patients, slow is fast - you get better outcomes by being cautious and deliberate.” she concludes.
Dr. Aarthi Kannan’s Guide to Healthy Ageing
Healthy aging is a community effort as much as it is an individual effort.
Start with micro-level changes at home and in the community.
Social isolation is a critical issue - many elderly people are left alone with no support system. Depression reduces motivation to eat well, stay active, or take medication. Even stepping out for a 15-minute walk daily can change one’s sense of well-being. Community support is essential - social, financial, and medical. We need to help each other out - elders for elders. Neighbours for neighbours. Children for parents.
Healthy ageing requires both health and financial stability. Lacking either can severely limit quality of life. We need more older volunteers and younger adults to come out and help people with retirement planning and healthy engagement.
Healthcare costs are rising. Policy changes are crucial in addressing this. Whether it is addressing supply chain costs or roadblocks for the elderly with dependable and widely accepted insurance coverage, this change needs to occur.
At a system level, we need geriatric-focused care. We need passionate and well- trained geriatricians who really focus on muscle strength, fall prevention, frailty, preserving cognition for cognitively healthy adults and addressing polypharmacy: through longer appointments, frequent preventive follow ups, and more attention to age-specific concerns. We need more discussions around healthy aging.
The 5Ms of Geriatric Care
Mind: Prioritise mental health, mood and memory/cognitive function.
Mobility: Maintain independence through daily and consistent movement.
Medication: Regularly review for unnecessary or harmful drugs.
Matters: Understand what truly matters to the patient - like attending a grandchild’s wedding, not just clinical outcomes.
Multi complexity
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