Adamson S. Muula 1,2,3
- Head, Department of Community and Environmental Health, School of Global and Public Health, Kamuzu University of Health Sciences, Malawi
- Editor-in-Chief, Malawi Medical Journal
- President, East, Central and Sothern Africa (ECSA) College of Public Health Physicians
I belong to the category of medical students whose initial in-call education and training were largely focussed on the period from conception, birth and stopping at age 50 years or thereabouts. I do understand of course that not everything can be taught in the undergraduate or even postgraduate curricula. Having completed much of my clinical attachments in Malawi, the focus was on all sorts of communicable diseases, surgical emergencies and injuries and obstetrics and gynaecology and what may be described as diseases of poverty.
While I raise the apparent omission of the curriculum which I was exposed to as an undergraduate, it (the curriculum) exposed us to key knowledge, attitudes and clinical competencies that prepared us for general medial work within our country and the region, as well as postgraduate education and training in clinical medicine, basic sciences and health service sciences. We were also introduced much early on to continuous individual study and group Continuous Professional Development (CPD. I however do not recall that we were intentionally introduced to gerontology or geriatrics. Yes, prostate cancer, Parkinson’s disease, osteoporosis. hypertension and strokes were taught, but not with a clear gerontology and geriatrics lens. Such lens would have provided us the opportunity to be introduced to the multi-faceted and multi-disciplinary disciplines of gerontology and geriatrics. It is possible the low life expectancy at birth at that time, way below 50 years, did not provide much encouragement to the teaching and learning of gerontology and geriatrics when living longer was impossible for the majority of our people. Malawi’s life expectancy at birth has improved significantly by at least 20 years in the past 20 years.
Gerontology is the study of aging and older adults. It is a multidisciplinary field of study and practice that incorporates knowledge from biology, psychology, sociology, medicine, and other disciplines to understand the aging process and promote healthy aging. In many countries, older adults are those 65 years and above. As an approach however, even persons younger than 65 years may benefit from gerontological approaches. It is estimated that 2.7% of the Malawi population are those 65 years above thus making the total number to be between 550,000 and 700,000.
Subfields of gerontology
Although gerontology is best practiced in an integrated manner, the following are its sub-groups:
1. Biogerontology: this focuses on the biological aspects of aging, including the study of aging cells, tissues, and organs.
2. Psychogerontology: this examines the psychological aspects of aging, including cognitive aging, mental health, and social relationships.
3. Sociogerontoloy: this explores the social aspects of aging, including demographics, social policies, and ageism.
4. Geriatric medicine: Focuses on the medical care of older adults, including the diagnosis, treatment, and prevention of age-related diseases.
Medical students and practitioners may need to have some background in all of these sub-disciplines.
Geriatric medicine
Geriatrics medicine (in short geriatrics), on the other hand, is the branch of medicine focused on the health care of older adults. In some countries, geriatrics is an established postgraduate specialisation or sub-specialisation for internal medicine doctors. Several of the principles of geriatrics are similar to Family Medicine/General practice. These are:
1. Comprehensive assessment: A thorough evaluation of the older adult’s physical, functional, and social abilities.
2. Patient-centered care: Care that is tailored to the individual’s needs, preferences, and values.
3. Interdisciplinary team care: Collaboration among healthcare professionals, including physicians, nurses, social workers, and therapists.
4. Prevention and early intervention: Emphasis on preventing age-related diseases and disabilities, and intervening early to minimize their impact.
Geriatric Syndromes
A person aged 65 years and above can be at risk of all the other medical conditions that others in the same sex and geographical settings (largely excluding pregnancy and obstetric conditions). There are however specific syndromes that are much more common among geriatric individuals compared to the rest of the society: These are:
1. Falls: A major cause of morbidity and mortality in older adults.
2. Dementia: A progressive decline in cognitive function, affecting memory, thinking, and behavior.
3. Depression: A common mental health condition in older adults, often underdiagnosed and undertreated.
4. Urinary incontinence: Loss of bladder control, affecting quality of life and social interactions.
Gerontology and Geriatric Care Challenges
1. Aging population: The growing number of older adults increases demand for geriatric care services.
2. Complexity of care: Older adults often have multiple chronic conditions, requiring comprehensive and coordinated care.
3. Workforce shortages: Insufficient numbers of healthcare professionals with geriatric training and expertise.
4. Healthcare system fragmentation: Lack of coordination and communication among healthcare providers and settings.
A call to action
We suggest that time has come for Malawi to consider deliberately strengthening its pre-service and in-service education and training curricula for health professionals in gerontology and geriatrics (for medical doctors and nursing and allied health professions). Older citizens should not receive healthcare solely designed for children, maternity and young adults. As our population is ageing, and the demand for care is increasing there is also need to aggressively intervene to reduce, if not eliminate altogether, ageism. Ageism is defined as discrimination against older adults. In addition, there is need for community programmes addressing the following:
1. Healthy aging programs: to promote healthy behaviours, such as exercise, healthy eating, and stress management. I am not oblivious to the challenges that these prescriptions may encounter within an environment of subsistence farmers, many of whom can barely mobilise enough food to eat and economic challenges are perhaps among the harshest in the world.
2. Cognitive training: aimed to improve cognitive function, particularly in areas such as memory, attention, and processing speed. Again, we would need to domesticate this in an environment where the majority of the older people have barely completed elementary school.
3. Social support interventions: focussing on building and maintaining social connections, reducing social isolation and loneliness.
4. Age-friendly environments: Design communities and environments that support the health, safety, and well-being of older adults.
Time has come for Malawi to build from its various gains in the medicine and health services and research.
Bibliography
- Stambler, I. Recognizing Degenerative Aging as a Treatable Medical Condition: Methodology and Policy”. Aging and Disease, 2017; 8(5): 583–589 doi:10.14336/AD.2017.0130
- Soares JP, Cortinhas A, Bento T, Leitão JC, Collins AR, Gaivão I, Mota MP. Aging and DNA damage in humans: a meta‐analysis study. Aging (Albany NY). 2014;6(6):432-9. doi: 10.18632/aging.100667. PMID 25140379; PMCID: PMC4100806
- Putney, Norella M.; Alley, Dawn E.; Bengtson, Vern L Social Gerontology as Public Sociology in Action. The American Sociologist, 2005, 36 (3). 88–104.
- Vicky RN Theories of Aging (Part 3) – Sociological Theories. Retrieved Friday, April 20, 2012, fromhttp://allnurses-breakroom.com/showthread.php?t=412760
- Andrews, GJ.; Phillips, DR. Aging and Place: Perspectives, Policy, Practice. London: Routledge, 2005. p.272.ISBN 978-0415481656.