With population ageing long becoming a matter of concern in Hong Kong, so has the wellbeing of senior citizens. "Currently, roughly 13 in every 100 persons are senior citizens in Hong Kong, and over 60% of patients in public hospitals are senior citizens," said Dr Felix Chan, former President of The Hong Kong Geriatrics Society and current member of the Elderly Commission. "One thing I often tell my students is that future recipients of their medical services will predominantly be senior citizens, whether they wish to pursue a career as a specialist or a general practitioner."

While public hospitals generally categorise geriatrics as a branch of medicine and medical care for senior citizens that are 65 years old or above, Dr Chan pointed out that it doesn't mean geriatrics is the only branch of medical practice you can consult once you have reached the age of 65. "Geriatrics is a subspecialty of medicine that focuses on patients suffering various kinds of degenerative diseases. According to Bernard Issacs, an innovator of geriatrics, this subspecialty can be broadly characterised by the four main symptoms of: incontinence, intellectual impairment, immobility and instability, and iatrogenesis (harm caused by diseases, adverse effects or complications as a result of medical advice, medical process, medication therapy, or medical device)," explained Dr Chan. "There are three reasons geriatrics was founded: (1) senior citizens may suffer from dementia or memory loss and therefore unable to articulate their condition – the same reason for the need for paediatrics; (2) some senior citizens are afflicted with multiple diseases, including ostensibly less severe ones that could have arisen from complicated causes, which therefore call for the necessary examination and follow-up by professionally trained medical practitioners that understand the physical and psychological needs of senior citizens; (3) senior citizens may be taking multiple medications – a past patient of mine was on over 20 medications at a time! – and it is one of the major responsibilities of a geriatrician to make a prescription where there is no drug duplication or incompatibility, and where the least amount of drug can effectively ameliorate the disease."

Look for the Symptoms

One of the biggest challenges faced by geriatricians is locating the causes of diseases, said Dr Chan. "Medical treatment is often delayed when senior citizens fail to articulate the symptoms because some of them see seeking medical attention as a taboo, while some fear becoming a burden of their family or simply refuse to disclose such personal information to the younger generations. For instance, the majority of male senior citizens suffer frequent urination as a result of enlarged prostate, but in seeing this as an embarrassment these senior citizens have delayed seeking medical attention – a patient of mine thought cutting down on water consumption and social activities was a solution, and in the end he was diagnosed with acute urinary retention. In addition, with the lack of dairy products in the Asian diet and lack of exercise, female senior citizens tend to suffer osteoporosis as a result of vitamin D deficiency, which could lead to osteoporotic fracture if they fall. High blood pressure, meanwhile, is also an illness that is oft-neglected by senior citizens because it is a symptomless condition; by the time the patient experiences dizziness and vision problems, he or she is already in dire condition – some senior citizens were only hospitalised and treated when they had a stroke or heart attack as a result of neglecting symptoms of high blood pressure," said Dr Chan. "While geriatricians will diligently perform observation and diagnosis, families of senior citizens also need to pay attention to their dietary changes, and accompany them to their regular body check-up."

"Physiology aside, emotional distress is also commonly experienced by senior citizens, with reasons including long-term illnesses, pains, the loneliness felt after their offspring have grown up and left home, inadequate financial support as a result of poor retirement planning, or witnessing the death of their cohorts one by one. Without proper care, emotional distress could worsen into depression," explained Dr Chan. "In addition to medication, we would also encourage senior citizens to participate in social activities to make new friends and expand their social life."

Your Health is Yours to Maintain

You may have already heard of these tips on health umpteen times, but they surely are the golden rules: maintain a routine of balanced diet, regular exercise and body check-up, vaccination if necessary, and refrain from smoking and drinking. "I can't stress more the importance of alcohol abstinence, as alcohol consumption is highly correlated with colorectal cancer, which has taken over lung cancer to become the number one cause of cancer deaths in Hong Kong," said Dr Chan. "There may have been research showing the cardiovascular benefits of moderate red wine consumption in the past, but it goes without saying that long-term alcohol consumption is harmful to the liver and kidney, and the World Health Organization has already classified alcoholic beverages as a carcinogen."

Equally important in health maintenance is consultation with the same general practitioner over time. "Hong Kong's healthcare system divides the market into public and private services, with about 90% of patients choosing public hospitals for hospitalisation, and 70% of patients choosing private medical practitioners for outpatient service. Unlike public hospitals where technology was harnessed to create the PPI-ePR (Electronic Patient Record sharing Pilot Project), private medical practitioners do not have a shared patient record system. So it's best for senior citizens to pick a general practitioner they are familiar with and often consult with, in order to avoid medication duplication, incompatibility or overdose, as well as to ensure standardised medication management and annual body check-up."

"Last but not least, self discipline goes a long way in health maintenance too," said Dr Chan. "Yourself, not your doctor, is the one you should count on in living a life of good health. It is wise to have your body check-up every year once you have reached middle age, and extra attention needs to be paid for those with a family history of hereditary diseases such as colorectal cancer and breast cancer; by all means have your Three Highs (high cholesterol, high blood pressure and high glucose) index checked every year to keep cardiovascular diseases at bay. Diseases are best tackled before they further worsen, so be a responsible senior and family member, and start building a robust foundation for stellar health to minimise the risks of diseases!"

Special Thanks:
Dr Felix Chan, former President of The Hong Kong Geriatrics Society and current member of the Elderly Commission