Elderly should also continue physical activity with the right guidance and medical advice

Health Care, Heart Care Foundation of India, Medicine Comments Off

Physical disability is one of the major issues faced in old age

New Delhi, 22 March 2019: Recent research shows that in India, there has been an increasing feminisation of disability conditions, in absolute and relative terms; elderly women spend more years of life in a disabled condition than Indian men do. The prevalence rate is much higher among widowed women, and the poor and the illiterate elderly. In addition, people with diabetes have a higher chance of being disabled.

As per the World Bank data on the total number of persons with disabilities in India, the number stands between 40 and 80 million. Disability research has not gained momentum in the country. A challenge for systematic research is the lack of appropriate data. Despite censuses and surveys collecting information, there is hardly any consensus on the real burden of disability, especially among the elderly.

Speaking about this, Padma Shri Awardee, Dr KK Aggarwal, President, HCFI, said, “Heart disease, dementia, diabetes, arthritis, cataract, sleep problems, depression, anxiety are some of the common health conditions prevalent in the elderly. And, most of these conditions co-exist, giving rise to polypharmacy, which has its own associated set of problems. In addition to these are the issues of disability, financial insecurity, isolation, loneliness, neglect. Left alone at home, they are also exposed to crime. From being usefully occupied for most part of their lives, they find themselves with plenty of time on their hands post-retirement. Hence, the challenges are not just health related but also economic and social. This is a vulnerable group and need to be looked after. They can still contribute to the society. By neglecting them, we are losing out on their skill and years of experience.”

A study by authors, from Stanford University School of Medicine, published in the Archives of Internal Medicine has shown that being active reduces disability and increases survival. Research indicates that older runners live longer and suffer fewer disabilities than healthy non-runners. This observation applies to a variety of aerobic exercises, including walking.

Adding further, Dr Aggarwal, who is also the Group Editor-in-Chief of IJCP, said, “One should take lessons from Yudhishthir in Mahabharata who walked till his death. However, a word of caution: if an elderly is walking or entering into an exercise program, he or she should have a cardiac evaluation done to rule out underlying heart blockages.”

“Article 41, a Directive Principle of State Policy, provides that the State shall, within the limits of its economic capacity and development, make effective provision for securing the right of public assistance in cases of old age. The Maintenance and Welfare of Parents and senior Citizen Act, 2007, also known as “Senior Citizens Act” explicitly states that it should be the duty of the children to maintain their parents.” (Press Information Bureau, October 1, 2015).

“Forget me Not” is a campaign proposed by the Indian Medical Association (IMA) for the elderly population enabling them to lead a healthy and productive life with dignity. Doctors need to be trained to take care of the special needs of the older people. As doctors, we should not only provide them medical care, but also be a support to them.

Rs 36 lakh awarded as compensation for medical negligence

Health Care Comments Off

Is it always negligent to miss a significant fetal anomaly on a routine ultrasound scan at 20 weeks?

Consumer Commission Order

Judges: Retired Justice Sunil Hali and retired District and Sessions Judge DK Kapoor

Complainants: Seema Kumari and her husband Atish Kumar

Allegations

Dr KC Sharma and his wife Dr Uma Sharma were running an ultrasound scanning centre and nursing home at Udhampur “without adequate qualification, expertise and recognition from Medical Council of India”.

Missed

Hydrocephalous; it could have been detected earlier, if the sonographers/sonologists were experienced and suitably qualified.

Expert’s opinion

Dr Manisha Langer, a qualified radiologist, told the commission that myelomeningocele can be detected by ultrasound within 15 to 16 weeks of pregnancy. The detection rate improves after 24 to 25 weeks.

Result of missed diagnosis

The pregnancy could not be terminated

Compensation awarded

Rs 20 lakh compensation to the couple for medical treatment; out of this, Rs 15 lakh to be kept in a fixed deposit for the child. Rs 15 lakh was awarded as compensation on account of pain and suffering undergone by the parents, and Rs 1 lakh as litigation charges.

Discussion

Sonographic diagnosis of open spina bifida typically occurs during the second trimester of the pregnancy.

Modern ultrasound equipment is undoubtedly capable of producing images that allow diagnosis of anomalies such as open lumbosacral spina bifida or atrioventricular septal defect. However, such diagnoses can only be made if considerable operator skill is combined with knowledge and experience.

In most cases the diagnosis of clinically significant fetal anomalies is quite straightforward, but evidence suggests that false-negative results occur regularly.

For example, European Surveillance of Congenital Anomalies (EUROCAT) (Ultrasound Obstet Gynecol. 2005;25:6-11) quotes a prenatal detection rate for spina bifida of only 68%, whilst a recent systematic review (Health Technol Assess. 2000;4:1-193) reports a detection rate for AV septal defect of just 42%. So, 32% doctors can miss the diagnosis at 20 weeks.

Was missing the diagnosis negligence?

Is it always negligent to miss a small open lumbosacral spina bifida (below L3) at a routine 20-week scan without extenuating circumstances (obesity, oligohydramnios)?

About 62% of experts state that it is not negligent to miss such a lesion.
24% say it is not negligent to miss a small spina bifida provided there is documented evidence of normal intracranial anatomy (absence of head signs).
Only 4/29 experts will say that such an anomaly should always be detected.
Was termination the choice if the diagnosis would have been done before 20 weeks?

No. Spina bifida is a manageable condition. It is not an indication of termination by itself. Higher lesion level, larger segment span and an inter-pediculate distance greater than 10 mm are associated with poor recovery.

What was the cause?

Probably folic acid not taken by the mother before the conception

Legal points

Doctors should take informed consent from the patient that ultrasound can miss the diagnosis.
Was she and if not, why was she not given folic acid?
If she was not on folic acid, then why was the ultrasonologist not alerted to specifically look for spina bifida?
One expert cannot be relied upon, if other experts or opinion say it otherwise.
Answer: This judgment should be challenged

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA