everybody and very good afternoon from Manipal Hospital in Ualga. Today we are here to tell you about the topic of 60 years and going strong and I have Dr. Yashaka Videsa, Dr. Gauravrasthavi and Dr. Raghia from different specialities of OBG Guyanese orthopedics and physical therapy. As of now I'll be introducing Dr. Yashaka Videsa who is the HIT of Obstetrics and Gynecology department. Hello. So over to you and we shall just start with the presentation and enlighten the audience about how to take care of them after 60 years and be strong. Good afternoon everyone. So we are going to talk on a very up to 60 years and going strong. As we know the population here in India beyond 60 is increasing day by day so we have to really take care of all the people who are above the 60 years of age. So there are a few aspects on which from a doctor's point of view and especially a gynecologist's point of view what all things you should take care of. So that is what I'll try to focus on. Next slide. So we all know prevention is better than cure. So the life first of all I'd like to tell you that life begins at 60. That the last 59 years have just been a practice. We all know that we have learned a lot and now we have to start our life because we know everything about the life. But still there are some mistakes which we are doing like any of the people above the age of 40 who should go for health checks are not going for health checks.  We also know that we should all do do walks, yoga, exercise to strengthen our bones, our muscles and to get fresh here. So please continue doing who are doing and who are not doing please start it. Don't postpone it for tomorrow. Start it from today though we know that during COVID you are not able to do it for but still in many societies they have started allowing it. So you can take a walk with full precautions of mask and sanitization. Then you should take your medications if somebody has diabetes, somebody has sugar, somebody has BP, somebody has cholesterol. So they should take their medicines in time. The problem which at the age of 60 people face is that they are not able to forget in the time of the medicine. They don't know how to maintain their charts and when to approach a doctor. First of all you should what my advice will be you should have some boxes kept ready if there are some young people at home they should help their elderly they should make some boxes for morning evening and night and put the medicines there so that they should not delay their medicines because somebody who's hypertensive they miss their medicine they can have a high BP. So the same way and somebody at house who is there even grandchildren remind their grandparents if they are forgetful your medicine is due especially people who are on insulin their medications should not be missed. They should take good sleep. This actually is a little funny to say because most of the people and old age start sleeping very less or they have a little problem in initiation of sleep or maybe they have lots of interruptions in their sleep because of urination, stress or because of many other reasons with age usually the sleep pattern disrupts and the sleep requirement also decreases a lot. But if you have a healthy abdomen, healthy bowel system and you are exercising and then there is no problem in sleep so first of all you should have a good bowel movement and your sleep is not disrupted and tired yourself a little bit do some type of exercise then you will have a good sleep. Healthy diet we all know what is healthy diet and what we should eat fruits everything. Scarmohydrates should be decreased proteins should be increased our diet proteins is important for everyone young children pregnant ladies and the elderly. So these three age groups they should always take a lot of proteins in their diet so please do it so that you will not get sick we're talking about prevention here so please start taking the proteins any disease you have if you have not taken care of it for you know that you have a little heart problem or you have some problem in your leg in your knees you have maybe a little bit of osteoarthritis but you are still not going to the doctor because you are scared if you will go that she will detect some other disease with you so please don't do that get yourself treated because once the disease spreads a lot and damages the organs then that the treatment becomes very complicated. So if treated early you can get treatment with exercise also you can get cured with minimal medications you can get. If somebody has some sexual dysfunction at this age usually patients suffer from some or the other they can always approach the doctor people are usually very ashamed of talking about such things sometimes the female partner doesn't is not interested sometimes the male partner is not interested but if both the partners have a little bit of interest they should talk to the doctor and solve those problems they should if somebody is drinking smoking and some addiction they have they should decrease it so because it's not the age when you should be continuing with those addictions and my request to most of the people because I even I have parents who don't have insurance so I would tell all my elderly people and their children if they have insurance in their offices they should take insurance for their parents I have taken my insurance for my parents also so take health insurance as early as possible children who are young and joint jobs they should ask their parents to take insurance give their parents insurance so that whenever they are sick in future they don't have lots of problems why we need to take care at 60 why are we talking about this topic right now why was it not needed earlier because we all know the quality of life has improved so much though we talk about a lot of pollution and we talk about so many diseases coming up but we still know the quality of the life life expectancy in our country has increased we have seen our grandparents and many other people and early they are they used to die at 40 and 50 but now right now even at 60 and 80 they are still there with us and we are taking good care of them and they're healthy and we expect them to stay with us for a long time so we because of the expectancy increases increasing we take care of our elderly and we should take care of our health health it's not that after 40 50 or 60 we are bedridden we should at least have that much of capacity to take care of ourselves very well so and we want and everybody who's elderly who's children are out of India who are children are settled somewhere else they're staying alone they have to take care all the needs of the family the the marketing the shopping the home and all the care everything has to be done by this couple only so they have to be healthy and active if they are not how will they manage so if one partner is sick at least the other partner should be healthy so that they can take care so they should prevent the falls they should take care of their partner be updated to the technology this is also a very important thing which I want all elderly to know because if I I have faced this problem like my parents they never wanted to change their phone they never wanted to upgrade their phones but nowadays you know everything is there you have online banking going to the bank at times can be difficult for elderly so these things are very safe if you have learned them properly so learn from your children and children who are listening to it should teach their children parents so that they don't have this problem and elderly should be very enthusiastic to learn it they should not say that it is think that it is a good so this is a chart which is I just to show you how at the age at the after the 40 age you see how our bones start deteriorating in this slide you can see there is rapid loss menopause after menopause and this slide is showing before menopause also we have this chart with us so this is showing that even before menopause after the age of 40 our bones start deteriorating a little bit and after 40 it is a sharp decline and so we should take care and after menopause especially it is a very sharp decline so please take care of your bones after the age of 40 perimenopausal also people start suffering from problems like mood swings, cramps, weight gain, nausea, irritability so you should meet your doctor and talk to her and some yesterday only I met a patient who was almost a case of premature menopause but she has been treated for a long time last two three years taking some medications having her periods and then again going back to no periods but nobody had yet investigated her and confirmed her diagnosis because if somebody has a post premature menopause they should get treated otherwise what will happen mid premature menopause is having menopause at a very early age that is less than 40 so what will happen our bones will start getting weaker before that so what you should do is you should meet your doctor and take hormonal therapy you should not avoid it hormonal therapy is for your good and not for your bad it might be bad for some patients that your doctor will decide whether you should not take hormonal therapy or you should take because there are lots of benefits with hormonal therapy then after the age of 45 when you are about to menopause the time is coming near when you are about to finish with your periods that is the time that hot flashes start coming people usually complain that there are a lot of sweating and they feel very heated up especially in the night time then they get up the whole body is full with sweat so this is a sign that you're having hot flashes they might have tachycardia and don't feel like eating anything so those things do happen and there is treatment for that few people have dryness and then after the age of 55 60 which we are talking is the osteoporosis stage which comes so and because the osteoclastic activity starts because doctor Gaurav and Afia will be taking care of the bone part so I will not be talking in detail about that so I just wanted to show you all these pictures you can see this first picture of the diet so this is what you have to take after the age of 40 all females especially males also have to take a lot of care of their bone health but especially the females they should take at least four to five six servings of milk products but it is not possible so at least two glasses of milk two categories of curd you and everybody you in every day you cannot take you can take lassi you can take cheese you can take paneer you can take chia seeds and lots of broccoli and all those these have folic acid mushrooms and then you have almonds so please and those who are non-vegetarian they should take fishes because it has omega-3 people who are vegetarian they should take super added omega-3 and some DHA products which are vegetarian are also come out in the market vitamin D is very important because bone health cannot be prevented just with calcium we need vitamin D and phosphates also for that so if required they should you should be given and your doctor will also prescribe magnesium is also deficient in most of our patients multivitamin is deficient in most of our patients and the care of this you can see this picture of how the bones start becoming porous porous is like a sponge so how dense the bone was the calcium starts deteriorating and becomes porous so what will happen if you have porous bone nothing will happen you will fall you will have a fracture otherwise if you fall what will happen you will not have a fracture you might just have a pain for some time you will be okay but if you have a very porous bone especially females they have lots of hip fractures and wrist fractures which is the most in the maximum area where the bone density weakens and then the skin everybody is working everybody is going to the office everybody wants to look young so skin care is also very important in the postmenopause mm was an H2 after the age of 60 so the treatment modalities hormone replacement therapy only after discussing with your doctor getting yourself investigated then we have management of urinary and rectal incontinence if you talk about urinary and rectal incontinence in India so it's the most underrated disease none of my patients will come to me with I will not say none few of them very few of them will come to this problem I have my urine leaks out or my motion leaks out but this is so common in most of our patients if I ask them a direct question you have this problem they say yes they have this problem people have stop being sexually active people stop going to social meetings gatherings because they are ashamed that they may have a urinary leak they may have a rectal incontinence they might have a lot of gas passing which is which will be uncomfortable but they never talk to the doctor and there are so many even in physiotherapy with kegels and lots of other methods even in yoga kapal bharti and many other diseases you can just cure a lot of a large part of urinary and rectal incontinence every person is not there needing a surgery only a very small group will need a surgery so you should go to a doctor they might be some some people have constipation so that is also leading to rectal incontinence and the passing of lot of gas and because of that pressure the vaginal area and the urinary area is collapsed so if they we solve that problem also a lot of it improves because as we said as the AV start aging after 60 our muscle mass decreases because of less of protein in there we are not exercising and the muscles of the pelvic area also start losing their strength so if we keep on exercising in that area like we exercise for our body parts but we are not exercising in that there might be a lady who's going to the gym regularly she's exercising all other body parts but maybe she's not exercising her muscles of the pelvic area so she might have urinary incontinence when she's lifting weights so we have to teach her that you should do this and that will treat her so the pelvic fold dysfunction is there then we have cancer prevention and treatments for cervical breast ovarian and uterine this is i'm talking about the female part in male we have prostate cancer which is there at the later age which is also has to be taken care though lung cancer mostly stays a very common cancer in the females also but cervical breast ovarian and uterine needs to be treated breast and cervical they have screening methods we can prevent ourselves from these two diseases ovarian and uterine i don't have a screening method uterine usually patients present with some or the other reading irregularity in ovarian which is can be silent but lot of ovarian screening tests diagnosis and technology advancements are taking place maybe in future we will have have something but still now there is nothing no diagnostic test for ovarian cancer then we have palliative care for people who are actually very sick and cannot be given any surgical modality so at home therapy just pain management therapy is there for them osteoarthritis we know lots of our elderly people have knee joint problems they're not able to walk properly with physiotherapy with exercise at least they can walk maybe they will not be running but they will be walking so please treat it at the earliest we have osteoporosis osteopenia so bone density geometry needs to be done to know whether our bones are really very weak because after the age of 60 Dr. Gauravil i think enlightening on that phosphates decreases so patients should be very sure about that they are taking phosphates and they are given phosphates by their doctors and some patients might need injectable for also some people might not need injectable so that has to be decided depending on your bone density and your levels and there are few patients i have come across they have been taking phosphates for a very long time without stopping and in that case the bones become brittle and if they fall they will have a fracture so please on your own don't take many patients come to us we should not take calcium that will cause stone but they are not they are taking phosphate they are taking other things and they are don't know what they should do but they are afraid of calcium what i feel is calcium tablets usually you take one tablet it is not even always 1000 milligram so even if you're taking one calcium tablet of 500 milligrams it is not going to cause stones in your body so please i think this is a myth that people think that if your doctor has specifically advised you your urologist not to take it then you stop taking it otherwise i think none of these patients choose to worry about the stone in the age after the age of 60 the mental health also is very important people might start having dementia Alzheimer's these are the diseases in which people are going for walks i am also very scared at times that my father might go for a walk and he might forget his way but right now he's healthy so not worried but they might be coming a time that this might happen so if we treat it at the earliest we do exercises and we meet our neurologist and take medications and multivitamins so this can be delayed maybe we cannot totally remove it from our life but it might happen not at 60 maybe at 80 but if it happens at 60 we can try to avoid it by taking medication in time then cosmetic care as we talked about that is required some people some females always want to look good some males also want to look good so they should also go for cosmetic care what is the major causes of death in this age group heart disease is the most important because in female till they have not attained the menopause their heart is the most healthier healthier than the males but as soon as the menopause their heart function starts decreasing and they should really take care good care of their heart and they should have regular checkups and many females have little bit arrhygmias which might need treatment because heart and misbeeds are very common in there so meet a cardiologist and scan whether you don't have any other super edit disease then we have cancers which is very common cause of death cancer is a cause of death only when not detected in time that is what I mean so please don't most of my patients say I don't want to go to the doctor because something or else will come because they will write a test and I'll do a test and some disease will come but they are not forgetting it that if the disease is detected late then treatment modality will be difficult then the other thing is stroke then we have COPD chronic obstructive pulmonary disease lots of people have pulmonary diseases though in females the disease will be a little less because they are less smoking but lots of females are smoking these days we never know when they are 60 they might have these diseases but at present males are more prone to these diseases then we have pneumonia influenza diabetes and lots of patients die because of accidents also like I will say even the hip fracture can cause the death of a patient because of fat embolism lot of blood loss and septicemia if not treated because at this age many times the patients the old people are not very receptive to any directions what the children say the doctors say they are very adamant to what they want so they should I think listen because the technology has advanced so much they should listen to their children listen to the doctors and let them treat them we'll just talk a little bit of the male partner because I think Dr. Charu is not there with us who would have highlighted a little more on the problems in the males the I will say that prostate care is very important in males and the rest of the problems are almost similar as in males or in females after the age of 60 and all medication medical complications to be treated they should also exercise and walk and psychological health is very important and sexual health also is very important for the male partner so checkups and care so I check up hearing checkup dementia and depression they should also be checked if we have a suspicion that we are very forgetful it's very common to forget in old age when we have lots of work to do or because of old age little bit of dementia can be normal but if it's increasing at needs treatment you should meet the doctor and nutrition you should be very careful if you have still have doubts always meet a dietician or go to blogs go to internet go to facebook ask somebody dietician in your home keep what is best for you treat your vitamin deficiencies calcium deficiencies vitamin D deficiencies take multivitamins proteins isoflavones is very important isoflavones are natural estrogen so all my females are usually tell them to take we have calcium with isoflavones which which I prefer to give to my patients because then they don't have to take it separately also at times because people usually don't take and we have this myth of not taking soya bean in our country everybody say most of the people are hypothyroid they say if you are treated a little bit of soya bean in your diet or twice or thrice in a week will not cause you any problem so soya bean is the richest source of protein in a vegetarian diet and most of our people are avoiding so I would suggest and I would prefer all of you to take a little we have soya milk we have soya buddy we have soya dal we have there and we have tofu with us so many sources of soya are there you can always take them and increase the natural estrogen in your body and phosphate and vaccination please all of you please take vaccination for all the diseases which I have mentioned pneumococcal influenza boost tricks hepatitis A diphoid hepatitis B so pneumococcal influenza and boost tricks if taken will prevent you from lot of diseases if you get sick and if you are will be prevented lung infections will be prevented and footwear is very important for our old age footwear and foot care podiatry is increasing a lot in our country maybe in touch it will have another department with us you should have a very good footwear you should not footwear come in main thing which we have to sure focus on footwear is they should not falling leads to fractures and lots of problems in general so please be very careful talk to your doctor if you don't have an idea and all medications should be taken in time as I said and they should take the help of the family members if they think they are forgetting the medicines thanks everyone so we will take the questions after Dr. Gaurav and Afia has completed the talk so I'll back to invite Dr. Gaurav is the consultant in orthopedics at Manipal Hospital and he will be of all female patients after the age of 60 and the main patients so because in males I don't think they have a lot of problem it's only the females who have to take a lot of care of their bone health. Hi everybody, first and foremost I should thank Dr. Yashaka Godeshwar for such a nice introduction for me I'm Dr. Gaurav Sumi I'm an orthopedic surgeon working in Manipal Hospital's workshop and why this talk is important because the most common problems people more than 60 years old have are musculoskeletal that is the bone and joint pains right that is the most common reason why people more than 60 years old enter or visit the hospital so coming to bone health, bone health is really important reason being fractured or something which are responsible for a lot of morbidity now that is rather the number one cause of morbidity amongst people who are more than 60 years old now the current definition is changing we no longer call people more than 60 year old as elderly right they we simply call them as more mature right now bone health has six components in people who are more than 60 year old number one is exercise which is the most important thing which all of you have to do now I will elaborate further what kind of exercise you need to do and further details would be discussed by our senior physiotherapist Dr. Afia secondly I'm going to talk about osteoporosis osteoporosis I am pretty sure that's not a new word for you it simply means soft bones and it is inevitable it happens with everybody now third thing which is very commonly asked to me in my clinic says nutrition what should I eat what should I not eat then vitamins vitamins are one of the most ignored topics recently but over the past 10 years they their prominence has increased and now everybody's well versed vitamins especially vitamin D fall prevention is something which Dr. Yashika has already talked about and also Dr. Afia will be having a word about it and the last and actually the most important is think strong right a sound body for a sound body a sound mind is important right if you are thinking strong nothing will happen to you right and I'll also elaborate on why I'm thinking strong is important so coming to exercises now all the people more than 60 year old both men and women they need to do moderate level exercises now the question is that how do I know whether the exercise I'm doing is a moderate level exercise of the severe intense exercise now the simple dictum is that if you can talk while doing the exercise then you are performing moderate level exercise like simply walking right you simply walk for 20 minutes in a day right while walking you can easily have conversation now that's a moderate level exercise for you group exercises are better for in Delhi for people over the six year old the reason being is that you do have interpersonal communication lot of coordination when you're doing group exercises plus you honestly speaking you enjoy doing those exercises now amongst exercise what is important is that you should do 150 minutes of exercise in a week now roughly that translates to 20 15 20 minutes of exercise in a day which is actually not much considering the fact that you are 24 hours in a day one thing which you have to avoid is you have to avoid impact exercises now it's no point you're going for a run right the moment you hit a treadmill you will surely visit me or one of my orthopedic colleagues because you will end up having knee pain so just avoid impact exercises what is more important for you is stretching now the western world has realized the importance of stretching so we have yoga out there we also have yoga here we are celebrating yoga days so yes you have to stretch right stretch your body that's important further details about it will be discussed by raffia nutrition why is nutrition important because it's commonly seen that people who are overweight they have pain in the joints they have pain in the back so yes you have to maintain their idle weight which is easier said than done right what is important is balanced diet so diet which is rich in proteins rich in carbohydrates rich in fat plus it also has essential minerals and essential vitamins so a simple Indian diet of having root tea and dal is actually a balanced diet plus a lot of fruits right fruits fruits fruits eat a lot of fruits now fruits are easy to digest they have the vitamins they have the minerals but also fructose is much well tolerated by the body as compared to sucrose now fructose is a food sugar whereas sucrose is a normal sugar which we eat now as we grow old our body is more comfortable with smaller meals but on a more frequent basis so that instead of eating twice or thrice in a day we should we can eat four times or five times in a day only thing is the portions should be smaller so instead of eating three chapatis right you should be comfortable eating one chapati but you have to eat it around four to five times in a day now avoid binge eating so all those barbecue nation type buffets right that is something which you have to avoid right you have a buffet and then you definitely have some stomach upset and you will be visiting about so that is something which you have to avoid now vitamins most of the vitamins that is the vitamin b complex vitamin a vitamin e are derived from balanced diet hence the importance of balanced diet however there are two vitamins which are notoriously not derived from diet and they are vitamin d and vitamin b12 and believe me vitamin b deficiency is is way more so it's some studies say that 60 to 70 percent normal population is depression vitamin d if you just look at the numbers right 1.3 billion strong country 50 percent of that well that's a hoping number now that's vitamin d is again important because that is crucial for bone health normally we require 1000 units a day that's a daily requirement so irrespective of your men your women right you need 1000 units a day the main source of vitamin d unfortunately sunlight right and i am pretty sure that not us or many of us are spending 20 30 minutes in a day in sunlight with our neck, whole arms and the exposed right if you're doing that then you're having your daily requirement vitamin d and so that is actually encouraged now what is very important which also mentioned is animal checkup right these are really important in animal checkup your vitamin d and vitamin b12 should also be assessed if they are low then you need to be put on supplements right now we're coming to vitamin b12 vitamin b12 is predominantly derived from non vegetarian diet in a country like ours where 60 percent of population is vegetarian vitamin b12 deficiency is not far from reality it is quite commonly seen and if that is less then supplementation helps tata afia would be measuring in a talk the vitamin b12 is also required for balance so if you are low in vitamin b12 then your balance would go haywire and you become more susceptible to bones now osteoborosis osteoborosis is inevitable everybody will have osteoborosis right what that you have to understand what happens with our bone density now when we are born right from that time till the time you become 30 to 35 years old the bone density increases gradually gradually and then it flat use and that starts declining after age of 35 years we cannot stop the decline but we can do control the rate of decline so instead of declining like this it will decline slowly slowly slowly like this how do we decrease the rate of decline exercise right so that is the importance of exercise modern level exercise that's like an investment right and your 20 minutes a day is an investment to keep your bones strong and to prevent you from fracture now in women especially menopause they contribute to osteoborosis which has been very nicely elaborated by Dr. Yashchika animal health checkups are important for osteoborosis so in animal health checkup do include bone densitometry assessment that is DEXA in case your bone density is less than minus 2.5 that means your osteoporotic that means your higher risk of having a fracture in case you fall or even in case you trip on a loose piece like carpentry right in that case you have to be on supplements which your doctor would prescribe you a fall prevention why are we talking about fall prevention again because fractures are the number one cause of morbidity in this country majority of fractures can be prevented not everybody have their bones broken in an accident right so believe me domestic falls that is falls in your bathroom or from stairs is way more common than accidents and they are very common cause of fractures so simple things like preventing loose items in the house like I mean loose carpets furniture which has been just put here where in case you have kids in your family then the normally put toys at random places your grandsons or granddaughters and then you might trip on that and then also you have to instruct your house tempers or you have to take your sons and daughters to take care of that eyesight is really important if you are having refractory errors if you're not able to see then you are at higher risk of falling again medicines certain medicines like for BP blood pressure etc that can cause dizziness and something called an orthostatic hypertension and the moment you stand you feel dizzy so you have to in case this is happening to you and kindly contact your physician they might need to alter those medicines you have to check your hearing also and because hearing problems are commonly associated with balance problems our inner ear not only helps in hearing it is also the balance center of our body now quickly talking about miscellaneous things the do's and don'ts especially now knee is the most common joint affected in aging knee osteoarthritis is rather the most common geographic problem noted it is even more common in factory errors everybody will have problems in the knee as they age now a common question people ask us which is better Indian commode or western commode now for knee specifically you have to avoid squatting so you have to avoid going all the way down so western commode is better also stairs is something which you have to be careful of right you have to avoid climbing stairs on a fast basis you have to climb it on a step by step basis right and again a very commonly asked question not related to this is a knee replacement is required then when should I get a knee replacement done now the answer is that if you're not able to walk 400 yards if you're not able to perform your activities are daily living like changing clothes wearing socks taking out socks and if you are not on daily painkillers if the pain is wearable and you need not take any painkiller right or the frequent basis then probably you can avoid getting a knee replacement now shoulder diabetes is the number one enemy of shoulders if you're diabetic you have to stretch your shoulder otherwise your shoulder will become stiff you have to take care whether your diabetes is controlled or not in case your diabetes goes haywire then the number one indication is your shoulder starts hurting right so conversely if you're diabetic and your shoulder starts hurting then you also have to visit your diabetologist or endocrinologist to see whether your sugars are normal or not now again a very common cause of pain in elderly population is pro-practice shoulders these are shoulders which come forward now that is predominantly positional when you are working on laptop or we are writing something of a shoulder they have a tendency to come forward we have to voluntarily retract it right that is very important you have to bring it back okay so that's some exercise which you have to do you have to ensure that your your position is not going wrong in case you're bending forward right then probably you will end up compressing your spine so you need to have a proper position that is very important foot now footwares people ask which footwear is good for me should I be a plant should I wear heels should I wear clothes footwear should I wear open footwear but the answer is open footwear is better than closed footwear because it avoids problems associated with sweat the footwear should not have a narrow box now narrow box means that it should not be narrow pointed because otherwise if you crumble upon your toes and you might end up having deformity of your grid toe which you would have seen called as bunion and haluxosis but sport shoes should always be prepared so whenever you're going for your morning walk please wear sport shoes you can easily purchase them if you're if you need to wear heels right if there's a manager in the house and of course you cannot attend it in sport shoes we understand that especially for all the women out there then you have to wear platform heels right you should shoot upwards till it goes you have more chance of having imbalance on it you're more chance of falling and if you fall you come to me now thinking strong is important because it says that you are old only when you think that you are old say if you are young in your mind right then you will not age right well that is not an elixir for youth but thinking strong is very important think that you're young person think that you can do what is what you can do now happy mind releases endorphins and that helps you if you are in the stress suffering of stress in your muscles especially the muscles in the back of the neck muscles in the lower back they become tight and that is a very common cause of pain in the neck and the back meditate that helps really helps right one more thing is keep yourself active as much as possible try to do your household chores yourself right try to do the cleaning and the dusting the more you do it the better it is right you should cook good for yourself just do not be a lazy person sitting on a cow singing that i'm old and everybody will help me right the day you think like that the day you become old and the day you invite problems so with that thing i'll thank everybody for watching this webinar i hope i was able to convey what i wanted to convey now next in line is dr afia she's a senior physio therapist and she will be elaborating more on what i was telling and she'll tell you fantastically what aging is hello everyone thank you goddess and dr nashika for like enlightening us about the topic 60 years and going strong first of all i would like to wish every senior citizen because today is then senior citizen day and we are enlightening you with the all these 60 years and going strong and according to me aging is not at all a lazy it's a natural condition that need to be nurtured and advanced so basically i'll be talking about the physiological the main common problems and what all preventions we can take because we don't have one-to-one solution for all we just give you a prevention tips we can give you some uh like exercises we can tell you some like what all changes you can make at home but every uh every uh like person is unique so they need if they for any problem they need a proper tailor-made exercise protocol if they have like priors Parkinson disease any neurological any musculoskeletal disease we just brief you about like the problems and the solution but not the like only that is only the solution okay so basically let's talk about like what are the like normal physiological aging physiology in of aging so first body composition there is all the gradual loss of lean mass usually we have seen that the elderly people get wrinkles means they start shaking their hands so basically muscle mass is lost so everything one thing we always remember is that the body has no one thing no one part is connected to each other one problem will be connected to each other so you need to screen up so increased body composition then bone mineral losses as Dr. Gaurav is also told you keep bone minerals is the resorption of formation in between imbalance with aging because it's a natural uh like uh physiology in our body so usually our bone uh osteoporotic and this is the main reason that we lost our bone minerals then we are also having more falls because of our postural changes our gait changes usually what happened like in old days or usually 60 years old our head thrust increase head thrust in the sense we start developing developing this kind of posture we like we want to sit like even if the old people want to hear if he just move his hands towards you then with this there is an extension because our normally we have this curvature of our cervical spine due to this posture our head spine got get started extended like straightening of the spine and with this we have a like with the aging time our posture usually we develop this kind of posture it's too posture usually so we have a saturated thoracic kyphosis then in response to that we have a like impact on the lower spine that is the straightening of spine and then we usually old age people develop the low back pain chronic then we have a scapular protraction and ulna deviation of man and ultimately all these posture leads to our the central of the gravity can shift and it leads to normally falls usually you have a bathroom slips common just because it's a sudden posture change and then they have a fall or trips we have our skin changes also like moisture content reduces the epidermal renewal reduces the elasticity your sensitivity to touch pain and temperature and even the vibratory sense of the old age people reduces so hence they are most susceptible to injuries because a lot a lot of times they don't feel usually you will see diabetic in our india is very common because we say that foot care is always a little size bigger because at that time they have all these touches and pain their sensitivity gets reduced and it leads to like some problems or some scars that they don't know that a diabetic may start this is we take on a coffee time but not that easily you need to take care of your every body part or tension they can only do that you need to look at what they can do if you have been able to do anything in the day, then all the things come in one line short things to take care of big things will come to your place along with that the gate is very important usually women's their pelvic area is not big like weddling type of it means like this is like a type they usually go like this and their base of support is narrow because they keep their feet a little bit straight and walk and in contrast, the men take a small step and along with that their base is wider so whenever you walk or you have parents or grandparents in your house, you should take them on a walk, you are very important to them, give them an auditory clue like you grandfather, grandmother, father, you should walk straight, make some steps, even if you don't walk much you should walk in a proper way, their hands are also swinging, if they are taking a walking aid, then they are also walking aid and opposite, they are kept together and then slowly they are going with the diagonal pattern, in this the swing phase decreases, the area of our legs is increased and the support time is very high, so when this is our body, then because of this, the energy costs increase and the energy costs increase, we get tired quickly and our walking speed is also increased by our old age people, so whoever is with us sometimes grandfather also goes fast or mom and dad go fast, this is our normal physiology, so what can we do, we need to correct their walking patterns, let them walk freely, why should they do a little, look you are walking a little wrong and always remember that whenever you walk, your heels touch first, then toes, then we also have a cardiopulmonary changes like our cardiac reserve decreases, contractile function and heart rate decreases, that is why our response is also decreased for exercise, usually when we see patients in OPD, then their children are redundant, they complain about this, they used to walk so much earlier, now they get tired so it is very important to accept everything, that is the main thing, one need to accept that yes, now these changes will come, but it is not that if they are walking less, then let him or her be, okay, we are walking for 5 minutes, at least we are walking, not isolated, bad ridden, that is the main thing, whenever we eat something, after 1 age, we eat, we used to eat 5 meals first, because our demand was more, so we had to give good supply, but now after 60, our physical demand also decreases, if we eat 2 meals, that is also enough, so that thing, after 60 years, the golden period, do not compare it from the first age, sometimes these pulmonary functions decrease, as I told you, usually in mains, so you do not have to add breathing exercises, breathing technique, normal breathing, improve the pattern, increase the expansion of your lungs, that is it, there is not so much tension in it, sometimes it happens, if a person is not walking every day, suddenly he will walk, because his heart and his lungs are not so adapted, then you have to gradually adapt to that thing, these are the physical changes, these are natural changes, you cannot do anything about it, so what is it, basically you do not worry about it, the response you have to give, you need to focus on that, okay, we are walking for 5 minutes, we are walking for 10 minutes, it is okay, breathing exercises, even in 10 minutes walk, if you do deep breathing once, and along with along, that is not an issue, then we have a neurological changes, because our nerves, they also start degenerating, usually people have tendency of tremor, atrophy of introsiais, which is our condition, these are diminished muscle strength, usually lower limb muscle strength starts working, because those are weight bearing joints, and most of our body, so it has to work, and along with that, our bone minerals are decreasing, muscle space strength, means the load is increasing, so that is why they get a little diminished, slowly you see, whenever you see this in your parents or in your grandparents, if you see, whatever is above 60s, their muscle tightness starts, because there is a habit, that the tone of their response is very alert all the time, you see their neck, which is as flexible as our neck, it is moving, their neck is also moving to the side, because slowly the tone, there is a psychological stress, the tone is increasing, along with that, gradually their flexibility exercises, means whatever it is, and it is not that spending, flexibility, you do all the exercise in one day, no one has to make their own routine, in a week we will do flexibility, we will spend three days, and just as Dr. Gaurav has also told that 150 minutes per week, so how long, means 10 to 15 minutes, you normally spend in it, now I will give you the most important thing, accommodation, whatever you want to be strong for, these are your physiological changes, which are only about it, but we need to accommodate for these changes, because these effects are irreversible, and the important thing is education of family, and even the patients, they are not patients, usually old age people, this is a natural ageing, you have to understand it, okay, it is not eaten, it is not going, it is okay, we need to accommodate, so without taking it, you have to modify your lifestyle a little bit, stress does not have to be increased along with it, exercises most important because in this age, osteoporosis, osteopenia and fractures are the chances, usually not impact aerobic exercises, usually light, very light weight bearing aerobic exercises is must for osteoporosis, so it was the theory of bots, use it or lost it, because our muscles are the most important, if you will not use it for 10 days, you will lose your power strength, so it is better to keep it functionally active, just functionally active, so just maintain a good, optimum health flexibility and functional strength, third thing important is that stress should also be there, and where the impairment muscle is a little problem, so always seek medical help, and stabilization of like impairment, it is necessary to have stabilization of anything, your heart rate is increasing or you are doing annual checkups with your doctors, all this is very important in this age, annual checkups, and it is not necessary, many people think that if we do it, we have to go again and again, once we take our exercise protocol, once we take our medicine chart, that no, these three ones will go, four ones will not go every day, because nowadays everyone is working, they have to take them to the hospital, it is a challenge to take their parents or grandparents, how to take them, because they are busy in their life, so it is okay to consult one time, whatever they are taking care of, whatever they are doing with them, they tell them to seek, understand, so that they continue at home, it is best to consult once with me for them, whatever is the best, because everyone is unique, so it will be a unique treatment for everyone, so it is best possible that you come, meet them once, make their chart once, exercise, or make a diet chart once, then you follow for three months, six months, and whatever is the best possible way, you talk for that, then major issues that are still being followed up, that is falls, falls are 30 percent of old age people, usually the stairs are still more, like those who are at home, they go carefully, there is something in the bathroom like this, it is very important, because of which we can reduce the percentage of 30 percent of this ratio, and whenever it falls, the hip fractures become very common, because usually the impact that comes from the floor, from the surface, it always joins the hip, and then we need an arthroscopy for the same, and as if I said, because the most of the contacts have hip, then pelvis or forearm, so the result, their fractures are very common, and remember that in old days, regeneration power is less, so my pain is also more, time is also more, I mean it will be fine, or maybe someone needs surgery for the same, so it is always better to prevent it, so ultimately what happens is that once one falls, which is a vicious cycle of everything, so once it falls a little, then a fear comes in the old days that we can fall, we are not going alone, so what happens is that the washroom of the bed is not going, someone comes in front of it, so the immobility also increases from this, and as you are doing the urine mold, then your urinary incontinence or any such problem can also start, and ultimately it leads to weakness and isolation of one person, isolation leads to depression, then from that depression the musculoskeletal will have an effect on your joints, on the bones, on the muscles, this vicious cycle keeps going, so that's why it's the most important thing, keep in mind small things, big things, give yourself, give yourself, what are the strategies that we can reduce with all the risks, first of all visual impairment, check up your reflection, go for the eyesight, if someone has cataract, then cataract instruction is important, and home safety assessment, that small rugs like if they want to stay in our home, in this area, then they should not have small rugs below them, so that they can fall with them, if there is no such hindrance in the middle, then the mobility area is free for them, audio vestibular dysfunctions, make your earwax clear, make an audiological evaluation, hearing aids, whatever we are using, wearing, because always remember that eyesight, vision, hearing, and proper reception, there are three things that keeps your balance so if your balance is not there, then there are more chances for you to fall, and habitual exercises, I must tell you, habitual exercise is simple exercise, which you can do, you can make your parents or grandfathers do at home, you just need to focus on two things, like you have to do your without movement of neck, you have to do the eye movement, that leads to like your brain, your extremus will reach inside your brain, habitual exercises are usually DOR, vestibular ocular reflexes, exercises, so you can do it at home by using a two pants or just focus on your nails, thumb nails, thumb nails, pain, you put it in front of you, a little bit of light, and just eye ball movement, both of your thumbs, same way, up and down sideways, you can do it easily and easily, then strategies, dysfunctions, vitamin B12, this is how I have told you, food intake, cervical spondylysis, you have to do it, balance exercises usually, narrow base, for this you need a lot of family members, you need a small, I don't know, narrow base of support, eyes open, eyes close, like in unstable surface for 3 minutes, so all this during this time, keep one family member with you, use appropriate walking aid, if it is must, you need it, correctly sized footwear with a firm sole, it should be a good sole, which I raised over in the side, it is very important for you, because when you are with ageing, it goes towards our flat feet along with the weight, if we have a proper sole and shoe size, the shock absorption and weight bearing joints, normally our weight lines fall on the right normals, there are musculoskeletal disorders, foot disorders, you need to take care of your diabetics a lot, and postural hypertension, sometimes in a hurry, it is a tip for old age people, that if you are not at all old, first get up and sit for 2 minutes, because it takes time to adapt our body, it is a normal policy, then we have common impairments, arthritis is very common, you usually try to make this a normal home regimen, at least your functional impairment, and if you have a grade 3, if you have an osteoarthritis, talk to the orthopedic consultant, what is the use of taking so much pain, why do you have to spoil your quality of life, talk to the contractor once, fractures are common, because osteoporosis always do, as I would say, light, like standing, and keep some hands, do some leg movements, light exercise, so that your bones get a little weight, light weight bearing aerobic exercises, usually for osteoporosis, TBI traumatic brain injuries, may be due to accident, break fall, STRIPS, BP, Parkinson's disease, I have seen a lot of patients in my opidine, people say that there is no cure for it, there is no cure for it, but we can ward off the progression of the disease, improve their quality of life, balance the secondary complications with it, so we need to take care of all these things, visual impairment, please go and check, hearing loss and neuropathy, because usually, peripheral loss is affected, vibratory sense, temperature, these all reduce our sense, so go for everything, checkups must, for home safety, the most important, elevated toilet seats, nowadays in every road market, every room is available, even the toilet seats are available for city-acted populations, so go must buy for your parents, buy for your grandparents, because always, pause usually, don't get up, grab handles, use the bars, so that they have a firm support to get up, no slippery bathrooms, like the washrooms, usually use the bars, keep in mind, don't get up and fall, these are all home safety profiles, that you need to know, this adjustment of high distance from bedela to floor is important, because sometimes, the height is very high, these days, soft floors, 10-inch mattresses, because of that, when you get up, your feet don't touch the surface, chances are, they slip, fall, so always, if anything is in someone's house, which is very low, then adjust the mattress, wherever the bed height is, so that their sleeping area touches the bed, if they are sleeping, usually, for urination at night, they have to sleep, so for that, if they are coming in the dark at night, they have to run, so for that, you need a lot of adjustment, and the low-chairs, the couches, if there is a problem with the muscles, if the bones are weak, then there will be more overload on their muscles, so always, optimum height chairs, these should be done, if they have a stick or something, if they have to pick up some objects, then they have to reach, these chairs are very high, so for them, you can see all this in your house, and give them some change, thank you, and once, a good professional tennis player has said, why are people afraid of getting old, you feel wiser, you feel more mature, you feel like you know yourself better, you feel that, for softwares, can not be, so always remember, it's a normal ageing process, these are physiological changes, now we have to adapt to these things, we don't have to worry about small things, because a lot of our social responsibilities, by age of 60, that also gets less, because we don't have to worry about anyone, they don't care about us, they don't care about those who are over 60 years old, so the new social responsibilities of grand children, or your own take care, it's very important, thank you so much, so we have few questions with us, one of the questions is, what all things I can add in diet, of my old age parents, for reducing fatigue, and muscle ins, many things we have already discussed, but I'll just repeat them again, first of all we should take lots of proteins in vitamin D, vitamin D in food products is usually not available and we don't have fortified vitamin D milk in our country, so what else we can do, we can have a little bit of, vitamin D is there, a little bit in mushrooms and vegetables and milk, we should take them, and eggs you can take, so eggs is a very good for fatigue and muscle ache, the main problem, detection is very important, what is the cause, the deficiencies is the cause, but there can be because of the muscle weakness, or there might be some injury in some part of the body, in the ligament, in the tendon, so you should get in yourself checked with the doctor once, and then you can start taking these vitamins, these will overall help, calcium is there, and in calcium you have to take milk, even if you are not, some people are in old age are not able to digest milk, so then they can take curd, they can take lacy, charge, so any product, paneer is also very good, so that will also lead to strong muscles and strong bones, and fatigue and muscle aches can be, and there are a lot of deficiencies of, deficiency of minerals, and micro minerals, so those like, we have magnesium deficiencies, so that can also cause a lot of fatigue, and you would be would like to ask as like we said, minerals, most communism of fatigue is sodium and potassium deficiency, also magnesium and selenium deficiency, and these are considered, but these are essentially minerals, which are available in fruits, available in vegetables, so a normal Indian diet is actually minerals, what we normally avoid is proteins, as Dr. Yashika rightly said is that, you should have diet in proteins, we feel that proteins are not digestible, so then they are not good, because it is very important, it is very easy to digestible, and and if you feel that minerals are lacking, then just like neemu that has vitamin C, if you take rock salt, it becomes rich in potassium, rich in sodium, if you are feeding it once, that helps a lot. Same way psychological health is important, because sometimes there is a specific stress here, tension can also cause a pain, and people feel it hard to go through that, so you need to take care, you need to involve like, you need to have a, even a good spiritual mind also, like everything should be balanced, diet, physical activity, and you have like emotional health, so these three components are interconnected with each other, if there is like psychological stress, so basically everything is connected, so one must be taking care of food, physical activity, and the cycle emotional managing of the patient, or old age people. Okay, thank you, you can take the next question. What do about supplements? What should we do about sleeplessness in old age? Okay, so usually sleeplessness happens in old age, because our physical demand is slowed down, so for that we have like, even in some apps, some like videos also we have like alphabets, binaural music, so before sleeping, just ask them to listen to those music for 5 to 10 minutes, these are just beats for us, so it releases the hormones in our body, relaxation hormone just as I told, and your twins also releases us in our body and it induces the sleep side, with this some kind of posture also induces the sleep lying down in supine position and just like touching your foot in this way, and just move your knee up and down for 4 to 5 times, and then relax in that same position for 3 to 4 minutes and it will help you to induce your sleeplessness. Like a butterfly to me? Yeah. One more thing regarding sleeplessness is that it is actually seen in all ages but more and more it is used for screens suppose if you are watching TV and suddenly you close your TV and think that I will go to sleep that normally doesn't happen or you check your cell phone, the moment the LED goes on your mind gets activated, so to sleep you have to avoid any sensory input so no hearing no seeing something, the moment you see a bright screen your mind gets activated as if it goes an alert mode, so of course you won't be able to sleep immediately after that so that is something I have seen many people read and I simply ask them, do you check your WhatsApp before sleeping and believe me majority of the time the answer is yes, I do check my WhatsApp before sleeping and I say okay that is the cause why you are not able to sleep. So I would just like to add like what we have discussed is that we should all have a sleep curriculum or practice at night before going to sleep so this is all included in that like what time you have to go to sleep before that 10-15 minutes before wash your face, wash your legs, change your clothes get into a comfortable attire you can even put on a soft music and a small dim light in elderly you will all suggest all of us I think will agree that there should be a light in the room the toilet doors should not be closed and the comfortable footwear should be there because they should not fall so because most of the elderly in my house also they want the lights should be totally off but even if not in the room in the bathroom some light should be open and before sleeping like you are listening to the music you can take a book if you are not able to sleep you read a book and most of the time what I have seen most of the people have some bobble issues that is the reason they are not able to sleep so please correct your bobble issues and exercise a little bit that will help you to induce I think the last question especially for Dr. Bauravani coming to whether knee replacement is indicated after 85 years of age I will just put into perspective a lot of studies about undergoing knee replacement in elderly that is more than 80 years old studies says that you have a higher chance of complications after 80 years of age irrespective of the age what basically is determined whether you can undergo knee replacement or not is how physically active you are see if I am a 75 year old I have kidney problems I am diabetic, I have osteobies then yes, knee replacement is not a surgery for me but if I am a very fit and active 85 year old who is not having any medical problems or just simple BP etc but if I am having pain in my knee and previously also I was walking kilometers and kilometers then yes I will benefit from knee replacement what literature currently says is that in case you are 80 years an elder and you are undergoing knee replacement then you should undergo one knee replacement at a time normally we do, we replace both the knees at the same time but there is a very clear cut literature a guideline from NICE that is a National Institute of Clinical Excellence in England which clearly mentioned that you have to replace knees one by one after once you have a patient who is more than 80 years old so if you are asking ask my parents to have a knee replacement they are 80 years old there are simply answers that depends upon their fitness, if they are fit if they are able to do their household chores themselves if they are independent then yes you can go ahead with knee replacement but it will be one knee at a time if they are frail if they have a lot of medical problems if besides knee they also have issues in their back, issues with their heart issues with their lungs then we should avoid having a knee replacement I would like to ask not to bore one thing because many of my patients also ask me this question after knee replacement what is the way, how can they get back to the normal life and how much days they will be starting to walk and how much days they will be can walk much better and what is the because of the old, because many old people are very scared whether they should go for it or not I mean that fear is always there and it takes us hours and hours of counseling and if the relatives do counsel their parents or their relatives a lot that okay right now is the time you have been eating pain killers for so long but many people are afraid so the answer is that you have to understand it is a major surgery it is not something which we are doing in a matter of minutes it is a very invasive procedure it is a major surgery, it has its own recovery times if you have been having knees which have been deformed bad for 15 years I mean expect you to be alright in a matter of few days after knee replacement you are allowed to walk that is the beauty of it, you can put full weight on it and you can walk on it normally we allow walking after next day but there is a dashboard of all now which says that you start walking immediately after the surgery I mean the moment the vet was found you start walking right on the day of the surgery you may after 4 to 5 hours of surgery so you can be alright but yes you will need walker the place in the knee we have to go through the main mother muscle of the knee which is your quadriceps that is extensor muscles so that muscle takes time to recover so initially you will be walking only with the help of walker yes you will have some difficulties but we do have a very good team of physiotherapists to help you those who are recovery period and we expect you to get rid of walker in 6 weeks of time some people do get rid of walker much earlier in 2 to 4 weeks some people take a bit longer what is more important is your muscles strength stronger muscles are the meridians if you are having very strong muscles then you will recover very fast after knee replacement that is the role of preoperative physiotherapy, preoperative exercises if you are somebody who is having department needs very weak muscles then probably knee replacement would reap its benefits in some say 6 to 8 months on an average its 3 months that is the time which we say that majority of people they become alright after knee replacement one thing you have to understand is knee replacement is a very fruitful procedure but it brings down your pain from a score of 10 out of 10 to say 2 out of 10 or 1 out of 10 do feel a bit of aches slight heavyness in your knee sometimes your knee might pain but majority of people are happy with it so and physiotherapy should be continued for all of us for at least 1 month I think the people have weak muscles only there will be each and all exercise the thing the moment usually patients for that our that surgery was done in a glator that surgery was done in 10 to 15 days means each and every body muscle strength, bone density is different so the most important thing is that for any patient this thing is very important that it will heal as soon as possible or its pain a lot of people are taking the same questions that that baby had done it will heal in 10 days so each and every body look at the muscle mass the best 3 months protocol gives a time limit and after knee surgery what all things they cannot do for every month I mean there is no current victim than what you cannot do you have to just understand the knee replacement of the knee implant its just like a car its made of machine its made of steel and plastic so I mean the life of my car depends on the way I am driving suppose I am going to drive very fast certain breaks even we are often 6 to 7 years but if I take care of that car if I am not driving it in a rash manner then my car would easily last 15 years 20 years the same thing happens in the knee if you squat squatting is possible even after knee replacement and the current implants are very well designed to allow you to squat so squatting is possible but the moment you squat you are putting a lot of load on that artificial knee so all the courses that undergo wear and tear those courses will also cause your artificial knees to undergo wear and tear so the more you squat and every time you squat and you are getting up you are placing a lot of load on that knee so yes your knee would wear and tear much earlier than if you would have not been squatting so that is why we simply advise them that if you can avoid squatting then that is very good but if you have to squat suppose you are in puja then you have to sit you do not have to sit you have to change the toilet if you are in Indian commode you have to use western commode because your daily squatting will reduce the requirement so this is the thing why do you come on running honestly speaking people who come who ask me that I was I love running and I want to go back to my passion of running the answer is yes you get down on knee replacement but again the moment you run so this is a wear and tear it will be a little early but it is popular as in the patients who have actually gone on training trips and they have come back from areas like Triund and other beautiful places right after having their knee replacement they were not able to do it for a very long time they were missing it what is the difference one question is there my mother is in law is diabetic and her kidney is also just 40% she is 17 overweight can you suggest some diet plan for her like we can see that there are two conditions the patient has diabetes and then she has kidney problems so with diabetes obviously she needs a lot to take care of her diabetes and she should take a diabetic diet and that also we have not mentioned whether she is on medication or an insulin if she is on insulin then she needs medication along with the diet chart and a diabetic diet along with kidney disease I think she should need a dietician to take a proper diet chart and if her diabetes is and she is overweight overweight she has to lose weight to get corrected her diabetes because ultimately even if you are overweight and you are taking proper care of your diet but you are not able to lose weight there is no use and your diabetes will not get corrected diabetes can be cured everybody should understand if you lose weight if we go back to our BMI you are almost your diabetes is 80 to 90% cured it is not a disease which will stay with you but maybe at an age of 70 it will be very difficult for us to treat her for that and ask her to change her dietary habit but if she is motivated enough you can do and with the kidney I think high protein diet cannot be given if she has uric acid is high and few kidneys let it all over then we should avoid so with kidney kidney is the main place where your blood gets filtered so salt is something which your kidney has to handle a lot so if you are actually a salt lover then that is something which you have to stop right it is said that you should not eat added salt so doctor sabji mein jeetna nama poot hai har sabji katta rahe ek fixa motor nama poot hai that should be enough right if you are having kidney problems you should not put added salt into it that is important right you have to avoid foods that are it is certainly released a lot of salt in the body like banana is one food which has a lot of potassium right and it can lead to potassium overall so yes that is something but my recommendation my general advice for you is that if she is having so much problem then she should have proper diet plan started and for that a diet issue would be a better person one thing I would like to add on this thing lots of my old patients and they have hypertension they are taking senda namak please senda namak is very rich in potassium they have stopped taking normal salt and their potassium is increasing please stop get rid of that habit take normal salt in less amount if you are going to have something on salad you can put a senda namak on that but don't make senda namak your staple diet I think many of the patients are doing this wrongly so we should avoid doing that one last question I think we can take it we have time one last question is from my side Dr. Gaurav only I have lots of patients who have weak bones after the age of 60 and the one thing I would like to know for them the bone densitometry when they should be done and what all medications like I usually give calcium and vitamin D phosphates also I give but there are some injectables are required in phosphates sometimes when they are very low so how to detect it when they should come for bone densitometry and when that patient should come to you directly for treatment so basically they say the prevention is better than cure getting bone densitometry is more a modality of prevention now the guideline says that women the moment you have your menopause you should get your bone density not during the time you are having your menopause once you are over with that that is only like 50 to 1 years old get your bone density done men the guideline says 65 years so 65 years of age when men should have their bone density tested and that is prevention but if you are having recurrent fractures some countries like Singapore for every patient who ends up having a hip fracture they will test the bone density they may be mandatory so it depends on hospital to hospital or cancer to cancer but prevention for the purpose of prevention get your bone density checked when you are 51 years old the moment you have your menopause in case you have premature menopause you can get your bone density checked for that by men 65 years any family history in which you should get your bone density early done yes it is not just bone density it is a proper bone screening procedure there are conditions rare conditions like osteolesal hemorrhage and recurrent fractures in case you are having repeated fractures and fractures by trigger trauma like you sustain the journey you just put your hand on the table and you broke your wrist that is a trigger trauma you did all actually so in case you are having specific fractures then you have to get your bone density checked there are a lot of genetic conditions where your bone density will be low but then the incidence of that is so rare the underlying says that there is an age parameter we are going to remember the most common cause of osteoporosis is actually menopause which is a physiological process and the next most common is senile that is aging so again a physiological process so these both causes are the most common cause of osteoporosis yes if you are having recurrent fractures if you have family history of recurrent fractures mom or dad had recurrent fractures or you check the moment you become structurally mature at least if you are very strong family history only at that time what is your take on taking calcium after menopause because many of my patients say that my doctor said that I will have kidney stones if I take calcium but my take is that they should take calcium because diet will not supplement with the adequate amount the reason for having stones if you take calcium calcium is vitamin D deficiency so what happens is that if you are rich in vitamin D then the moment you take a calcium it will be absorbed from your stomach that is the role of vitamin D and vitamin D will simply take the calcium and put it in the bone conversely if you are deficient in vitamin D you will take calcium most of it will be absorbed and will pass in your feces some that is absorbed will not be able to go into your bone because you are not having vitamin D in the urine so when you have high concentration of calcium in the urine plus you are dehydrated if you do not have a habit of drinking water then this calcium gets concentrated and you form stones so palpit is not a calcium topic palpit is a fact that you are deficient in vitamin D so you have that is why all the screening procedures now all the health checks now they insist on getting your vitamin D and vitamin D pulse check that is the role the old ladies who are most proposal they should take calcium regularly yes the calcium dictum is 2 months 1 month rule that means you do not have to take calcium independently regularly take it for 2 months leave for 1 month then take it for 2 months leave for 1 month but yes calcium you have to take it if your diet is not written calcium lots of patients are like we I think we remember one of the patient who was taking phosphates for a long time they have brittle bones so I think the patients who are at home and taking the same medication for last 1 to 2 years they should visit doctor and just update their prescription they should keep on taking them or not the problem in treating osteoporosis is that all the medication which we have in the market for treating osteoporosis you cannot take them independently this phosphonates doctor is talking about are those tablets which are taking once in a week or once in a month by your doctor advice user the moment you take them for a duration more than 2 years they can actually end up damaging your bone bone construction and destruction is something which keeps on happening bone destruction is not bad that is important for demodulating so once a new bone is formed with time this bone will age what it does is it destroys that age bone and then deposits new bone in that what these tablets for osteoporosis they do is they remove the body's ability to destroy that bone so there is a mechanism in our body which are responsible for destroying those bones now what happens is that when you remove that mechanism these medicines will suppress the bone destruction mechanism then the bone which was formed say 5 years ago or 6 years ago becomes ageing and will soon crumble under stress they end up actually having prejudice fractures these fractures are very nasty very difficult to treat there are higher chances of not uniting despite the fact that you might not hate on them you might put bone grafts so that is why we advise all our patients who take this process will not take them more than 2 years now coming to injection you would have heard about injection that my doctor has advised me there are injections which I have to index myself to increase my bone density those injections are expensive they cost me around 6-7000 rupees a month again the same thing with that those injections are teriprotide injections they are again for bones to increase the bone density but again you cannot take them for more than 2 years because there are studies that continuous administration of teriprotide can lead to a kind of bone cancer but there are theoretical studies till now there has been no case report or somebody had a bone cancer because of teriprotide administration on a long basis but there are a lot of theoretical reports so that is why we simply ask you to not take them now another thing you would have heard is nasal sprays right so a lot of people advise nasal spray to take and for long term again the limit for nasal spray is around 6-8 months you cannot take it for more than 6-8 months because it decreases the blood supply of your nose so in the nose you have a bridge what is nasal septum so continuous take of carcinoma nasal spray can actually lead to these septal corporations so again we do not take it for more than 6-8 months so and those who are having very similar osteoporosis they are advised anabolic steroids which are returning so anabolic steroids are first introduced for treatment of osteoporosis they initially became very popular then they have these problems with the heart so but we do give them and for very early patients they actually are much safer than vescosaur in teriprotide injections and they are much cheaper than either of these right but again you cannot give them you cannot give more than 10 injections in a span of around 14-18 weeks so all these medicines they have their own limits they are not free of side effects that is why prevention is better than cure that is why exercise that is why take a good diet exercise even though we are talking about some stupid things just have a habit of doing more things that is very important to have healthy moods thank you Dr. Gaurav you have enlightened me I can picture everything very well we will end with the last question can you just tell the old people what exercises they can do at home and specify the bone which is important in that area actually the thing is usually for old age people we don't need to have high impact aerobic exercise or strength training we just want our old age people to be healthy, functionally independent we need to be functionally independent for this you can go for a light walk for 10 minutes just a light walk taking care of your gait pattern because usually the gait pattern is altered in old days so one should take care of the gait pattern walking straight with a proper base of support with a proper swinging of arms and one should take care because with aging the lower body muscle strength decreases because of the bone mineral loss and even over stretch on the lower leg muscles so one need to take care of doing light exercises if one has a hypertension problem no one will go for isometric exercise on lower leg quickly it increases the pressure on the upper so one should take care for that just light movement exercises including the large muscle group if one can do mini squatting sitting and taking the knee up to the chest including all the large muscle groups you can do every joint moving flexible and then you can have a strength which is for your functional movement or due to the activity that you don't feel any fatigue or over stress on the muscles thank you everyone