Leisure, Lifestyle & Wellness
The bliss of old age

Old age is a pleasure and should be enjoyed without the fear of disease and death. Think young and remain young at any age

“When you are old and grey and full of sleep,
And nodding by the fire, take down this book,
And slowly read, and dream of the soft look
Your eyes had once, and of their shadows deep”
—William Butler Yeats


Many of us, like Shakespeare, abhor old age. I am one of those who adore old age and respect it for its forbearance, compassion, understanding, and also for its maturity. Old age is a time when one has the advantage of both long standing empirical and existential wisdom (not knowledge). Some of my readers have urged me to write on old age diseases like diabetes, cancer, hypertension and heart disease, etc. I normally do not replicate a medical textbook in my articles and do not like this reductionist disease concept. I agree with Professor Mary Tinnetti of Yale University when she wrote an article entitled “End of the Disease Era” in the American Journal of Medicine in 2004; 116: 179, where she says that: “The time has come to abandon disease as the focus of medical care. The changed spectrum of health, the complex interplay of biological and nonbiological factors, the aging population, and the interindividual variability in health priorities render medical care that is centered on the diagnosis and treatment of individual diseases at best out of date and at worst harmful. A primary focus on disease may inadvertently lead to undertreatment, overtreatment, or mistreatment.”

We could club them all into one class of age related maladies. In my experience of nearly half a century of treating patients, the biggest problem of old age, especially in the affluent section of society, has been the adverse drug reactions. Many of these patients have been on a long laundry list of chemical drugs for the various diseases mentioned above. Each specialist gives a few drugs of his/her choice unmindful of what his counterpart in the other specialty has given. The poor patient tries to comply with all of them at the same time little realising that this kind of polypharmacy has no scientific evidence to support it even in this era of evidence based medical claptrap.

What is old age? Quantum physics tells us that matter and energy are but the two faces of the same coin. So the human mind is but the human body. Your thoughts are your body in that sense. If you always think that you are old and infirm, you WILL be old and infirm. If you think you are young and healthy, you SHOULD be so. Chronological age is only a mirage. Body cells die and get replaced regularly; so much so you are not the same person that you were three months ago. At any given time your true cell age is just about six months. But if you think you are old the thoughts get passed on to the new cells and make them old! Think young and remain young at any age.

In the elderly and the old elderly, diabetes is not serious disease. It is just the exhausted pancreas trying to cope with the demand. If one were to diet sensibly-eating small feeds six times a day avoiding frank white sugar in food and eating as much raw vegetables and fruits as is possible in the diet—and avoiding sedentary lifestyle of sitting in front of the TV all day, exercising regularly, with a positive state of mind and enthusiasm to help another human being in distress, the blood sugars can be controlled as also the other metabolic fall outs of diabetes. The best exercise in old age is a daily walk, at one’s own pace for at least half an hour a day would do wonders to your health. Do not get frightened of our medical scare mongering to get you hooked on to our drugs. Mark Twain was quite right when he wrote: “do not read health books, you might die of a misprint!” Most lay articles are either sponsored by vested interests or are copied from some medical textbook source and will invariably be scary.

DO NOT get your blood sugar checked daily. A quarterly level of glycosylated haemoglobin (A1c) level will do. Try and keep it below 7.5. Even if the sugar occasionally goes up do not panic, it will come down. Take good care of your feet, washing it daily at the end of the day with soap and water and drying it fully before retiring to bed. Have shoes which are a size bigger than normal, lest you should develop pressure points in the feet. Should you develop any new symptom, however trivial it might be, see your family physician for guidance? Most of the time it might be of no consequence but do not self treat yourself or take advice from other patient's experience as your guide. Do not rush to a specialist directly bypassing your family doctor.

The specialist does not know you well and will be at a loss to size up the situation. You will end up in the circle of never ending tests and scans and referrals which might not only cost you a fortune but might damage your health as well. You must have a humane family doctor as your friend, philosopher and guide. Similar advice holds good for high blood pressure. The latter, however is, most of the time, a white-coat effect in old people. Tudor Edward Hart followed for decades a closed group of coal miners in North Wales and found that drugs were not needed especially in women above the age of 65 for mild to moderate high blood pressure. A recent large study did show that slightly higher blood pressure is needed in the old elderly. If your doctor decides that you need drugs, discuss the pros and cons with him and ask for details as to why long-term drugging is mandatory. Ask for absolute risk reduction statistics and not relative risk reduction statistics. The former would most of the time show drugs in bad light. In medicine we use two types of statistics—the ones you look up and the ones that you cook up. The drug companies use the latter statistics to sell their wares but the doctors should be able to look up the right data.

Having said what I said above I must hasten to add that if one is already on drugs do not stop them suddenly without consulting your doctor first. If both of you decide to cut them down do it very gradually under the doctor’s supervision. This article is not a medical prescription and the writer is not your doctor. Your doctor is your boss. Follow her/his advice correctly. Mine are only suggestions for both of you to arrive at an informed decision. The take home message is that both diabetes and high blood pressure are not serious and dangerous illnesses in old age and are a part of living long in this planet. The human mind is the boss here and fear kills faster. Please note that the treatment of most old age illnesses is based on the following simple rules:

1) Change of lifestyle to a healthy one
Eating in moderation, exercising regularly, getting enough sleep daily, avoiding alcohol and tobacco totally, loving ones near and dear ones, trying to be of some use to society if one’s health permits, and enjoying life as it comes, will make you healthy and fit. Greed, jealousy, anger and pride are killer risk factors which could be avoided. Love, camaraderie, universal compassion and true humility should stimulate the doctor within all of us, our immune system. Keep your body and brain working as far as possible remembering that if you do not use them you lose them!

2) Tranquility of mind
Music, yoga, praanaayaama, listening to good deeds and words of others, helping others by being a giver and not a taker keeps one healthy. Your mind becomes tranquil. Having a good hobby helps. Keeping oneself busy also keeps the mind free from negative thoughts. Needs are a must but greed kills! Have a heart to keep your heart healthy.

3) Drug:
Rarely ever, if ever, is the best advice.

Many of us believe that there is a pill for every ill. This concept is not only naive but dangerous. While certainly there is no pill for every ill, there is an illness following every pill. While pills thrill they could easily kill also. So before embarking on life-long drug therapy have a friendly long chat with your doctor of the pros and cons oaf such an action and take your final decision. Medicine today is no longer a paternalistic activity. It is a partnership between a humane doctor and his patient.

In old age most people suffer from adverse drug reactions due to polypharmacy. Many of those patients do very well when we take the drugs off gradually and let hem bask in the sunlight for an hour or two every day. Sunlight not only is a good germ killer but gives us the best tonic for our immune guard by supplying the pure vitamin D3 which stimulates the human immune system—the backbone of disease resistance.

I have deliberately avoided two other old age maladies—cancer and the other so-called disease “high cholesterol”. The latter would need one sentence to dispose it off. High cholesterol is not a disease! It is a body parameter and 90% of it is produced in our own liver for our own good. So each one of us has different levels and the average need not be normal. Change of diet to vegetarian, avoiding too much carbohydrates and regular walk would set it right for you. Drugs never! Cancer is not a disease and is an aberration of normal cell death (apoptosis) process.

How I wish I knew more about it. Even the best Nobel Laureate biologist, Albert-Szent Gyorgyi, feels that he cannot say what cancer is as he finds no difference between the working of the cancer cell from that of the normal cell. He does not think that he could suggest any method that could selectively kill cancer cells without concurrently killing the normal body cells. There are several alternate methods of cancer management in addition to our three pronged attack, but most of them are kept under the wraps by vested interests. I suggest an informed reader to go through the Abraham Fitzgerald Report, 1953, in the USA which is available on the net regarding this topic. That report was a secret document for 50 years. It is now open for all to see!

Old age is a pleasure and should be enjoyed without the fear of disease and death. Death, they say, is not the end of life but only a part of it. Our effort must be to see that death is dignified without having to go through the intensive care unit of a hospital en route to heaven. May God give wisdom to all doctors to follow the prayer of Sir Robert Hutchison.

“From inability to let well alone; from too much zeal for the new and contempt for what is old; from putting knowledge before wisdom, science before art and cleverness before common sense; from treating patients as cases; and from making the cure of the disease more grievous than the endurance of the same, Good Lord, deliver us.”—Sir Robert Hutchison, 20th century physician, British Medical Journal, 1953; 1: 671.

May mankind be happy and healthy to live long.

“Learning is an ornament in prosperity, a refuge in adversity, and a provision in old age.”—Aristotle


(Professor Dr BM Hegde, a Padma Bhushan awardee in 2010, is an MD, PhD, FRCP (London, Edinburgh, Glasgow & Dublin), FACC and FAMS. He is also the editor-in-chief of the Journal of the Science of Healing Outcomes, chairman of the State Health Society's Expert Committee, Govt of Bihar, Patna. He is former Vice Chancellor of Manipal University at Mangalore and former professor for Cardiology of the Middlesex Hospital Medical School, University of London. Prof Dr Hegde can be contacted at [email protected].)

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COMMENTS

nagesh kini

4 years ago

Dr. Hegde,
This is an excellent material to those in the sixties.

nagesh kini

4 years ago

Excellent read for those in the silvering sixties.
There are many who refuse to believe that aging is inevitable. The age-related maladies must be accepted as facts of life!

Narendra Doshi

4 years ago

Dr Hegde,
Pl provide the link to the article on Cancer by Abraham Fitzerald Report 1953 USA.
tks in advance

M G WARRIER

4 years ago

Dr Hegde, I wish you were my family doctor. This article is an excellent guide for anyone who has a ‘patient’ at home or one who would like to follow a healthy lifestyle and use medication only for keeping good health. The concept of family doctor has to be re-invented in the present scenario. The specialists and surgeons are necessary. But the job of understanding the individual and his/her circumstances and background by a medical practitioner who will be available on call cannot be entrusted to a busy specialist who is running/flying from one Super-Specialty Hospital to another. One wishes, some arrangement is put in place, by which each family gets tagged to a doctor or hospital on an ongoing basis so that maintenance of health rather than treatment of ailments becomes a priority.M G Warrier

Hospital

4 years ago

Nice article.

Sensex, Nifty in no man’s land: Thursday Closing Report

Global cues may help the market find further direction

The market closed in the green on global cues as the world awaits an announcement from the ECB which would help the debt-stricken states deal with increasing borrowing costs. Yesterday we had mentioned that a higher high on the Nifty would change the trend. Today the benchmark breached yesterday’s high but settled below it. The Nifty moved almost in the same range as yesterday. The index has to sustain itself above the low of 5,216 of the current decline which begun on 24 August 2012 for further direction. The National Stock Exchange (NSE) saw a volume of 49.10 crore shares and a advance decline ratio of 881:777.

 

The market opened almost unchanged from its previous close as investors were jittery ahead of the crucial European Central Bank (ECB) meeting, later in the day. The continued disruption of parliament proceedings, which threatens to washout the entire Monsoon Session, also dampened sentiments. Among the global markets, US indices closed flat with a mixed bias overnight while the Asian pack was up in morning trade on speculations that the ECB meet will announce fresh a bond-buying plan.

 

Back home, the Nifty opened eight points lower at 5,218 while the Sensex added eight points to its previous close to resume trade at 17,321. The opening figure on the Nifty was its intraday low while the Sensex dipped to its low at around 10.40am. At this point the benchmark touched 17,295.

 

However, the market hovered on both sided of its previous close till noon in the absence of any fresh cues. Support from the European markets, which opened in the green, helped the domestic enter into the positive in noon trade.

 

Export-oriented sectors like technology and auto witnessed buying interest in anticipation of a favourable announcement from the ECB. The gains helped the market hit the day’s high in the last hour. The Nifty rose to 5,260 and the Sensex went up to 17,418 at their highs.

 

However, the market pared some of its gains in the last leg of trade, but settled in the green with minor gains. The Nifty closed 13 points higher at 5,238 and the Sensex rose 33 points to 17,346.

 

The broader indices outperformed the Sensex today, as the BSE Mid-cap index closed 0.31% higher and the BSE Small-cap index rose 0.24%.

 

The top sectoral gainers were BSE IT (up 2.55%); BSE TECk (up 1.85%): BSE Auto (up 0.73%); BSE Healthcare (up 0.59%) and BSE Bankex (up 0.52%). The losers were BSE Fast Moving Consumer Goods (down 1.76%); BSE Consumer Durables (down 0.86%); BSE Capital Goods (down 0.76%); BSE Realty (down 0.04% and BSE Oil & Gas (down 0.01%).

 

Of the 30 shares in the Sensex list, 17 stocks settled in the positive. The key gainers were Wipro (up 4.43%); Infosys (up 3.58%); Jindal Steel (up 1.98%); Tata Motors (up 1.90%) and ICICI Bank (up 1.86%). The losers were led by BHEL (down 3.20%); ITC (down 2.69%); Bharti Airtel (down 2.09%); Hindustan Unilever (down 0.98%) and HDFC Bank (down 0.91%).

 

The top two A Group gainers on the BSE were—Torrent Power (up 9.86%) and Ambuja Cements (up 4.55%).

The top two A Group losers on the BSE were—Gujarat State Petronet (down 4.48%) and BHEL (down 3.20%).

 

The top two B Group gainers on the BSE were—IOL Chemicals (up 19.90%) and Finotex Chemical (up 19.82%).

The top two B Group losers on the BSE were—ATN International (down 14.75%) and Kaweri Telecom (down 14.65%).

 

Out of the 50 stocks listed on the Nifty, 29 stocks settled in the positive. The main gainers were Wipro (up 4.67%); Ambuja Cements (up 4.66%); Infosys (up 3.54%); ACC (up 2.61%) and Jindal Steel (up 2.49%). BHEL (down 3.06%); ITC (down 2.63%); Bharti Airtel (down 2.62%); Ranbaxy Laboratories (down 1.45%) and IDFC (down 1.43%) settled at the bottom of the index.

 

Markets in Asia closed mostly higher on hopes of a favourable announcement from the ECB later today. The Chinese market closed higher even as Goldman Sachs cut its forecast of economic growth for the Asian giant.

 

The Shanghai Composite gained 0.79%; the Hang Seng rose 0.34%; the Jakarta Composite surged 0.67%; the Nikkei 225 added 0.01% and the Seoul Composite climbed 0.38%. Among the losers, the KLSE Composite tanked 1.40%; the Straits Times fell 0.22% and the Taiwan Weighted dropped 0.55%.

 

At the time of writing, the key European indices were up between 0.58% and 1.30% and the US stock futures were in the green, indicating a positive opening for US stocks.

 

Back home, institutional investors were net sellers in the equities segment on Wednesday. Foreign institutional investors withdrew funds worth Rs188.25 crore while domestic institutional investors pulled out a total of Rs166.27 crore from stocks.

 

Mahindra Satyam (Satyam Computer Services) will provide IT services to Australian carrier Jetstar, the budget airliner of Qantas, under a new contractual arrangement. Jetstar will receive services such as desktop support services from the Indian provider, according to an Australian Financial Review report.  The stock jumped 2.76% to close at Rs98.70 on the NSE.

 

Kochi-based Federal Bank, which has seen high growth in its gold loan book in recent months, has introduced a new facility that offers an overdraft facility against pledged gold. “Easy Gold”, which the bank claims is the first such product in the country, offers a debit card with an overdraft facility using which customers can withdraw money or use loan amount through any ATM or PoS (point of sale) terminals.  The stock rose 0.15% to close at Rs402 on the NSE.

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Banks’ net interest margin likely to remain under pressure, says Kotak Institutional Equities report

Retail deposit rates are likely to be a bit stickier compared to the earlier cycle, says a Kotak Institutional Equities report

 
There is a steady decline in market deposits (CD). Cuts in wholesale deposit rates on the back of improving liquidity conditions should benefit select wholesale banks. But NIM (net interest margin) would remain under pressure as pricing power shifts to borrowers. These are the observations made in a Kotak Institutional Equities report.
 
Retail deposit rates are likely to be a bit stickier compared to the earlier cycle as interest rates are unlikely to come down sharply. Further, RBI (Reserve Bank of India) has directed banks to have a sound policy on differential rates. The government has asked banks to reduce their dependence on bulk deposits. These arguments have been made in the Kotak report.
 
The Kotak report notes that most banks have started to reduce their wholesale deposit rates with liquidity conditions turning comfortable in recent weeks. Incremental CD ratio (since 6 April 2012) is at 16%, as credit demand is currently in a slack period, while growth in deposits has been strong. There has also been the positive impact from the recent cut in SLR (statutory liquidity ratio) of 1%. Select banks are still offering bulk deposits at a marginal premium over retail term deposits. On the other hand, the government has been insisting on banks to reduce the share of bulk deposits in the overall deposits.
 
For the banks, the deposit profile has significantly changed (primarily from urban markets, non-individual in nature who are interest-rate sensitive with high degree of awareness of alternate instruments) making it a challenging exercise to mobilize/ retain them. Banks are yet to cut retail term deposit rates materially despite the three month CD currently at 8.4% (10.7% in March 2012 and 9.1% in June 2012). These observations in the banking sector are also made by the Kotak report.
 
Kotak’s analysts believe that the decline in wholesale rates is likely to benefit Andhra Bank, Central Bank, Corporation Bank, IOB, OBC, UCO and Vijaya Bank, among public banks, and Yes Bank and IndusInd Bank among private banks. High CASA ratio banks like SBI and HDFC Bank are unlikely to be benefitted in the current phase.
 
NIM is likely to remain under pressure; and Basel-III guidelines and provisions can act as a floor, according to the analysts. The report states that  NIM is likely to remain under pressure in FY13-14E as revenue growth is expected to slow down (13% CAGR) on the back of slower demand for credit (14% CAGR) and NIM compression (about 20 bps) as pricing power shifts to borrowers. Lending spreads, especially for public banks, are at a near-term high (4% as of FY12). Kotak expects a compression of about 40 bps, going forward in FY12-14E. Private banks are likely to report stable performance as NIM is likely to improve for ICICI Bank and mid-tier private banks like Yes Bank and IndusInd Bank.
 
However, the Kotak report doesn’t expect NIM to compress sharply (similar to FY09-10) for two reasons: (1) Basel-III guidelines require banks to shore up core equity which would require higher internal generation of capital, and (2) overall provisioning environment will remain at elevated levels as banks make higher provisions for fresh slippages. Indian banks make about 70% of their overall revenues from NII (Net Interest Income), as contribution from fee business and treasury income is unlikely to change materially.
 

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