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November 14, 2018

What Mugabe's fall teaches us about health in old age

Zimbabwe's President Robert Mugabe falling off a dais after addressing supporters at Harare International Airport. Photo/COURTESY
Zimbabwe's President Robert Mugabe falling off a dais after addressing supporters at Harare International Airport. Photo/COURTESY

Confucius suggested that a human being’s greatest glory was, not in never falling, but in rising every time they fell down.

The quote is associated with having the character to not quit when things do not seem to go your way. It also implies that in order to achieve success, one must take risks. And defining risk is where we seem to have the most difficulty. What kind of risk should we accept in pursuit of what we believe to be glory?

There are some people who appear to have a ‘risk free’ attitude to life. Such people believe in their own infallibility and counsel. Once they have decided on doing something it really does not matter what anyone else says, they go ahead and do it, any objection to their idea being brushed off as misguided. When you come across such people you realise that risk is not universal, risk is a concept that resides in mind of the beholder. When someone expresses risk they are defining the relative importance of the different possible adverse consequences following a particular decision.

Given any particular situation therefore, different people will perceive it differently. In public health, a major part of which is about prevention of ill health, peoples’ risk perception is a major factor in why some people are healthier than others. The problem is greatest when we look at non-communicable diseases.

 Many of us now have a sense of what non-communicable diseases are. What readily comes to mind include diabetes, hypertension and cancer. But they also include injury, resulting from road traffic crashes, violence and household accidents; and mental illness such as depression. Today we all know someone who suffers from a non-communicable disease, what we probably have difficulty with is grasping how our behaviour contributes to the risk of developing one of these conditions.

Unfortunately the conditions themselves and the state of knowledge about them do not lend to absolute clarity on what we should do. Compare what we know about malaria and what we know about diabetes. To get malaria you are first bitten by a mosquito, ten to 14 days later, the feeling of malaria, that is typical symptoms of fever, malaise and headache begin. Most of us know not to play around and look for a lab test and medication. A week later and there is recovery in almost all cases. Over a life time depending on the part of Kenya you come from an adult living to old age will have had several episodes of malaria, but in old age will not look back and say that malaria I had when I was 32 years is still causing me problems. Compare that with diabetes, the cause of which is not as direct. We talk of ‘risk factors’, such as lifestyle, no exercise, processed food diet, leading to abdominal obesity, and high blood sugar.

The time between the poor lifestyle and development of diabetes is measured in years not days. Once diabetes develops it teases, some days, months a patient appears to be well, then there are times they feel poorly. However all the time there is the continuous progressive march of the disease. One of the underrated consequences of diabetes is brain injury. 

 Brain injury can occur due to the disease itself, or as direct consequence of a complication one of the most common being a stroke. The same pathology that leads to development of diabetes continues to affect the blood vessels making them narrow and unable to properly deliver blood and therefore oxygen to the heart and brain. A stroke happens when there is insufficient supply and that organ part dies. Brain injury can also be indirect, as a result of a fall.

Especially in elderly persons, those over 65 years, already with diminishing eyesight, weaker body muscles, poorer limb coordination, a small stroke can affect some particular muscles in the arms or legs, meaning that even in the house that they are so familiar with a missed step leads to a fall. It is easy to hit one’s head on the corner of a table, a door or any other object in the house.

The result can be a concussion or even severe brain trauma. Concussion can occur without loss of consciousness and the person may complain only about a ‘bump’ on the head, which heals after some time. Given that many elderly people often accept ‘being old’ as part of the territory it can be difficult for another person to detect pathology when our thinking is that the person is just growing old.

 Studies done show that, elderly women with diabetes are prone to suffer falls and the older they grow the worse the problem. The inability to immediately get up on their own is a risk factor indicating a poor prognosis of the disease. In that sense we all laughed at the president of Zimbabwe when he fell, but he immediately got up! The lesson should be the older we grow the greater the risk of a fall. For those around the elderly it means taking greater care, and looking out for signs that all may not be well.

 

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