Jara/Geriatrics, Hetu, Common Ailments, Physical/Psychological/Metabolic Aspects Of Jara And Care Through Rasayana
Author: Prof. Y. K. Sharma, Former Dean, Rajiv Gandhi Govt Post-Graduate Ayurvedic College Paprola- Himachal Pradesh
Definition:
Jara is state of becoming “Ksheen” (debilitated), physically and psychologically weak as a result of old age usually after 60 years of life. The word geriatrics too is derived from Latin word “geras” meaning “to grow old”. Aging is described as a progressive loss of adaptability with passage of time so that individual is less and less able to react abruptly to challenges from the external or internal environment. with time the individual becomes progressively more frail and in need of increasing support to maintain his or her autonomy.
Synonms:
The word jara has few synonyms like:
Jayas (that which has grown),
Varshias (fully evolved or matured),
Jyeshatha (that which is older in age),
Jarishth (that which is many years old),
other synonyms used for old age are:
Jaran, Jarati, Jaraut, Bridh, Nishaphala, Gataartava, Pilankani, Senescence, Geriatric, etc.
Dacade wise aging:According to Shrangdhar one attains decadewise aging as below.
1. Balayam – childhood
2. Vriddhi – growth
3. Chhavi – luster
4. Medha – sharpness in perception
5. Twak – skin and appendages
6. Drishti – visual acuity
7. Shukra – fertility
8. Vikram – valor and courage
9. Vuddhi – cumulative intellect
10. Karamindri – physical capacities
Finally there is loss of ultimate that is functions of mind and life sustenance.
Jara hetu ( Aetiopathogenesis of aging):
Kalasya parinam – swabhawaja or essential by Charak
Other ayurvedic literature mentions few specific factors for jara esp Aakaljara
1. Pantha – excessive travelling or physical activities
2. Sheetam – taking unwholesome or chilled food
3. Having sexual desires for older women or to remain sexually active even after onset of oldage.
4. Kaddana : taking tubers in excess in food.
5. Manaspratikoolta; to remain under continuous mental stress.
Charak in description of Rasayana, describes that indulgence in “gramya ahara” leads to agnimandya, vataprakopa and dhatukshaya. Thus it is important factor for premature aging
Two major factors responsible for aging are:
1. Srotorodha
2. Agnimandata.
What the modern science concludes regarding factors of aging:
1. D.N.A Cross linking theory : failure to manufacture essential enzymes/proteins.
2. Random Damage Theory- free radical damage.
3. Somatic Mutation Theory- death in groups
4. Pacemaker theory or organ system : decay of endocrinal and immunological potentials
5. Death hormone
Aging is gene/environmental controlled phenomenon.
Onset of jara is accompanied by: Dosha kshaya, Dhatu kshaya, Mala kshaya, Ooja kshaya and Mano karya kshaya. That is; deterioration of shareerika, vachika and manasika functions. All these are reflected in features of aging.
Major metabolic changes in geriatric patients:
-Presence of inclusion bodies in cells like metabolic debris, lipids, calcium, cholesterol
– intracellular sodium increases and potassium falls.
– ph and intracellular water contents decreases.
– total body water decreases
– fat accumulates in body leading to fall in specific gravity of body from 1060 to even 1036
– cellular metabolism suffers due to altered dna, rna and enzyme systems
– oxygen uptake and utilization decreases
– body temperature falls
Features of jara:
– Sharirshaktiheena- regression of physical capacities
– Smiritinasha – diminishing memory
– Manasik glani – loss of cheerfulness and alertness
– Balinam – appearance of wrinkles
– Palitya – greying of hair
– Dantashaithilya – loosening of denture
– Swabhava vaipparya – change in personality components.
– Kasa swasa pravritti – proneness to repeated coughs and dyspnoea on effort
– Sarvakriya asamarthata ; loss of physical, perceptual and mental faculties
Features of vatavriddhi are found as permanent features in old e.g.
-Vakayaparushta
-Karshya
-Gatrasfurana
-Nidranasho
-Alapbalatvam
-Ghadvirchissaya.
Old people show features of dosha and dhatu as well as mala kshaya:.
The important among them are:
Mandachesta – slowness of physical and mental activities
Aapraharsh – unsatisfying nature
Mudhasangyata – slowness of perception and resolution
Nishprabhava – loss of lusture
Rookshta – dryness and wasting
Sandhisathalya – unstability of joints
Manoshunyta – lack of ideation
Shramm – easy fatigability
Shirashaithilya – prominant and tortuous blood vessals
Sfeeg, greeva, udar shuskata : wasting of muscles
Asthi shool – degenerative bone disease
Klaivya – erectile dysfunctions and sterility.
Features of jara attributable to ooja kshaya:
Durbalata- general debility
Aabeekashanam – intaking of small quantity of food.
Vyathitendriya – ailments and diminished capacities of indriyas.
Duschaya – lack of lusture
Durmana – decreased mental capacities
Rookshta – dryness of skin
Features of aging are due to anatomical and physiological regressions in body over the years. It is at physical metabolic and psychological level and once onset occurs it is progressive. Every system contributes to these features. Only when it hampers the quality of life , threatens life it is usually appreciated.Physical incapacities are more complained and attended than mental.
Selected age related changes and their consequences:
General – increased body fat and decreased body water leads to obesity, anorexia
Eyes – presbiopia and lens opacity – blindness.creased testosterone, oestrogen – decreased libido, impotence, sterlity
Respiratory – decreased lung elasticity and increased lung stiffness – dyspnoea and hypoxia
Cardiovascular- increased arteriosclerosis, decreased autonomic responsiveness – heart failure, lowered tissue profusion, heart block
GIT- decreased liver function – lowered appetite, portal ht, decreased gastric secretions – poor digestion, anaemia decreased colonic motality – constipation and impaction of stools.
Haematological and immune system – anaemia, lowered immunity, autoimmune damage
Genito urinary – increased frequency, retention, incontinency, BPH.
Muskuloskeletal – power power, tone , fracture, incordination.
Nervous system – dementia, delerium and depression.tremers, ataxia.
Aging and mind functioning:
Major change is loss of neurons leading to dementia resulting- loss of memory, deterioration of intellect, change in behavior, change in personality, apathy
mood instability, alzheimer’s disease leads to early onset of the features with fast progression, mind functioning deterioration is accompanied by proportianate bodly functioning deterioration
Why sudden interest in geriatrics?
Economic development of world with better food, better living conditions, better health care there is demographic transition. Further low birth and death rate has lowered younger and increased older population. Average life expectency over 60 years with
high geriatric load and high geriatric care need both domiciliary and hospital
Common geriatric ailments and remedies:
Cataract –IOL.
Denture loss – artificial denture
Hearing loss – hearing aid
Osteoarthritis – joint replacement
Ataxia – prosthetic support
BPH – TUR.
But, what for brain, mind, autonomic and voluntary control over activities ?
Extended physical life may be vegetative in nature with low quality of life without
Emotional component, memory, insight, gross ataxia, incontinence, unproductively.
The need is to extend life of mental or neurological components along with physical and other biological components of geriatric life for quality of life which gives
Physical wellbeing
Mental wellbeing
Spiritual wellbeing
Social wellbeing
for biological wellbeing ; preventive, curative, palliative as well supportive care is needed
Geriatric care through ayurveda:
Physical care: through proper swasthvritta, dincharya, ritucharya, yoga,
Biological care : through required balanced diet, vitamins, essential minerals, specific drugs and rasayanas like ashwagandha, chyavanprash, amritprash, shilajeet, medhya rasayana, pranakameeya and other ayushyakameeya rasayana.
Mental and spiritual care: mangal, pranipatgamanam, sadvritta, aachar rasayana, aparigrha, family support
Social care : By society and government through economic support, old age care home, free travelling and health insurance, legal support, terminal care. Care through NGO’s
Secondary prevention of old age related disorders:
– Screen for hypertension, DM, CAD
– Prostate and colorectal cancers
– Breast and cervical cancer
– Dental ailments
– Stress
– Depression
– Stroke factors
Ideal atmosphere for aging:
– Staying in family
– Open life in villages
– Less stress
– Regular physical activity
– Definite purpose of life
– Medical care at hand
Factors that sustains life and delay jara:
-Aahar – milk, snehapana, madhur rasa, low salt, laghu aahara
-Rasayana
-Avoiding alcohol and smoking
-Avoiding fasting
-Avoiding excessive sexual activity
-Regular exercise
-Avoiding hard exercising
-Regular cold water bath
-Day time sleep
-Regular avyanga
-Social care
-Spiritual care.
Final word:
Population aging is a global phenomenon. With ever falling child mortality rate and death date the number of geriatric patients and hence need of geriatric care is being felt. Of various aspects of geriatric care physical and mental care is most important to assure health and productivity in individuals till fag end of life. This will assure minimum hospitalization of geriatric patients and there by prevent additional load on hospital facilities which are already overflowing with uncontrolled epidemics of Communicable and non communicable ailments. State at its level has to assure social care, legal care, financial care of geriatric patients. Ayurveda can play a major role in this campaign by promotion of health in old people by not only use of rasayans but also through other modalities like preventive, promotive and curative health care.
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