It’s never easy to watch parents age. So often, it’s a sudden realization, an almost physical jolt when your father struggles to lift his suitcase or your mother needs to pause during a gentle walk. You start calling or visiting more often, asking for more details about their health, maybe even worrying how you’ll care for them and also your own children—because in India, caring for elderly or infirm parents is the responsibility of adult children.

“Geriatric care, or the care of the elderly, is still a very new specialization in India, with only eight qualified doctors graduating yearly from the country’s top medical institutions,” says Dr. J. Prabhusankar, geriatric physician at Government Theni Medical College in Tamil Nadu. “We need more specialists and more awareness amidst the general public.”

It can be a daunting prospect, but remember that it’s likely more dispiriting for your parent. A nation-wide study released in 2008 by the NGO Help Age India paints a depressing picture of old age in today’s world:

At least 62% of India’s senior citizens interviewed were financially dependent on their children; a majority were in poor health and felt exceedingly insecure; and nearly all lacked adequate (or any kind of) health insurance.

However, neither you nor your parent are alone. Soon, India will have more elderly people than ever before, according to the same study: By 2026, the number of people over 70 is expected to increase five-fold; by 2050, one in every five people will be senior citizens (60 years or older).

While this may be comforting in a broad sense, it does nothing to change the actual fact of care. As parents age, they become more vulnerable to various niggling health issues. Small problems suddenly loom large, and others come out of nowhere. Knowing how to identify and/or avoid these problems can mean a happier and healthier life for the whole family.

GET ANNUAL CHECK-UPS

If you have elderly parents above the age of 60, Dr. S. Sivakumar, department head and Professor of Geriatric Medicine at Madras Medical College and General Hospital, recommends an annual check-up. If financial problems are not an issue, get the full list of tests below before meeting a geriatric specialist for further consultation.

Blood sugar test: This is a standard check for diabetes. There should be two tests—one after fasting for at least 8 hours, which can give an accurate diagnosis of diabetes, and one taken two hours after the start of a meal, which marks peak glucose levels.

Eighty percent of his elderly patients are afflicted with diabetes, high blood pressure, or both, says Dr. Prabhusankar.

Chest x-ray: A front-to-back view of the chest gives the doctor a view of how the lungs, heart, and larger blood vessels are functioning. Essential, because cardiovascular diseases often affect elderly people.

ECG (electrocardiogram), or ECHO study: It’s a non-invasive and painless way to diagnose the most common types of heart problems. A timely ECG can be a life-saving procedure.

Complete blood count: It evaluates overall blood count and assesses the risk of conditions and diseases like infections, anemia and leukemia.

Complete lipid profile: This test determines cholesterol levels and assesses the risk of a potential heart attack.

Urine routine test: This will check for easy-to-miss infections such as a UTI (urinary tract infection), common and hazardous for the elderly.

Blood urea, serum creatnine, and serum electrolyte test: This test checks if the kidneys are functioning well. Aging can affect the health of the kidneys, so monitoring is required.

Ultrasonograms of the kidney, bladder, and transrectal area: This looks at the pelvic area to check for inflammatory diseases and abnormalities that could indicate cancer.

Thyroid function test: Hyper and hypothyroidism is common among the elderly, and can easily be corrected with medication. A simple blood test that checks thyroid gland function is essential.

Dementia and Alzheimer’s screening: In this test, a doctor will ask an elderly patient questions that require problem-solving, logic, and cognitive ability to answer. This is a critical test to identify any mental degradation, which is not uncommon during aging.

DEXA scan (women only) / Prostate ultrasonogram (men only): A DEXA scan measures women’s bone mineral density and pinpoints risk for osteoporosis, a condition that causes bones to become brittle and more easily breakable. While osteoporosis can affect men, it is more severe for women.

“Calcium supplements and Vitamin D are often prescribed before menopause in order to strengthen the bones,” says Dr. Prabhusankar. “This is critical when you consider how hip fractures, due to sudden falls and poor bone strength, are exceedingly common in elderly women.”

Hip fractures, he adds, are extremely dangerous and often life-threatening. In other words, best avoided through routine tests.

For men, a prostrate ultrasonogram rules out prostrate cancer, a silent disease that generally affects only elderly men.

In addition to this list of tests, which check for serious conditions specific to elderly people, keeping up your parents’ general good health is also important. Dental screening for general cleaning and denture fitting is often overlooked in the face of more serious potential conditions. Other common age-related ailments affect hearing and vision, so consider regular hearing checks for your parents, and if necessary, timely cataract surgeries.

BEWARE OF TOO MANY PRESCRIPTIONS

Often, a prescribed drug can cause a side-effect in an elderly patient, for which another specialist may prescribe yet another drug. This issue of cascading prescriptions is one of the biggest problems in geriatric care.

“In India, most elderly patients end up taking several drugs a day to due to multiple complaints. In some cases, this can become toxic, so if your parent is taking too many drugs, please review these prescriptions immediately,” advises Dr. Prabhusankar.

Consult a doctor about your concerns before eliminating any of the medications outright.

STAY SENSITIVE

Caring for elderly and infirm people is about more than just medicine. Every day kindnesses can go a long way.

“When you know an elderly parent is hard of hearing, never shout in their ears,” says Dr. Prabhusankar. “This can needlessly startle them. Instead, speak softly and clearly, with your mouth close to their ear.”

Caregivers should take pains to head off potential mishaps, too. Ensure floors aren’t slippery, especially in bathrooms, and that there is good lighting. If your parent is infirm, with weakened reflexes, help them to do precarious activities like lighting pooja lamps or cooking.

Above all, be patient. Even a small problem, like a UTI, can plunge an elderly person into a confused state. Be on the lookout for any unusual symptoms or behaviors, in case your family member needs treatment for a more serious condition. But also be mindful of the person’s independence.

“Regardless of retirement, elderly people should be allowed to contribute to family, society and the country as long as possible,” says Dr. Sivakumar.

And of course at any age, time, attention, and love are essential to health and happiness.