“Yogic principles also help us lead a better life and become better human beings, thereby helping us to improve our mental and emotional health.
1. Dr. Anuja, could you share your journey into Homoeopathy and holistic healthcare, and how it has shaped your approach to elder care?
Being an empathetic Homoeopath I had always wanted to help the people who needed the care and support. Old age is the most challenging years of life, it has always intrigued me since I was a child about how I can contribute to their betterment in health and general well-being as a human being and as a doctor. The principles of Homoeopathy regarding how to cure a sick person are very similar to my vision. So, I felt I was under the safe umbrella of Homoeopathy to ensure the cure without adding further harm or suffering to the already toiling elderly, who were going through a constant struggle to live a life of self-dignity and minimum dependency. Though whatever I could do till now was the bare minimum, I am contented that I am on the road to my destined goal to be a better citizen and a responsible doctor.
2. You’ve served as a Medical Officer under NHM and have worked extensively in the community. How has your experience influenced your views on accessible healthcare for the elderly?
As an ex-medical officer of the National Health Mission, I had a great opportunity to deal with senior citizens of Trivandrum daily in my Outpatient clinics. I was fortunate to serve them in certain old age facilities as well, where I visited once a month for regular check-ups and treatment. It was then that I realised how much the inmates waited just to meet me and valued my presence and time with them. The mothers used to call me “mole” the Malayalam name for a daughter instead of a doctor. The motherly warmth of these women craving for the same in return made me realise how much they genuinely valued my efforts. It gave me the motivation to stay focused on my mission to consult them and render the best treatment Homoeopathy can provide.
3. With your expertise in yoga therapy and palliative care, how do you view the integration of traditional healing with digital tools like telehealth?
Digital tools and telehealth are blessed developments in the field of Medicine. There is no doubt that it is inevitable at this hour. Yet when it comes to palliative medicine, where the patient really wants to be heard, seen, and cared even for a pat on the shoulder or a mere physical presence if the caregiver will mean a lot to them. Humans need that, especially when they realise this beautiful life is too short and they are nearing the point of losing the luxury of being alive. In palliative wards, once the pain and suffering are under control, we witness patients craving the presence of their dear and near ones more than anything. Those who don’t have the luxury of any kith and kin around find solace in the brief moments of talking with their caring doctor or nurse. I think in digitalisation we can’t promise that. Yet it is the fast and smart way to ensure the perfect treatment is delivered on time, irrespective of the distance between the patient and the doctor. Regarding Yoga therapy, digitalisation might have helped to reach many patients all over the world. However, I have felt restricted in doing the physical exam, correcting the yoga postures, treating bedridden patients, in treating patients who are visually impaired or have trouble with hearing. So,
hough telemedicine has its benefits it has its limitations as well.4. How effective have you found virtual consultations for senior patients, especially in terms of continuity of care and patient comfort?
As I have mentioned above, though virtual consultations are not my personal choice, it has helped me reach patients far and wide. Tech-savvy elderly patients prefer virtual modes due to a wide array of reasons. I have seen many patients who are not keen to have hospital visits due to their physical restrictions or mental introversion which is a characteristic symptom of depression seen widely in old age, opt for the virtual modes with contentment. The comfort of not having to commute and wait in a hospital environment to consult a doctor makes the virtual mode a preferred choice for many. It also ensures easy follow-ups as it is time-saving and hassle-free. Therefore, it’s a need of the hour.
5. What are some challenges elderly individuals face in accessing telehealth services, and what strategies can make virtual consultations more inclusive for them?
The lack of proficiency in modern technology and lack of sensory perception in the elderly can make the use of the Telehealth facility difficult. In Kerala, where the percentage of elderly mothers are still illiterate and poor to afford mobile phones, it is still an impossible option. On the contrary, even if he or she is bedridden yet has the family supporting them it will be the easiest mode ever. The interfaces that are specially built for the sensory disabled can prove very beneficial.
6. Wearable health devices are becoming more common- what role do you see them playing in elderly care, especially for early detection and preventive health?
Wearable health devices are now on trend as a fashion statement of affluence as well as in detecting health risks, providing personalised care, and early health assessments. The long-term effect of wearing one is yet to be studied. The questionable effects of it might be anxiety, accuracy concerns, psychological dependency, etc. An inaccurate metric can evoke unwanted anxiety in an already unhealthy individual and lead to further harm. So, they are to be used with caution and tried to be used as little as possible.
7. In your experience, are older patients and caregivers receptive to remote monitoring tools? How can we improve digital trust and usage among this group?
In Kerala where there are people of different cultural and economic backgrounds differences of opinion exist in this topic of discussion. If the Government provides the underprivileged means to access such services free of charge and health educates them on the potential benefits a large percentage of senior citizens might get benefits. The emerging cost of living and lack of knowledge of the benefits of RPMs will likely make them less accessible to a large group of underprivileged patients. On the contrary, affluent patients have benefited from the same. Sometimes overuse or misuse of such RPMs may lead to misdiagnosis too. So, I always cross-check laboratory values to make sure the patients are not manipulating the health variables.
8. How can practitioners ensure that the human touch and empathy of traditional consultations are retained while using technology like remote monitoring?
I think I have already mentioned my view on the same. When I can’t be near the patient physically, I make sure I listen well and try to be completely mentally present to acknowledge their concerns with empathy. I always try to visit them in person during the first assessment or when a change of medication is required or whenever the patient asks for it. I don’t think a purely virtual way of treatment is complete. Empathy is thus ensured without compromise whether it’s traditional or teleconsultation. A human touch of kindness can sometimes make the recovery speedy and can enhance the faith and trust in the doctor in a patient who craves for it, but might not be always welcomed by patients with conditions like anxiety disorders, or OCD/ Obsessive Compulsive Disorder etc. So, it’s always best to assess the needs of the patients thoroughly before offering any treatment, medication or even a warm touch of greetings.
9. How can holistic health principles such as yoga, mental wellness, and preventive care be supported through telehealth platforms for the elderly?
Telehealth is a blessing for those who are in remote areas where commuting to a hospital is difficult. It will be beneficial to the bedridden patients in their homes or at an old age home. Yoga and meditation can be delivered to any patient who longs for it irrespective of their distance through the same. The guided meditation and certain Chair Yoga postures are very beneficial to patients with restricted mobility. Preventive yoga asanas can prolong the appearance of chronic diseases one is destined to have due to genetic tendencies. Yogic principles also help us lead a better life and become better human beings, thereby helping us to improve our mental and emotional health. Yoga is restrictions of mental modifications or citta vritti nirodha. When the mind is calmer, our body functions in its optimum way thereby reducing the risk of being sick.
10. In rural or under-resourced areas, what is the role of community health workers in bridging the gap between elderly patients and remote care technologies?
Community health workers are the backbone of the health care system. Their constant endeavour ensures a healthier society. The health education classes, the free medical camps, palliative visits, etc. make patients aware of the possible solutions for their mental and physical health issues. So, they know where and how to approach when needed. Community health workers in rural areas can pay regular visits to the patients and after appropriate screenings may refer the cases to the concerned specialists. They can provide counselling services, encourage healthy lifestyle choices, educate the patients and family members how to use the telemedicine facilities. They can even be relied upon for emergency first aids too. Community health workers may also help to bridge the communication gaps of language limitations between the patient and the doctor. Thus, in short, their professional contributions can definitely improve the quality of health care.
11. What is your message to fellow practitioners and policymakers about embracing telehealth and remote monitoring as tools for compassionate, holistic elder care?
I would request the policymakers take the necessary steps to implement the best telehealth facilities and remote monitoring tools for every patient irrespective of their economic status as it’s the need of the hour. I would suggest all the doctors update their technical knowledge of the current developments in the same so that we can uniformly render the best services to the needy. Telemedicine and remote monitoring tools can bridge the geographical gaps between Health care providers and patients and it will be inevitable in the future. Virtual counselling can be beneficial in cases of emergency like panic attacks or irresistible suicidal ideation which needs immediate intervention. Elderly patients deserve to be treated with dignity, compassion and empathy by the health care providers using the most advanced health services available. Therefore I recommend all my fellow practioners to embrace newer advancements in telemedicine and remote patient monitoring (RPM) with an open mind and never forget the importance of empathetic and compassionate approach towards our elderly patients as only humans can provide them with perfect authenticity.