Pediatric to Geriatric: Smooth/Theatric Transitions in the Journey

By Babuji Lankipalli

Introduction

Life begins with birth and ends with death, is a generally accepted statement. In some cultures, life begins from conception and grows from there. This life goes through stages – childhood, youth, adulthood and old age. The first two predominantly constitute pediatric phase and the last two, geriatric phase. According to dictionary [Merriam-Webster], the adjective pediatric connotes anything related to or affecting or being an infant, child or adolescent. Likewise, geriatric means: of or relating to or appropriate for elderly people. The term elderly may have different nuances – in some cultures, where the longevity may be lower, 50 may be considered elderly and in other cultures, with higher longevity, it may be 60 or even 70 years of age. While pediatrician is a medical specialist that focuses on health issues in the pediatric phase, the geriatrician focuses on health matters in the geriatric phase. Depending on the family background and parental health, the metrics that define health and ill-health may also differ. For example, in a family or community, an average height and weight of a similar aged child is 150 cm and 50 kg may be considered normal, while in another community, it may be considered overweight or underweight.

Western medicine¹, with its origins around 400 BCE (Hippocrates’ lifetime), relied on the balance or imbalance of four humors or fluids, namely black bile (or melancholy), yellow or red bile (sanguine), blood and phlegm, in a person’s constitution, to be the cause of health or disease. With the observations, empirical knowledge and scientific advancements, the western medicine has now branched into various specialties in the present time. Eastern medicine, predominantly consisting of Ayurveda, with origins in Indian subcontinent and Traditional Chinese Medicine (Acupuncture/ Acupressure), based on the number of people that used these approaches and the multi-millennial antiquity of these methods, have their own beginnings, from Indian and Chinese cultures. In acupuncture², qi (or chi), a person’s life force energy, that is associated with yin and yang, is considered to be the main causative factor in health or disease. The harmonious flow of qi (through meridians or pathways for the flow of qi, the vital energy) results in health and its disharmony, in disease. Tai Chi is a method to bring the balance in yin and yang which in turn assists in the balanced flow of qi.

Review

In this review paper, we will look into the Ayurvedic approach to one’s health and wellbeing, with emphasis towards the smooth transition into and out of geriatric phase of life. Ayurveda takes into account all five elements (space, air, fire, water and earth) that constitute the world that we live in, as a basis for varied individual constitutions, that are nothing but different combinations of these five elements. The person whose constitution^3-4 is predominantly air and space is considered to be of Vaata type, while the predominantly fire-water combination results in Pitta type and the water-earth combination results in Kapha type. These three types are sometimes used synonymously as three doşas (doshas), As one’s natural constitution, these are termed as one’s Prakriti⁵ [In Sanskrit, Pra: original, kriti: Creation or genetic blueprint] while the disturbed state of this constitution is termed as Vikriti. Health would be a result of complementing interaction of a person’s constitutional type with one’s environment – which includes climate, the food and the sensory inputs one takes in, mental disposition, during the course of one’s life. The conflicting interaction of these factors results in disease. According to World Health Organization [WHO]⁶, health is defined as a state of complete physical, mental and social wellbeing and not merely an absence of disease or infirmity. This statement is very similar to what Sushruta Samhita⁷ (an Ayurvedic text) mentioned centuries ago –

“Sama dosha sama agnishcha samadhatu mala kriyaaha|
Prasannaatma mana indriyaha swastha iti abhidheeyate ||”

Sama dosha denotes balanced doshas (according to one’s vaata, pitta or kapha constitution), sama agni (balanced or healthy fires), samadhAtumalakriyA (balanced tissues and eliminations), Prasannaatma mana indriyaha (soul, senses and mind in a content, peaceful and blissful state) is named as (abhideeyate’) health (swastha).

Main purpose o Ayurveda⁸, as any other science about a person’s wellbeing, is to maintain the health of the healthy and to cure the disease of the unhealthy or sick.

Swasthasya SwAsthya rakshanam Aturasya vikAra prashamanam Yoga is also widely used as a complement to Ayurveda in self-healing and self-realization^9-13.

Aroma therapy¹⁴, Marma therapy¹⁵ and Chakra healing^16-17 are also some of the healing methods used by many seekers of health. Indian Materia Medica¹⁸ by Dr Nadakarni is a good resource on Ayurvedic herbs and herbal preparations. Geriatrics is a subject among the eight branches in Ayurveda, as enumerated by Vagbhat in his classic work Ashtanga Hridayam.¹⁹ These eight branches are –

Kaya Chikitsa	General Medicine
Bala Chikitsa	Pediatrics
Graha Chikitsa	Psychiatry
UrdhvAnga Chikitsa	Diseases and treatment of Ear, Nose, Throat, Eyes and Head
Shalya Chikitsa	Surgery
Damshtra Chikitsa	Toxicology
Jara Chikitsa	Geriatrics
Vrushya Chikitsa	Aphrodisiac therapy

Ayurveda has basis in reincarnation and karma theory, which explains some of the otherwise inexplicable reasons for the present state of one’s health (or lack thereof). The following page gives a brief outline of such thought process before probing into the states (normal or abnormal) and transitions (smooth or theatric).

INFINITY… Space… North Pole
Praarabdha (Karmic baggage), Old tendencies (Proclivities).. lead to Incarnation
Invisible (to human eye) to Visible: Life appears “on Horizon” in Space
Building Blocks:              AIR                         FIRE                      WATER                 EARTH
(Living being takes shape from above 5 elements and adjunct faculties and such)⁵

Living being in the Visible/ Finite world
Pediatric Phase: Integration and Building*
Geriatric Phase: Disintegration/ Dissolution*
Health-Disease Metrics, Interventions – Partial/ Full Resolutions or Total relapse
Organic disharmony/ disease and ultimate Dysfunction
Single/multiple organ dysfunction leads to death
(*most likely event; integration or disintegration.. healthy/sick state may happen in any phase)

Revised Kaarmic baggage (lighter or heavier based on how journey was spent)
Visible to Invisible: Life dissolves “into Horizon”…. in Space
South Pole… Space… INFINITY
Repeat Life Cycle… until the iterations lighten/ destroy the karmic luggage/ baggage,
Ultimately leading to Self-realization/ Nirvaana

With sky, the Father and earth, the Mother (or vice versa), the divine drama on the mortal plane unfolds. The soul, unfettered by elements or features of any kind, to play a karmic role, dons from relatively infinite ether, with a breath of air, through the spark of earthly father and the support of earthly mother, with gentle watery or fiery(?) feeling/ attachment between these two Parents, who become the Creators of a new life form on this planet. Then, as the conceptus/ fetus residing in amniotic fluid, with the channels ready for nutrition and sustenance, the heart’s rhythm of this small life form gets going. As this fetus is so dependent on the earthly Mother for coming into this life to work out (and lighten possibly) one’s karmic baggage, the scriptures extoll the Mother’s role as being no less than that of Divine Mother, who sustains the whole Creation.

Based on the time of conception and the previous karmic load of this life form, the fetus’ constitution is decided. Also, based on the prior karma, after about nine months in Mother’s womb, the baby comes out into the world, with a destiny to fulfill, that is decided to certain degree on the planetary positions, seasons and the environmental conditions prevailing at the precise moment of birth. Once born, this infant will have a form and name.. and grows into a toddler, in a span of a year or two.. influenced by genetic make up, dietary intake and environment factors (both internal/ external, physical/ mental) and associations.. this young lad or lass starts life.

Health and Disease

The science of Ayurveda helps to keep one’s body and mind in healthy state, to assist one’s progress, as everyone goes through one’s journey – with all its challenges, pains/ pleasures, commissions and omissions, from childhood to youth to adolescent to adulthood to senility. Methods and metrics in this health science need to be understood and applied to fully realize their utility in keeping oneself healthy. Swastha-vritta is a set of recommendations that will protect one’s health and atur-vritta are the approaches taken to regain one’s health from sick state⁷. Swastha-vritta are the following –

Dinacharya	Follow daily regimens (in tune with one’s prakriti)
Ritucharya	Follow seasonal regimens
VegavidhAran	Avoid suppression of natural urges
AahAr, VihAr	Follow correct diet, activities
AachAr, VichAr	Follow correct behaviour and thought process
Samyak IndriyArta SamyOga	Indulge in optimum use of sensory and motor organs
SadAchAr	Adopt ethical behaviour

Even after following the above steps (as consciously and practically feasible for an individual), if one gets sick (Aatur), due to

Shareer	Metabolic (from internal causes)
Manas	Mental
Aagantu	Environmental – from external causes like trauma or infection
Sahaja	Natural – like hunger, sleep, thirst or ageing

The knowledge of the following three factors is essential to resolve the sickness. These are –

He’tu	Causative factors and pathogenesis
Linga	Signs and symptoms
Aushadha	Drugs (broadly any practice that helps alleviate/ nullify symptoms)

After going through adolescence, typically one gets married and has his or her own family. This is considered a proper approach to life, in terms of paying one’s dues, to forefathers, who were responsible for the continuity of the lineage so that one could come along and have a body (and family) to work out one’ own karma, that will likely assist towards one’s salvation. After you take care of your own family, while maintaining decent health, and helping the less fortunate ones in society, you can work on lightening your attachments and/ or responsibilities so that you can focus on getting over your own shortcomings – both in terms of physical wellbeing and/ or mental afflictions that may be hampering your progress towards better health that will likely foster more meaningful life for your and possibly others’ sake.

When does a person switch from pediatric to geriatric phase in life? Some folks think that there may be a magical switch in brain that gets triggered around 40 years of age, when the body’s building phase may be at the highest and slopes down after that, if no active intervention is not applied. These active interventions typically mean taking better care of one’s health and giving it a priority, as we all get busy with our work and tend to put the health matters in the back seat, until we see some signs of exhaustion (or get sick) and feel the depletion of energy reserves in the body, which affect our productivity at work and put a question mark on our sense of wellbeing. Keeping up with one’s yearly health check-ups, as mandated by many work place policies is one way to keep track of our vital signs and vitality. The commissions and omissions that one indulges in, either in youth or afterwards, would have a bearing on one’s health, especially when we grow older, past 40’s as body’s repair and rejuvenation mechanisms were already (too) generously used up – by not having a healthy routine and dietary habits, for example. Proper rest, exercise and diet, with a healthy attitude about life tends to keep us healthier, way past our 40s, into 50’s and 60’s.

General signs of geriatric phase setting in are –

1. having less energy to do things that one used to perform with ease
2. becoming less productive – either at work or at home
3. feeling less focused
4. worrying more than that may be necessary for health
5. becoming more susceptible to sickness
6. taking longer to recover from sickness
7. not able to take in food and digest it well
8. thinking process getting slower and memory becoming less sharp

As geriatric stage or phase is a critical juncture in one’s life, between youthfulness and senility, it is of paramount importance that one understands, monitors and adapts healthier ways to slow its onset and manage the metrics well enough to have a better quality of life that lies ahead, especially as the life expectancy of the populations has been increasing in the past few decades, in most modern societies.

Life expectancy in US²⁰ is 79 years today, compared to 68 years in 1950. Therefore, aging in a gentler way is quintessential for 60 million people in US who are older than 65 years. These trends are similar in other industrialized countries with above average healthcare systems. Some of suggestions given in Time magazine’s recent article²⁰ are very similar to those that were suggested in some of the Ayurvedic works of yore, with adaptations to our modern life-styles. These suggestions are –

1. Begin each day by listing what you are grateful for
2. Do resistance training three times a week
3. Reach out a friend once a week
4. Cut down on processed food and meat
5. Try one new thing a month

The countries with higher life expectancy will have more geriatric population. Geriatrics has origins in Greek – geron meaning “old man” and iatros meaning “healer”, while gerontology is a multidisciplinary study of aging process. The purpose of geriatrics, as a medical specialty, is to prevent, diagnose or treat diseases – either chronic or acute, in older adults. Dehydration, frailty, being prone to falls, urinary incontinence, confusion, malnutrition, functional decline, memory lapse are all various aspects that tend to dominate as one gets older. If one is genetically predisposed to certain ailments and one’s environment or routines aid in speeding up or slowing down such processes, such matters ought to be discussed and preventive care needs to be provided, sooner than later.

We can look into some of the salient aspects of geriatric phase, in turn –

Hydration: For smooth functioning of the body, hydration is very important. Water, liquid or fluid intake, in its many forms would aid in keeping one hydrated. Along with hydration, electrolyte balance is also usually checked to assure proper organ function. Drinking tea or having alcohol will make one prone to getting more dehydrated, as they tea and alcohol are diuretic. Some over the counter (OTC) drinks may have many ingredients that may have detrimental effects for especially older people. Some of the Ayurvedic herbs may be helpful in hydration while some may cause dehydration. Any family member or physician taking care of an elderly person needs to understand the importance of hydration and proper (type, timing and amounts) use of various fluids or medications.

Frailty: As we grow older, it is not uncommon to feel weak, as our body metabolism slows down and the physiological processes no longer work as efficiently as before. Progressive or sudden unintentional weight loss, fatigue, muscular depletion are some of the common causative factors in making a person frail. An Ayurvedic physician, after due observation and examination, may suggest ways to build up the depleted dhaatus (building blocks of various tissues), in a gradual way, with a healthy dietary regimen or rasaayana (herbal concoction that assists in tissue building and strength.

Susceptibility to Fall: Falls²¹ are the leading cause of emergency department admissions in pediatric population. Especially in patients with osteoporosis, this can be more common or fatal. Such falls may cause significant injury or permanent disability. Some practices that will help limit or eliminate the falls are –

1. Improving balance and muscle strength
2. Removing environmental hazards
3. Using assistive devices/ technology
4. Treating chronic conditions
5. Adjusting medication (e.g. so that the patient does not get [too] drowsy)

DEXA (Dual Energy X-ray Absorptiometry) is a common diagnostic clinical tool used to assess one’s bone health (or bone mineral density). Ayurvedic approach to bone-building works well most some patients. An Ayurvedic Vaidya (Physician) may provide valuable tips to build bones and bone strength, which decreases a person’s susceptibility to falling and hurting oneself.

Urinary incontinence: When a person leaks urine by accident, it is considered to be urinary incontinence. ²² While it is more likely in older women than older men, the severity may vary with each individual. Some of the more common reasons for urinary incontinence are – urinary tract infection, vaginal infection or irritation in women, constipation, weak or overactive bladder muscles, weak pelvic floor muscles, blockage from enlarged prostate in men, damaged nerves that control bladder muscles, diseases such as arthritis that make it difficult to get to the bathroom sooner. By following healthy daily routines (dina charya), seasonal routines (ritu charya) and adjusting dietary regimens, the urinary incontinence may be treated effectively in Ayurveda, depending on the duration of this ailment.

Confusion: When the connectivity of one’s thought process is not cohesive or is incoherent or disconnected, confusion occurs. In Ayurveda, nervine tonics or nervine stimulants are used to minimize the confusion. Some examples are Ashwagandha and Braahmi.

Malnutrition: Malnutrition and poor nutrition affects a substantial percent of hospitalized and institutionalized elderly patients. Any or a combination of physiologic, psychologic, pathologic or socioeconomic factors may contribute to inadequate or improper nutrition. A physician needs to assess the root cause(s) for malnutrition, as this will likely have far reaching effects on multiple organ health.

Quality of life, functional abilities and independence are natural concerns of any elderly person. He or she wants to live independently, as long as feasible or practical. As long as they can independently engage in self-care, with their activities of daily living, they are less apt to want to depend on home care services, skilled nursing or assisted living facilities. Each individual and his or her situation is different and so the transition into any of the above support systems has to be an individual’s or immediate family’s decision. Socioeconomic factors play a vital role in the selection of the best option for an elderly person’s care.

One of the reasons is the erosion of personal responsibility and the decay of family structure, from each passing generations. When society or societies emphasize one’s rights over one’s responsibilities and covertly or overtly allow the “rights” of one person or group to trample on those of other person or other groups, then the social fabric becomes rather frail and individual’s importance or health becomes secondary. Might may be used as being synonymous with right. When might and power of one or some dominate the human societies, at the cost of wisdom and collective wellbeing, such societies are not sustainable for long. That is why, in some cultures, the family unit is emphasized and one’s responsibility towards one’s own family teach so many of life’s valuable lessons. For human species to survive and thrive, a healthy and all encompassing outlook of a universal family where we are the caretakers of the planet and not its owners, is extremely important.

In advanced or industrialized countries, geriatrics is a major medical specialty. In developing countries, there are not many Institutions that are offering degrees or competent qualifications to care for their elderly. As the elderly populations are increasing more so than the infant populations, on account of decreased fertility and birth rates, in many countries, better understanding of geriatric populations and their care is VERY important in keeping the medical expenses (in relation to the respective GDPs) in check. With the wars happening around the world, the times appear to reflect less tolerance among various nations. With technology driven more by profit and control motives than humanistic and peaceful ends, with media promoting more indulgence than moderation in one’s intake or hoarding of the resources, with the climate change affecting us all, we all need to wake up as a human species.

AGING – final thoughts

Aging in place of one’s choice and aging in peace are dreams of any normal person. Not all folks have their dreams fulfilled. That being so, if the individual’s realistic efforts and social structure allows such aspirations or dreams to be realized to a good degree for a good percent of people, that society may be considered to be doing well. In old age, the some individuals opt to have power of attorney, transferred to a loved one who is likely to uphold their preferences, when the geriatric person is too senile to decide what is good for oneself. Advance directives given to a legal entity or a family member or a person with sound judgement.

Elder abuse – physical, financial, emotional, sexual or otherwise, is also becoming a more common occurrence in our “advanced” society. The selection of caregivers or caretakers is a critical factor is assuring the wellbeing of one’s loved family members, when they grow too old to take care of themselves. Some of the educational institutions and some non-profit organizations have family education and support programs²⁰, that elders and their family members can make use of. In some instances, psychiatric care may be more important than fulfilling the physical needs to shelter and timely eating habits. In such cases, competent and humane mental healthcare professionals play a crucial role.

In any journey, it is desirable to have a smooth transition, rather than a jerky one – whether it is from childhood to adolescence or adolescence to adulthood or from adulthood to old age. While societal structure and functioning style can be a contributing factor, the choices one makes as an individual play a more, if not the most, important role, in how we age and pass on.

If would behoove us as human beings to believe in karma theory – as the perpetrators of any crime against anyone else, especially elders, will likely have far reaching effects on the people who are indulging in such inhumane and immoral treatment of fellow-human beings. Further, prevention is better than cure. So, if the prevention is emphasized early on, in one’s life and it becomes a social movement for the benefit of all, our society will do well in long term. The study and the application of Ayurvedic principles in staying healthy or in becoming healthy can a boon to humanity. May the geriatric populations, as well as the rest of us, have a graceful passage through life’s phase, after they contributed their share to the wellbeing of all the rest of us.

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Endnotes/ Bibliography:

1. Humoral theory Harvard Library 
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2. Acupuncture Basics https://www.nccih.nih.gov/health/acupuncture- 
effectiveness-and-safety 
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Sanskrit Pratishtan Delhi 2016) 
4. International Journal of Health Sciences and Research (www.ihjsr.org)  
Vol 9 Issue 8 (August 2019) pages 455-459. General review article 
5. Marc Halpern Principles of Ayurvedic Medicine – Chapter 2 (Harmony is Health  
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7. Sushrutha Samhita Sutrasthaana 15.10 
8. Charaka Samhita Sutrashthaana 30:26 
9. BKS Iyengar Light on Yoga (Harper Collins Publishers India 2005). 
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Marma Therapy – Energy Points in Yogic Healing (Lotus Press, Twin Lakes, WI  
2019). 
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Techniques that Balance the Chakras (Embassy Books, Althea Press, Berkeley,  
CA 2017) 
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Health, Harmony and Inner Peace (Konecky and Konecky, Old Saybrook, CT  
2002) 
18. KM Nadakarni Indian Materia Medica Volumes 1 & 2 PopulaR Prakashan, 
Mumbai 2025) 
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21. CDC (16 December 2020). “Keep on Your Feet”. Centers for Disease Control and Prevention. Retrieved 12 September 2022.
22. “Urinary Incontinence in Older Adults”. National Institute on Aging. 24 January 2022.
23. Evans, Carol (2005). “Malnutrition in the Elderly: A Multifactorial Failure to Thrive”. The Permanente Journal. 9 (3): 38–41.