DUBAI // Old people with chronic diseases who fast during Ramadan could be putting their health at risk.
"The majority of the elderly have multiple chronic illnesses and are taking multiple medications," said Dr Salwa Al Suwaidi, a geriatrician and director of the Community Center for the Elderly in Dubai. "It is important that their families and children make sure that they are receiving the right medicine at the right time."
Experts stressed the importance of consulting a doctor before deciding to fast. Those with uncontrolled blood-sugar levels are usually discouraged from fasting. The most dangerous risk for diabetic patients is hypoglycaemia, Dr Al Suwaidi said.
"Blood-sugar levels should be measured throughout the day, and if at any point they are below 70 they need to break their fast. This is extremely important," she said.
"We've read about cases of elderly in other countries who died because their blood-sugar dropped and they refused to break their fast."
Hyperglycaemia - increased blood-sugar - can also cause problems, she said, but "it's hypoglycaemia that can kill".
Figures from the Dubai Diabetes Center show that about a third of its 5,000 patients are over 60, and more than half still choose to fast during Ramadan.
Dr Hamed Farooqi, director of the centre, said patients are not discouraged from fasting unless it is deemed dangerous for their health.
Type 1 diabetes, in which the patient's body is not producing insulin and relies on an external source, is more difficult to control while fasting. Type 2, in which the body is producing insulin but is desensitised to it, is easier to manage.
"Fasting is possible in both categories," Dr Farooqi said. "The patient should visit the physician and make sure the situation is controlled prior to the start of Ramadan."
A known complication among older diabetics is "hypoglycaemic unawareness", when an individual's blood sugar drops unknowingly, Dr Farooqi said
"Patients with this condition have been experiencing sudden falls of blood sugar for years and no longer recognise the symptoms," he said. "Fasting is completely discouraged for these patients as they can go into a coma."
Signs to look for are shaky hands, rapid heartbeat, sweating and complaints of hunger, Dr Farooqi said.
Another problem among older people is dehydration, said Dr Abdul Kader Fawal, general manager of Emirates Home Nursing. This is particularly common among the elderly who have kidney disease. There must be a balance between having enough water but not too much.
"The average usage for an elderly person is one litre to two litres a day," Dr Fawal said. "We advise patients to make sure that the consumption is adjusted in a way that after they break their fast they have as much water intake as frequently as possible, especially before they fast again. There is also a need to limit their physical activity or exercise that could consume energy as well as water."
Convincing an older family member that it may be safer not to fast is a challenge, Dr Fawal said, adding that sometimes the best option is to allow fasting under close, professional supervision.
"No matter how much you try to explain to them that it could potentially be against their health, they still insist on fasting, thinking they can cope with it," he said. "The idea is for us to anticipate any potential problems. If they maintain our instructions and baselines, the likelihood of complications will be very minimal, provided that there is also communication with the treating doctors when it comes to deciding upon alternative times of medication."
The effects of fasting among older people are not always negative, said Dr Maryam Mohammed Al Blooshi, a general physician at the Old People's Home in Ajman.
Those with hypertension and high blood pressure can use fasting as an opportunity to control their cholesterol levels, she said.
About half of the 140 patients Dr Al Blooshi visits as part of the Ministry of Social Affairs' elderly home-care programme are fasting.
"Because they are not consuming anything for 14 hours, it helps bring down levels of cholesterol," she said. "It helps detoxify the body. It depends on the patient, the disease they have and how serious it is. Some patients can't fast, but for others it can help."