Should the elderly fast during Ramadan?

While Muslims across the world look forward to fasting during the holy month of Ramadan, elderly people (60 years and above) are often in a fix on whether or not to observe fast. We spoke to some experts in the medical field to guide the elderly Muslims for fasting this month.
Should elderly people fast?
Those in a good health with no major health issues can observe fast. However, elderly people who are underweight with chronic illness are advised to avoid fasting. Frail and weak elderly patients who fast can be at the risk of complications like hypoglycaemia, hyperglycaemia besides metabolic decomposition.
"Elderly who are not generally healthy should discuss with their physician before they attempt fasting. This is more important for those who are suffering from lifestyle disease like diabetes, hypertension and thyroid," physician specialist Dr Javaid Shah told Khaleej Times.
Assessing the functional capacity, cognition, mental health and comorbidities in those suffering from diabetes is important before they chose to fast, he added

What problems can they face?
Dehydration is one of the most serious problems for the elderly caused by their lack of the sense of thirst and consequently the lack of drinking water, notes Dr Javaid. The elderly should drink water and fluids in abundance and at frequent intervals after breaking the fast. The breakfast meal must be balanced in its content of different nutrients, preferably of low-calorie, easily digestible and low fat ingredients. Excessive fat hinders digestion in addition to causing many complications to the liver and blood vessels.
They may complain of headaches, especially during the first days of fasting, when the body tries to adjust and adapt to the requirements of fasting.
"We must differentiate between the headaches originating from illnesses which may occur due to the change in the pattern of treatment or as a result of the patient's inattention to treatment, and that which often occurs as a result of fasting.  One of the causes of headaches associated with fasting is the drop of the level of blood sugar as a result of longer periods of fasting. This syndrome disappears when the body adapts to fasting."
Dietary tips for elderly while fasting
Eating properly cooked food is important as it makes digestion and swallowing easy. Green salads help in providing vitamins, minerals, necessary salts and also contain fibre.
Experts suggest small walk after breaking the fast which helps in activating blood circulation and relaxing muscles.
"The Sahur is important for the elderly. It provides the body with the necessary food and energy and helps them to endure the long periods of fasting. Delaying having the sahur is better than taking it early as it diminishes the feeling of hunger or thirst," said Dr Javaid.
He added that health problems can emerge as a result of excess food intake, foods that make the diet unbalanced, as well as insufficient sleep.  Drink sufficient water between Iftar and have enough sleep to avoid dehydration. The body's immediate need at the time of Iftar is to get an easily available energy source in the form of glucose for every living cell, particularly the brain and nerve. Dates and juices are good sources of energy.  Dates are excellent source of sugar, fiber, carbohydrates, potassium and magnesium.
Smoking is a health risk factor and doctors suggest avoiding smoking.
" If you cannot give up smoking, cut down gradually starting a few weeks before Ramadan. Smoking negatively affects utilization of various vitamins, metabolites and enzyme systems in the body."