Geriatric health

Nutrition

1-Energy requirement:
60-74years → 2300kcal/day for males, 1900 kcal/day for females

75 years → 2100kcal/day for males, 1900 kcal/day for females

• The diet should be balanced and meals should be taken at fixed times
• Adequate intake of fluid, tea and coffee should be drunken in
moderation and those should be restricted after 6 P.M
• Special needs of person should be considered (low salt in
hypertensives) and avoid obesity
• Very spicy food should be avoided and avoid hard fibers for person
with oral problems , soft fibers, fruits and milk are suitable
• Red meats, eggs and animal fats should be restricted, eat fish( good
source of animal proteins) and plenty of bread and cereal
• Good intake of calcium for women and prophylactic doses of
vitamin D for people who don’t get out regularly

2-Malnutrition among elderly:

• Risk factors
Social risk factors Medical risk factors Some Drugs
-Loneliness -few or no teeth -digoxin and chemotherapy cause
-Isolation -psychological disease loss of appetite
-Immobility -chronic disease -NSAIDS cause blood loss
-Poverty and ignorance -diminished vision and -purgative case potassium loss
-dependence hearing -metformin cause causes B12
-arthritis and weak muscles malabsorption
-cotrimoxazole antagonize folate

• Example of nutrient deficiency in elderly:

➢ total energy reduction leads to wasting and under nutrition

➢ potassium deficiency leads to constipation and arrhythmias
➢ anemia due to folate or vitamin B12 or iron deficiency
➢ vitamin D deficiency leads to fractures and osteomalacia
➢ water deficiency leads to dehydration and urinary tract infection
➢ mineral deficiency (calcium leads to decrease bone density)
➢ protein deficiency leads to edema and low plasma proteins
➢ vitamin C leads to hemorrhages
➢ dietary fibers deficiency leads to constipation

3-ASSESSMENT of the nutritional status in elderly:

• It’s difficult because:

➢ poor memory of elderly so the history of diet may be unreliable

➢ the recommended intakes of some nutrients are not standardized
➢ vertebral column deformities leads to wrong height assessment
➢ clinical examination is complicated by the presence of other disease
➢ Edema can be due to CVS disease
➢ Loss of ankle jerks is due to aging of nerves rather than nutrient
deficiency.
➢ Normal range of several biomarkers are not settled yet

• Methods of nutritional assessment include:

➢ The knee height measurement and ulna length → the height

➢ Weight for height standards are not strictly
 Communicable

Diseases

1-Pattern of diseases: multiple diseases, mostly chronic with increase

susceptibility to all infectious disease due to lowered immunity , gradual in
onset, late diagnosis and treatment

2-Infectious disease mostly affecting elderly: ( Pneumonia,

Influenza, Herpes zoster)

• pneumonia • influenza
-it’s a fatal disease to the elderly -Chemoprophylaxis: amantadine( associated with
-highest occurrence in winter and spring CNS side effects) or rimantadine hydrochloride
-Risk Factors: influenza, chronic lung disease for influenza A, its used in non-immunized
and exposure to environmental irritants persons or groups with higher risk of
-Prevention: complication and with vaccine to achieve
1- avoid overcrowding, proper care of maximal protection
influenza patients
2-polyvalent vaccine containing capsular
polysaccharides for all elderly every 5 years,
during epidemics of influenza and pneumonia
and in geriatric house

• Herpes zoster ( shingles):

➢ Caused by varicella-zoster virus due to reactivation in dorsal root

ganglia, its enhanced by stress and immunosuppression
 ➢ C/P: unilateral localized vesicular eruption on the skin supplied by
affected nerve and associated with paresthesia and severe pain and
post herpetic neuralgia in 30% of elderly
➢ Prevention:
1- Varicella zoster immunoglobulin given within 72 to 96 hours after
exposure.
2- Live attenuated vaccine in 2 doses 4-8 weeks apart subcutaneously
and effect persist for 9years.

NCD

Vision impairment Hearing impairment Oral and dental problems

-Gradual reduction of visual acuity -slowly due to gradual Loss of teeth leads to:
-cataract is a common condition deterioration of the nerve -malnutrition
-affect mental status, person -constipation
become shy and isolated -poor oral hygiene

Musculoskeletal disorders Incontinence Cancers

-80% of elderly have some type of
osteoarthritis
-they suffer from restricted movement of
hip, knee and spine
-they prefer to remain indoors and often
use analgesics.
-urinary incontinence -more prevalent in old age
-less common fecal - cancer colon is of high
incontinence occurs prevalence in males and
cancer breast in females
 • Osteoporosis: is reduction of bone tissue which lead to bone
fragility and increase susceptibility to fractures
➢ Pathogenesis: bone breakdown by osteoclast exceed new bone
production by osteoblast gradually after age 30
➢ The normal annual bone loss is 0.1 -0.2% of total body calcium and
may reach 0.5% after the age of 40 and 1% in postmenopausal
women.
➢ C/P: low back pain, risk of fracture and sometimes loss of teeth, only
x-ray indicates the progress the disease.

➢ Risk factors: sedentary habits and immobilization, risk in women is 6

times more than in men, low calcium or excess phosphorus intake,
alcohol and smoking, long time use of steroids, low or deficiency of
estrogen or surgical removal of ovaries

➢ Prevention: should start in childhood through:

1-primary prevention: fresh milk products, minimize the use of

animal protein, daily intake vitamin D (10micrograms) and
calcium(500mg) with adequate fluid intake to prevent kidney stones,
avoid smoking and sedentary life and immobilization, encourage
people to play outdoor games(sun exposure).

2-secondary prevention: through screening by bone mineral density

for risk groups to predict future fracture.

• Accidents: because of loss muscle power, gait and balance

disorders, most of elderly accidents happen in their homes.

➢ Simple falls on floors or stairs are a common cause of impairment

resulting in fractures of legs and hips.
➢ Timed up and go test:
1- Elder is asked to stand up, walk to a certain line on the floor(
3meters), turn around and walk back to the chair and sit down at
his regular pace with time calculation from start of moving
2- Interpretation:
<10 sec normal , <20 sec good mobility can walk without a gait
aid, <30 sec problems he requires a gait aid, >40 sec high risk of
falls
 • Mental and psychological disorders:

➢ Depression: it is the most common mental disorder in elderly

➢ Anxiety: generalized anxiety disorder is the most common anxiety
disorder and frequently associated with traumatic events or illness
➢ Dementia which is loss of intellectual capability, there is 2 types:
1-Primary dementia or Alzheimer’s disease:
▪ Its risk factor include genetic background, down syndrome, history of
head injury, maternal age less than 20 or more then 40, exposure to
cigarette smoking and chemicals
▪ There is no drug treatment can cure it but drugs can alleviate
symptoms or slow down their progression

2-secondary dementia may be due to sensory deprivation, endocrine

disorders and transient delirious episodes.

Health
Services

(3 levels of health care)

1-primary health care for elderly:
• Primary prevention:

➢ Health education:
→ to elderly and caregiver of an elderly
→to maintain a healthy life style
Methods:
1-mass communication through mass media is the most suitable and
effective method because it reaches millions of people, main source of
 entertainment for elderly and suitable for majority of the elderly who
are illiterate, can provide information to and about elderly.

2-through counseling

➢ Immunization:
1- completing the schedule of tetanus and diphtheria (given every 10
years)
2- Influenza vaccine
3- Hepatitis B vaccine for high risk group
4- Pneumococcal vaccine

o Scope of health education:

1- diet
2- Smoking
3- sleep
4- Physical activity
5- Personal and oral hygiene
6- bowel movement
7- Social activity
8- Prevention of accidents
9- intake of antioxidants
10- Intake of hormonal replacement therapy
11- Other health measures

• Secondary prevention:

➢ Early detection is done through regular assessment and screening to

measure the function ability and disability
 ➢ Management of current illness through treatment of diseases and
follow up, undergoing minor surgical procedure and provision of
drugs

• Tertiary prevention: (rehabilitation):

➢ Done in the center, special institutions or at homes

➢ Primary health care workers should be in contact with other
organizations to supply resource for elderly

2-acute care in hospitals: comprehensive geriatric care should be

maintained together with the treatment of actual cause of admission

3-chronic care for elderly: at their home or in special institutions, it

include health care, nutrition, psychological care and cultural programes