GERIATRIC HEALTH

Dr Nabeel ahmed

Assistant Professor
Department of
Community Medicine
 What is GERIATRICS ??????
• Geriatrics is the science that deals with the study of
diseases and their treatment peculiar to old age

• Clinical gerontology is the study of pathological

aspects of old age

• Gerontology is the study of physiological and

physiological changes which are incident to old
age( study of ageing process).
AGING
 AGEING
• It is a progressive and generalized
impairment of body functions resulting in,
loss of adaptive responses to stress and
increasing the risk of age-related diseases.
• People more than 60 yrs are considered
elderly.
• Old age is not a disease but a normal and
inevitable biological phenomenon.
 Theories of aging
• Genetic theories-
– somatic mutation of genes.
– genetically determined life span.
– cross linkage/loss of important cellular components and DNA.

• Random damage theories-

– accumulation of toxic metabolites and free oxygen radicals.
– reduced physiological capacity and wear-n-tear of cells of vital organs.

• Non-enzymatic glycosylation of proteins.

• Autoimmune theory; according to this as the age advances there
is flattering in the process of protein synthesis resulting in the
production of new protein ,which is not accepted by the body
resulting in the production of antibodies against it
 Branches of geriatrics

• Gerontology
• Clinical gerontology
• Social gerontology
• Geriatric gynecology
• Experimental gerontology
• Preventive gerontology
 Demography of geriatric
population
• World population: current >6.7688 billion

• projected >8 billion (by 2025)

• Population of elderly(>65 yrs) in the world: early 20th century-

approx 12 million.

• In 2009-approx 80million.

• Population of elderly(>65yrs) in India: approx 8% of total

population.
Indian population
 Physiological changes due to aging and
their consequences

• Problems in elderly are multi-faceted and

often a single problem may be the result of a
complex chain of decompensation of body
functions.
 HEALTH
PROBLEMS
OF THE AGED
 Health problems of the aged

• Physical problem
• Psychological problems
• Social problem
• Economical
 Physical problems

Ailments % of occurrence
Visual complaints 88 %
Loco motor system 40 %
disorders
Neurological 18.7 %
complaints
Cardiovascular system 17.4 %

Source: Report of the Independent Commission on Health in India

 Respiratory system 16.1 %
Skin conditions 13.3 %
GI tract 9%
Psychiatric complaints 8.5 %

Hearing loss 8.2 %

Genito-urinary 3.5 %
complaints

Source: Report of the Independent Commission on Health in India

 Visual complaints
• 88% of the complaints in old age is visual
problems like
– Cataract
– Glaucoma
– Retinopathy
 Eye /Ear
Physiological Consequences Effects
changes
Denaturation of Cataract Blindness
lens protein

Loss of Presbyopia
accommodation

Corneal Arcus senilis

clouding
Lax eyelids and Ptosis and dry Xerosis
reduced eyes
lacrimation
Retinal Defective colour Blindness
degeneration vision

Degeneration of Presbyacusis Deafness

cochlear hair cells
 Locomotor system disorders
• It forms 40% of the old age complaints
• They are:
– Fibrositis
– Osteoarthritis
– Rheumatoid arthritis
– Myositis
– Neuritis
– Gout
– Spondylitis of spine
MUSCULO-SKELETAL SYSTEM

Irreversible loss Reduced muscle Locomotor

of motor units strength disability
and fibers
Deposition of
fat
Loss of Osteoporosis Pathological
mineralization fractures
Wear-n-tear of OA and RA Mobility
articular problems
cartilage
 Neurological complaints
• Neurological problems form 18.7% of the old
age complaints
• These are:
– Dementia
– Parkinson's disease
– Alzheimer’s disease
 CENTRAL NERVOUS SYSTEM
Degenerative Impaired cognition Alzheimer's
changes and behavior disease and
other
dementias
Reduced Bradykinesia Slow
transmitter activities
substance
synthesis
Impaired Hypo/hyperthermia
thermoregulation
 Cardiovascular complaints
• CVS disorders for 17.4% of the different old
age complaints
• These include:
– Atherosclerosis
– Thrombus formation
– Myocardial Infarction
– Hypertension
 Cardiovascular system
Reduced Reduced Syncope
cardiac cardiac output
myocytes
Reduced nodal Arrhythmias Heart failure
activity and and heart
conduction blocks
Rigid and Hypertension Syncope, IHD
narrow blood and stroke
vessels
 Respiratory complaints
• Respiratory condition make 16.1% of the old
age complaints
• These are:
– Chronic bronchitis
– Asthma
– Emphysema
 Respiratory system
Reduced cough Aspiration RTI’s and pneumonias
reflex and ciliary
action
Reduced lung Dyspnea COPD, asthma
elasticity

Reduced alveolar Hypoxia/hypercapnia

surface area
 Skin conditions
• Skin conditions form a major part of old age
complaints
• Skin conditions include:
– Senile wrinkles
– Scaly lesions
– Scaly dermatosis
– Blistering diseases
– Neoplastic disorders
 Skin and its appendages
Loss of elasticity of skin Wrinkling

Loss of hair Alopecia and baldness

Brittleness of fingernails

Slurred speech
 Gastrointestinal complaints
• GI disorders for about 9% of the old age
complaints
• These are:
– Peptic ulcer
– Constipation
– Ulcerative colitis
– Carcinoma of GIT
 Gastro-intestinal tract
Reduced gastric Non-ulcer Poor absorption
acidity and dyspepsia and and deficiency
intestinal constipation states
motility

Reduced Impairment of Hepatic failure

regenerative metabolism and
capacity of detoxification
hepatocytes
 Endocrine system
Impaired glucose hyperglycemia Diabetes
tolerance mellitus
Impaired thyroid Hypo/hyperthyroidism
function
Disturbed Osteomalacia Fractures
vitamin.D
metabolism
Reduced sex Impotence in males
hormones and Reproductive
synthesis organ cancers in
females
 Hearing loss
• Hearing complaints form about 8.2% of the
old age complaints

• These include
– Nerve deafness
– Conductive hearing loss
 Genito-urinary complaints
• These form about 3.5% of the old age
complaints

• They are:
– Enlargement of prostate
– Dysuria
– Nocturia
– Frequency and urgency of micturition
 Genito-urinary tract
Reduced no. of Impaired Accumulation
nephrons excretion of toxins in the
body
Reduced renal Impaired Accumulation
blood flow and excretion of toxins in the
reduced GFR body
Reduced Urinary UTI
bladder incontinence
capacity
Prostatic BHP Frequency
hyperplasia in
men
 Geriatric Gynecology

Atrophy of UTI’s and Carcinoma

vaginal and atrophic cervix
urethral mucosa vaginitis

Weakening of Prolapse of Ulceration and

pelvic muscles uterus carcinomatous
change
 Hematology
Reduced bone Anemia's
marrow reserve

Reduced T-cell Non-resolving Prone to

function infections infections

Increased Auto-immune
synthesis of disorders
auto-antibodies
 Psychiatric complaints
• These form 8.5% of the old age complaints
• These include
– Alzheimer’s disease
– Depression
– Anxiety
– Delirium
– Schizophrenia
– Personality disorder
– Suicide and deliberate self harm
 others
Atrophy of Reduced food Nutritional
mucous intake and change deficiency
membrane of of taste and smell states
mouth

Loss of teeth same as above

Decreased no. of same as above
taste buds
Decreased same as above
salivation
Decreased same as above
sensation of
smell
PSYCHOLOGICAL PROBLEMS
 Psychological problems
– More reliable and are independent of age
– But, elderly patients less willing to talk about
psychological problems
– Pay attention to:
• anxiety
• physical discomfort
• adaptation to a new lifestyle
 PSYCHOLOGICAL SYMPTOMS
– Sleep
– Interest
– Guilt (“Are you a burden to others?”)
– Energy
– Concentration
– Appetite
– Psychomotor changes
– Suicidality (“Do you wish you could die?”)
 SIGNS AND SYMPTOMS IN GERIATRIC
DEPRESSION

• SYMPTOMS • SIGNS

– MOOD
– APPEARANCE
– COGNITIVE
– BEHAVIOUR
– VEGETATIVE
– PSYCHOMOTOR
– VOLITIONAL RETARDATION
– PHYSCHOMOTOR
AGITATION
 INCIDENCE IN ELDERLY
• MAJOR DEPRESSION
– 3% community dwelling
– 14% two years after spouse dies
– 15% medically ill
– 25% long-term-care settings
 Social problems
• Abuse
• Dependency
• Insecurity
• Rehabilitation
 Abuse
• Abuse of the old
– Mistreatment of older people – referred to as
‘‘elder abuse’’ – was first described in British
scientific journals in 1975 under the term ‘‘granny
battering’’
– The abuse may be of a physical nature, it may be
psychological (involving emotional or verbal
aggression), or it may involve financial or other
material maltreatment.
 Elder Abuse

• It refers to ill-treatment of an elderly person.

• It can be-physical abuse
-psychological abuse
-financial abuse
-sexual abuse.
• It is a very sensitive issue and requires a high
index of suspicion.
• Abuse is generally divided into the following
categories:
– Physical abuse – The infliction of pain or injury,
or physical or drug induced restraint.

– Psychological or emotional abuse .

– Financial or material abuse – The illegal or
improper exploitation or use of funds or
resources of the older person.

– Sexual abuse – Non-consensual sexual contact of

any kind with the older person.

– Neglect – The refusal or failure to fulfill a care

giving obligation. This may or may not involve a
conscious and intentional attempt to inflict
physical or emotional distress on the older
person.
 DEPENDANCY

• PHYSICAL, FINANCIAL, FUNCTIONAL and other

dependency has a major affect on the self esteem
of the old.
 Insecurity
• Insecurity of being abandoned by their
children.
 Rehabilitation
• This is one of the main problem of old age.
 Economical problems
• No or inadequate source of income
• Total economical dependence on children for
their daily needs
 Need for geriatrics
• Elderly population will keep on rising due to
advancing medical technology.
• Diseases present atypically and at an earlier
stage.
• Often a multi-organ system involvement.
• Worsening of pre-existing diseases are
frequent.
• Burden over the health care system.
• Burden over the nations economy.
PREVENTION AND MANAGEMENT
 Prevention and Management of
Health Problems in Geriatrics
• One of the most important measure of how
civilized we are is how we treat our elderly.

• According to Sir James Sterling Ross ”you do

not heal old age, you protect it, you promote it
and you extend it.”
Multi-disciplinary Geriatric Assessment
(Geriatric Clinic)
• The concept of geriatric clinic suits best for
assessment and management of diseases and
disabilities in the elderly.
• Components-
– Gerontologist/Physician
– Physiotherapist
– Occupational therapist
– Ophthalmologist
– Audiologist
– Psychiatrist
– Dietitian
– Nurse and
– Social worker.
PREVENTIVE HEALTH CARE
 Preventive Health Care in Elderly

• The role of prevention in geriatrics is to delay the

onset of age-related DE compensatory problems
of body functions.

• It includes-
– Primary prevention.
– Secondary prevention.
– Tertiary prevention.
 Primary prevention
• Health habits-
– Inadequate nutrition
– Addiction to smoking & alcohol
– Lack of exercise
– Inadequate sleep
• Predisposing factor for coronary heart disease
– Modifiable-
• smoking, obesity, HT, DM, hyperlipidemia,
hypercholesterolemia, etc.
– Non-modifiable-
• age, sex, genetic factors, etc.
• Immunization-
– Influenza
– Pneumococcal
– Tetanus.

• Osteoporosis prevention-
– Calcium and vitamin-D supplementation.
– Hip protector devices.
• Injury prevention
• Burns accidents and falls should be
prevented by;-
– Removal of obstacles
– Keep the floor dry
– Bright lighting
– Flat shoes
– Railing/holding bars in bathrooms
– Low level switches
– Easy and safe access to water.
 Secondary prevention
Screening
• Screening helps in early detection of
modifiable risk factors and their adequate
management.
• Hyper/hypotension, diabetes mellitus
• Dental problems
• Drug adverse effects
• Cancers
• Infections
• Nutritional deficiency states
• Eyes /ears
• Early detection and treatment is an important
step in secondary prevention of disease and
disability.
 Tertiary prevention

• It deals with rehabilitation and caregiver support.

• Rehabilitation is a problem solving process focused on

the patients functional abilities.

• Rehabilitation team includes; a physician, a

physiotherapist, an occupational therapist, a speech
and language therapist, a psychiatrist, a dietitian, a
nurse and a social worker.
INTERVENTIONS IN REHABILITATION
 Interventions in rehabilitation
• Hard interventions-
– drugs.
– physiotherapy.
– occupational therapy.
– aids and adaptation.
– speech and language therapist.
• Soft interventions-
– advice.
– education.
– counseling.
– encouragement.
– listening.
 Supporting the caregiver

• Social attitude

• Physicians support

• Organization of “day care centers”

• Hospitalization in c/o chronic illness

• Counseling the caregiver

 Prevention and management of
elder abuse
• Assessment of physical and mental capacity
of the elderly.
• Assessment of general quality of care

• Assessment of relation with the abuser

• Assessment of abusers for their problems
• Counseling the abusers
• Institutionalization in old age homes
HELP AGE INDIA
 Help age India
Help age India supports the following programmes to make life
easier for older people:
1. Free cataract operation
2. Mobile Medicare units
3. Income generation and micro-credits
4. Old age home and day care centers
5. Adopt a grant parents
6. Disaster mitigation
 References
• Park Textbook of Preventive and Social
Medicine
• Oxford Book of Public and Health
• New Oxford textbook of Psychiatry
• www.who.int
• http://socialjustice.nic.in/
THANK YOU