HEALTH PROBLEMS OF

OLD AGE

DR SOBIA NISAR
 COMMUNICABLE DISEASES
• Usually acute in onset (with the exception of tuberculosis)
• Requires early diagnosis & treatment
• Common problems (in order of frequency)

 Pneumonia  Tuberculosis

 Urinary  Skininfection & Decubitus ulcer

tract Infection
 Gastroenteritis  Meningitis
 Endocarditis
 Sepsis of uncertain origin

• Important cause of hospitalization and death

• Reflect underlying deficits in immune system due to ageing
• Usual association with age related organ change
• Microbiological diagnosis very difficult
• Early empirical treatment with broad spectrum antibiotics
 VACCINATIONS
 Seasonal Flu (Influenza) Vaccine

 Td(Tetanus,Diptheria ) Vaccine

 Zoster (Shingles) Vaccine

 Pneumococcal Vaccine
PREVENTION OF COMMUNICABLE
DISEASES
 NON- COMMUNICABLE DISEASES

 Common problem in community living, institutionalized and hospitalized

older patients
 Important cause of disability and death
 Multiple in number and, in combination
 Multi systemic affection
 Similar nature of exposure
 High cost of care
 Five important NCDs: CAD, HTN, DM, COPD & Cancer
 Other important NCDs: musculoskeletal diseases and mental health
problems
ASIANS-METABOLICALLY OBESE
 DIABETES IN OLD AGE
 Usually onset is in younger age with metabolic syndrome
 Chronic complications of diabetes are extremely common

 OHAs are mainstay of treatment

 Tight control of diabetes not required as risk of hypoglycemia

is increased.
 DIETARY CHANGES AND LIFESTYLE
MODIFICATIONS IN DIABETES
 Increase activity
 exercise plan/schedule
 Manage your weight
 Dietary changes
 Learn about carbohydrate counting and portion sizes
 Make every meal well-balanced
 Coordinate your meals and medications
 Avoid sugar-sweetened beverages

 Reduce stress
 Remember your medication
 HYPERTENSION
 Goal is < 150/90 mm HG
 Lose extra kgs and watch your waistline

 Exercise regularly

 Healthy Diet
 Diet that is rich in whole grains, fruits, vegetables and low-fat
dairy products
  Reduce sodium in your diet

 Limit the amount of alcohol you drink

 Avoid tobacco products and secondhand smoke
 HYPERTENSION
 Reduce your stress
 Monitor your blood pressure at home and make regular
doctor's appointments
 Get support from family and friends
 CANCER IN OLD AGE
 Age is the strongest risk factor of cancer
 Cancer is one of the five common causes of death in
older people
 Diagnosis in older patients is usually made at an
advanced stage of the disease.
The delay in diagnosis is due to:
lack of interest in the screening for cancer;
lack of awareness about the problem; and
fatalistic attitude towards cancer in general
 PREVENTION OF CANCER AND
SCREENING
 Secondary prevention by early detection by screening is more
useful.
 Some common cancers which should be routinely screened are
 Lung - Chest X-ray
 Colorectal - Digital exam, stool occult blood
 Prostate -Digital exam, PSA
 Breast - Self Exam, mammography
 Cervix - Pap smear
 Because of several social and behavioural reasons older
individuals may not be very keen on cancer screening
programmes.
 PREVENTION OF CANCER
 Don't use tobacco
 Eat plenty of fruits and vegetables and Limit fat

 Maintain a healthy weight and be physically active

 Protect yourself from the sun

 Get immunized

 Get regular medical care

 Avoid risky behaviors

 COPD & ASTHMA

 A frequent cause of disability and immobility

 Often confused in diagnosis of each other
 Cough, expectoration, breathlessness with or without
wheezing are the usual symptoms
 High risk of pneumonia
 Progression to respiratory failure and heart failure
 Treatment: Inhaled bronchodilators in chronic disease
and intensive care with oxygen in acute exacerbation
 Vaccination with influenza and pneumococcal vaccine
 DEMENTIA

 A group of symptoms
o Memory loss
o Problems with reasoning, judgment, language
 AND
 Problems with day to day functioning
(work, driving, social relationships)
o AND
 A progressive illness
DEMENTIA OR
NORMAL AGING?
 Normal changes of aging
o Slower to process information
o Hearing and vision may decrease
o Motor speed decreases
 Unlike dementia, these changes
should not prevent normal day-
to-day activities
PREVENTION - WITHOUT
DRUGS
 Exercise the brain
 Exercise the body
 Keep socially active
 Quit smoking
 Alcohol in moderation
 Wear a helmet and avoid hitting your head
(sports)
 Healthy diet
 Omega fatty acids (fish oil)
OSTEOPOROSIS: DEFINITION
 Definition: A disease characterized by low bone mass and
microarchitechtural deterioration of bone tissue leading to
enhanced bone fragility and a consequent increase in fracture
incidence.
 WHO: BMD T-score of -2.5 or less

Normal Bone Osteoporosis

 CLINICAL IMPACT OF OSTEOPOROSIS
OVER TIME

Symptoms
Signs  Neck becomes
 Kyphosis weak
 Pain in back
 Loss of height
 Breathing
 Abdo bulges difficulties
 Clinically  Indigestion & GOR
 Stress incontinence
diagnosed
 Difficulty with
fracture mobility following a
fracture
LIFESTYLE ISSUES
 Tobacco- eliminate it
 Alcohol – moderate it

 Food – eat it

 Exercise – do it

 Fall Prevention – work on it

 NUTRITION
 Appropriate Body Weight
◦ BMI 22 - 25
 Adequate nutrition
◦ Protein, Calcium, vitamin D
 Multi-vitamin daily
◦ C, D, K, Copper, Manganese, Zinc, Phosphorus
 Nutritional supplements
◦ Ensure, Boost
Risk reduction for osteoporosis
 hypertension, obesity, colon cancer, diabetes, metabolic
syndrome
 OSTEOARTHRITIS
 Osteoarthritis (OA) is a slow-progressing joint
inflammation that can result from cartilage degeneration.
WHAT DOES OA AFFECT?
 OA onset at where joints occur, most commonly affecting the hands and
finger-ends, neck, lower back, knees, and hips

 It is painful and depressive

 falls in the elderly, leads to weakened bone and muscle strength

 Frequently, OA patients complain of:

 Stiffness in a joint after getting out of bed or sitting for a long time

 Swelling and pain in one or more joints

 A Crunching feeling or the sound of bone rubbing on bone

 EFFECTIVE TREATMENTS FOR OA
 Goals of Treatment  Acupuncture
 ControlPain
 Improve Joint Function  RestoreLifestyle
 Maintain Normal Weight

 Treatment Options
 Exercise
 Pain Medications
 Strengthening, Aerobic, Agility  Acetaminophen
 Weight Control  Corticosteroids
 Surgery  Hyaluronic Acids

 Complementary Methods
 RHEUMATOID ARTHRITIS

 Inflammatory arthritis
 Prevalance increases with age

 More commomn in elderly women

 Distal symmetrical arthrites

 Small joints of hand, elbow wrist and ankles

 Acc

 Low grade fever malaise and weight loss

 GOUT

 Most common arthrites affecting elderly

 Inflammatory response to urate crystals

 Acute and chronic forms

 Acute is relapsing and self limiting

 Chronic form causes bone and joint destruction and

topaceous deposition
 Polyarticular gout
 GERIATRIC DEPRESSION
 Common problem
 Affecting approximately 15 out of every 100 elderly

 Chronic or serious illness is the most common cause of

depression in the elderly
 Can easily be diagnosed with Geriatric Depression Scale

 Most depressed elderly people can improve dramatically

from treatment
 Treatment options:
 Behaviouraltherapy
 Pharmacotherapy
GERIATRIC DEPRESSION SCALE
BPH
OTHER GERIATRIC SYNDROMES
GERIATRIC SYNDROMES
GERIATRIC SYNDROMES
GERIATRIC SYNDROMES
GERIATRIC SYNDROMES
GERIATRIC SYNDROMES